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The doctor to detect the monkeypox outbreak tried to warn about how it was spreading

MARY LOUISE KELLY, HOST:

There are now more than 11,000 monkeypox cases here in the U.S., and the numbers are rising as the country races to control the outbreak before the disease becomes entrenched. Remember; it wasn't that long ago that most of us hadn't heard of monkeypox. But like all epidemics, it had a beginning.

JUANA SUMMERS, HOST:

A moment in time when one person caught the disease and it spread from that person to more and more people. Nailing down this chronology can be useful in understanding how a virus spreads, but doing so is very difficult. This time, however, scientists have gotten pretty close. They've been able to zero in on some of the outbreak's earliest cases, cases which showed up years ago in Nigeria. NPR's global health correspondent Michaeleen Doucleff has this exclusive story about the doctor who detected those first-known cases and the warning he tried to issue to the world.

MICHAELEEN DOUCLEFF, BYLINE: This story begins five years ago with a doctor named Dimie Ogoina. Back in 2017, he saw what's perhaps the most important patient of his career.

DIMIE OGOINA: They brought my attention to a young boy.

DOUCLEFF: An 11-year-old boy with a very strange rash that looked like blisters.

OGOINA: He had skin lesions that are very large, affecting the face and all over the body.

DOUCLEFF: Ogoina is an infectious disease specialist at Niger Delta University in southern Nigeria. And when he saw the size of the lesions - or pox - on the body, he wondered if the boy had what was then a rare disease - a very rare disease.

OGOINA: The suspicion of monkeypox just came up.

DOUCLEFF: So Ogoina tested the boy and he was right - monkeypox. At the time, he thought this monkeypox outbreak would act the way it always had, the way it had been described in textbooks and scientific papers since the 1970s. That is, the virus came from an animal, like a rodent or a monkey.

OGOINA: It affects mainly children.

DOUCLEFF: Because when they're out playing, they often come into contact with animals.

OGOINA: There was this speculation that this young boy played with monkeys around the community.

DOUCLEFF: Furthermore, the virus doesn't spread very easily between people because it's not very contagious, especially between healthy adults. So the previous outbreaks were small, only a few dozen cases in rural areas. And Ogoina and the other doctors thought that this one back in 2017 would be the same.

OGOINA: So we felt, OK, could be the regular monkeypox that we know has been described in the central Africa.

DOUCLEFF: But a few weeks later, Ogoina started to become concerned. The outbreak began to grow very rapidly. Cases popped up not just near this one boy but all over.

OGOINA: We are seeing cases just suddenly appearing across the country.

DOUCLEFF: The virus seemed to be spreading further and faster than expected, and it wasn't kids getting infected but rather men in their 20s and 30s.

OGOINA: Young men, active men. It was very, very unusual at that time.

DOUCLEFF: These men didn't fit the typical profile for monkeypox either. They weren't handling animals. They were middle-class men living in busy, modern cities. And the rashes weren't in the typical place on their bodies. Instead of being on their face and extremities, the men had blisters around their genitals.

OGOINA: There were very, very extensive - very, very extensive genital lesions that appeared.

DOUCLEFF: Ogoina started to investigate these patients more and found that many of them had high-risk sexual behavior - multiple partners, sex with prostitutes. Ogoina started to realize something, something huge - that the virus had changed, and for the first time, it was spreading through sexual contact.

OGOINA: We have already proposed that sexual route is something that we need to look - really look at.

DOUCLEFF: Interesting. So fascinating because it's so different than what you see in the textbooks, right?

OGOINA: Yeah, it's completely different. Why are they not affecting children? Why not females? Why not the elderly? Why are we having young men 20 to 40 years only?

DOUCLEFF: Ogoina knew these findings had massive implications. It meant the virus no longer needed to jump from an animal, but instead, it can more easily jump from human to human. And that meant the current outbreak would be extremely difficult to stop. It meant monkeypox was no longer just a threat to communities in Nigeria but a threat really to the world. So Ogoina warned Nigerian health officials years ago. They wouldn't listen. At an international meeting, he tried to bring up the possibility of sexual transmission. Somebody told him to be quiet.

OGOINA: We had one meeting. Somebody said, I should not say it.

DOUCLEFF: Really?

OGOINA: That they have experience - yes. At one meeting, like this, somebody said, I should not say it, that it is not possible. We should not worry.

DOUCLEFF: Jump ahead five years.

(SOUNDBITE OF MONTAGE)

UNIDENTIFIED REPORTER #1: Tonight, the World Health Organization's sounding the alarm on the rapid spread of monkeypox.

UNIDENTIFIED REPORTER #2: More than 70 countries now reporting cases, the U.S. nearing 2,900 infections.

UNIDENTIFIED REPORTER #3: New York City is the epicenter of the outbreak in the U.S.

DOUCLEFF: And for the first time in history, monkeypox is spreading across the world and just as Ogoina predicted - through sexual contact. Right now in the U.S., approximately 94% of cases have been transmitted through sexual or intimate contact in gay and queer sexual networks. In fact, Ogoina's insights and knowledge go even further. He says the outbreak in Nigeria in 2017 actually never stopped. Health officials just stopped looking for cases and the outbreak went underground.

OGOINA: That attention to monkeypox just dropped, and on account of that, there was declining surveillance and the like.

DOUCLEFF: Over time, that outbreak grew bigger. Then it did something extremely unusual. It turned into the huge international outbreak we're fighting right now. Michael Worobey is an evolutionary biologist at the University of Arizona. He's been studying the genes of monkeypox virus taken from patients in Nigeria in 2017 and ones taken from patients in the current outbreak. He says the gene sequences, their patterns, tell a very convincing story.

MICHAEL WOROBEY: Yeah, I think in many ways it's really clear.

DOUCLEFF: The data haven't been published. It's still preliminary. But Worobey says the pattern in the DNA sequences shows that this international monkeypox outbreak started in Nigeria years and years ago, even before the little boy showed up in Ogoina's office.

WOROBEY: It's clear that there's been continuous cases or endemic transmission in Nigeria from 2017, maybe a little bit before 2017. And then something from there just got exported out.

DOUCLEFF: Exported out to Europe, North America, Asia - really, exported out all over the world. He says the data are indisputable.

WOROBEY: These are the things that are obvious to someone who looks at the genetics.

DOUCLEFF: So this means that Dr. Demie Ogoina, the Nigerian doctor, was the first person to detect this international outbreak. And it means the world has had at least five years to prevent monkeypox from spreading all over the world. But the international effort to stop monkeypox in Nigeria has paled in comparison to the effort in Europe and North America. For example, since monkeypox started showing up in the West this year, there has been a rapid effort to vaccinate millions of people. But the same hasn't been true in Africa. To this day, Nigeria hasn't seen one monkeypox vaccine. To say this is a point of frustration for Ogoina is an understatement. In fact, he calls the weak international response a lost opportunity for Nigeria and for the rest of the world. Michaeleen Doucleff, NPR News. Transcript provided by NPR, Copyright NPR.

Michaeleen Doucleff, PhD, is a correspondent for NPR's Science Desk. For nearly a decade, she has been reporting for the radio and the web for NPR's global health outlet, Goats and Soda. Doucleff focuses on disease outbreaks, cross-cultural parenting, and women and children's health.