The U.S. Centers for Disease Control and Prevention has confirmed monkeypox infection in three more Hawaii residents previously classified as probable cases.

With the three confirmed, in addition to the first two, all five cases of monkeypox in Hawaii are now confirmed, according to the Hawaii Department of Health. All are on Oahu.

DOH reported the first probable case on June 3 in an adult resident that had recently traveled to an area with confirmed cases, and who was hospitalized at Tripler Army Medical Center. On June 8, DOH reported a second probable case in an adult resident who came into close contact with the first.

Then on June 9, DOH reported a third probable case of monkeypox in an adult resident that had no travel history and at the time, no known connection to the first two cases.

On Tuesday, DOH identified two more probable cases of monkeypox, and said that all five were connected to one another.

Health officials describe monkeypox as a rare disease caused by the monkeypox virus, which is spread primarily through close contact, but which can also be spread through droplets and direct contact with body fluids, lesions, or bedding and clothing used by someone with monkeypox.

Infection begins with flu-like symptoms such as exhaustion, fever, headaches, chills, muscle aches and swollen lymph nodes. It then progresses to new or unexplained rash or sores, often on the hands, feet, chest, face, or genitals. Patients generally become ill within 21 days of exposure.

Individuals with monkeypox symptoms should immediately contact their health care provider, DOH said, but reminded members of the comunity “to respond with an inclusive, fact-based approach when discussing monkeypox.”

“Stigma is unacceptable and can drive people away from seeking healthcare services,” said DOH in a statement.