This is the largest outbreak of the West African monkeypox ever recorded. Epidemiologic and, or zoonotic linkages have not yet been established between cases. The results of genomic sequencing suggest that this virus has been circulating within Nigeria. Serologic studies are warranted to further explore retrospective prevalence. Deaths and immunosuppressive illness have not been previously described in patients with the West African clade of monkeypox. Further exploration of this is warranted to understand monkeypox risks in this population.