HONOLULU (KHON2) — Hawaii health officials reported that all probable and confirmed cases of monkeypox in Hawaii are connected, after two additional probable cases were announced on Tuesday.

The health department identified connections between all five cases.

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In addition to the two new probable cases announced on Tuesday, the CDC confirmed Hawaii’s first case of monkeypox on June 9 and the second probable case which was reported Wednesday, June 8.

“The risk to most Hawaiʻi residents remains low,” said Deputy State Epidemiologist Dr. Nathan Tan. “Anyone who has close contact with someone with monkeypox is at risk of infection—regardless of who they are, what they do, or if they are sexually active.”

The department is conducting contact tracing and coordinating treatment.

Monkeypox is a rare disease caused by the monkeypox virus. Infection begins with flu-like symptoms such as fever, headache, muscle aches, chills, exhaustion, and swollen lymph nodes. Infection progresses to a rash or sores, often on the hands, feet, chest, face, or genitals. Individuals generally become ill within 21 days of exposure.

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Monkeypox can spread through direct contact with body fluids, lesion material, or items used by someone with monkeypox as well as close, prolonged contact with an infected person or animal. Monkeypox can be spread through large respiratory droplets. These droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.

Officials said that some of Hawaii’s cases are among gay or bisexual men but caution that anyone is at risk when coming into contact with someone with monkeypox, regardless of sexual orientation or gender identity.