Mpox circulated in Nigeria for 8 years before it sparked a global outbreak. What happened? And could it have been stopped? n 1 May 2017, a 35-year-old man with lesions all over his body came to the university hospital in Port Harcourt, an oil industry hub and the capital of Rivers state in southern Nigeria. A deep ulcer had eaten into the shaft of his penis. “It actually looked like it was going to drop off,” says Bolaji Otike-Odibi, the dermatologist who treated him.
Tests—and her experience—ruled out chickenpox, syphilis, and molloscum contagiosum, a viral infection that causes pearl-like bumps on the skin. “I asked all my colleagues,” Otike-Odibi recalls. “It was something we had never seen before.”
She took a sexual history of the man, who lived in Eleme, an hour’s drive east. He told her he had multiple sexual partners and that a condom had broken during intercourse a few days before the sores appeared. During the man’s hospital stay, which lasted 45 days, a second patient was admitted with similar lesions, including on his genitals, and a similar sexual history. He tested positive for HIV, but that didn’t explain his condition. “We were worried that this was an epidemic,” Otike-Odibi says.
The first two patients were discharged; in the subsequent months another two who fit the same profile arrived. Both had more advanced HIV infections and both died. “I took their pictures, I took their histories, because I knew that one day, somebody will tell me what this thing is,” Otike-Odibi says. “This is not normal. This thing means something.”