Risk Assessment Method for Global Monkeypox Importation into China - May 2022-September 2025.

Introduction: In the context of globalization, the risk of cross-border transmission of infectious diseases is continuously increasing. There is an urgent need to develop a scientific, dynamic, and practical tool that captures regional heterogeneity in importation risk, thereby facilitating more targeted prevention and control measures at ports of entry. Methods: We devised an extensible importation risk assessment framework by selecting key indicators through a Delphi expert consultation process and assigning their respective weights using the Analytic Hierarchy Process (AHP). Taking monkeypox (mpox) as a case study, we applied the framework to the global mpox epidemic spanning from May 2022 to September 2025 under three risk scenarios: Clade I, Clade II, and a non-clade-specific (aggregated) scenario. We then analyzed the temporal evolution of major source countries, the spatial distributions of provincial risk levels, and the association between clade-specific importation risk indices and domestically reported mpox cases across the study period. Results: =0.12). Conclusion: This framework effectively captures the structural shift in the sources of mpox importation risk and the regional heterogeneity in risk levels across PLADs in China. It thereby provides a risk-driven decision-support framework for prioritizing port-of-entry screening and tailoring surveillance strategies to high-risk areas.