Though the surge in Sierra Leone has received much of the attention, cases are also rising in two other countries in West Africa: Ghana and Liberia.
The test the US Centers for Disease Control and Prevention uses to identify clade I mpox cases is 'most likely not reliable' for detection of the substrain identified in the study, the authors say.
Another mpox study today showed that dose-sparing vaccine administration of the Jynneos vaccine appeared to have worked.
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Germany had reported one other clade 1b case in October, and the patient recovered fully.
Activity continues to fluctuate across different countries, with cases of novel clade 1b continuing to rise.
The study's safety board recommended halting enrollment after an assessment showed the chance was less than 1% that the study would demonstrate efficacy if completed.
Recent detections in Zimbabwe and Zambia were confirmed as the novel 1b clade.
UK health officials said the overall threat to the UK population remains low.
Seven countries outside of Africa have now reported imported clade 1b cases.
Some of the group's concerns include rising case numbers, expanding spread, and response challenges.
The vaccine will allow younger children, vulnerable to infections from household contact, to be immunized.
The California case makes the United States the sixth country outside of Africa to report an imported clade 1 case.
Meanwhile, amid a steep rise in Uganda, health officials have identified new mpox clusters in sex workers.
