Investigators in Europe say most of the cases have been in gay or bisexual men.
Countries around the world are on alert for the spread of monkeypox, a rare viral disease first reported in the Democratic Republic of Congo in the 1970s, after new cases emerged in Europe, and the United States confirmed its first infection.
The United Kingdom was the first to confirm a case of monkeypox earlier this month, after a man arrived from Nigeria carrying the infection. Since then, eight other UK cases have been found.
The two newest cases have no travel links to a country where monkeypox is endemic, so it is possible they were infected through community transmission, said the UK Health Security Agency.
The latest ones do not have known links with previous confirmed cases.
Health authorities suspect some of the infections may have occurred through sexual contact – in this instance among gay or bisexual men – with four of the UK cases identified among people who visited sexual health clinics after developing the rash associated with monkeypox.
The virus spreads through close contact and the agency is advising individuals, particularly those who are gay, bisexual or MSM, to be alert to any unusual rashes or lesions on any part of their body.
“The extent of local transmission is unclear at this stage and there is the possibility of identification of further cases,” the World Health Organisation (WHO) said in a statement on Wednesday.
In Spain, health authorities issued an alert over a possible outbreak of monkeypox after 23 people showed symptoms compatible with the viral infection.
The health ministry cautioned that the suspected cases – all in the Madrid region – had yet to be confirmed, but said a nationwide alert had been issued “to guarantee a swift, coordinated and timely response”.
Elsewhere in Europe, Portugal confirmed it had identified five cases of monkeypox.
Across the Atlantic, US officials on Wednesday reported a case in a Massachusetts man who recently travelled to Canada. Health officials are looking into whether it is connected to the outbreaks in Europe.
The man’s travels reportedly occurred at the end of April to meet friends and returned in early May. A CDC statement said he used private transportation.
US health officials said they are in contact with the UK and Canada as part of the investigation.
“I do think we are preparing for the possibility of more cases,” Jennifer McQuiston of the US Centers for Disease Control and Prevention said.
Last year, Texas and Maryland each reported a case in people who travelled to Nigeria.
Monkeypox comes from the same family of viruses as smallpox.
It is usually mild, although there are two main strains: the Congo strain, which is more severe – with a 10% mortality rate – and the West African strain, which has a fatality rate of around 1%.
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