The Centers for Disease Control and Prevention has confirmed all five monkeypox cases reported in Hawaii as state health officials maintained that the overall risk to the public remains low.

The state Department of Health said the five patients were connected but declined to say how they contracted the virus.

“We’re not going to go into further details on that just to make sure that we protect the privacy of these individuals,” DOH spokeswoman Katie Arita-Chang said.

She said some of the confirmed cases were among gay or bisexual men and the risk of community spread is low. But the DOH urged caution.

“We really want to emphasize that anyone who has exposure to monkeypox is at risk of infection, regardless of who they are, what they do, or if they’re sexually active,” Arita-Chang said.

Monkeypox is a rare disease that’s closely related to smallpox, meaning the vaccines are considered similarly effective for both diseases.

According to the CDC, people can contract the monkeypox virus through contact with skin lesion or bodily fluids, including saliva or sexual contact, as well as using materials contaminated with the virus.

The virus has spread outside of Africa, where it’s endemic, to 37 other countries, with 113 cases reported in the United States, most in California and New York.

“We want to emphasize that vaccination is not recommended for the general public at this time, but it is recommended for folks who had contact with someone with monkeypox,”  Arita-Chang said. “The vaccine is best and most effective when it’s administered within 14 days.”

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