The Hawaii Department of Health this morning reported four additional cases of monkeypox, bringing the total reported in the state since early June to 22 cases.

DOH said it has identified four additional cases of monkeypox in two Oahu residents and one Maui resident, all of which remain under investigation, and a Hawaii island resident whose case is related to community exposure.

The first monkeypox case in the state was reported on June 3 in an Oahu adult resident who had traveled to an area with confirmed cases. Since then, monkeypox cases have been diagnosed in all four major counties.

“With nearly 16,000 monkeypox cases reported in the United States, it’s expected that we will see more cases in Hawaii,” said Deputy State Epidemiologist Dr. Nathan Tan in a news release. “We continue to work to conduct contact tracing and follow-up with all cases. We encourage all eligible individuals to get vaccinated to stop the spread of monkeypox and protect our community.”

DOH continues to say the risk to most Hawaii residents remains low. Monkeypox is mainly spread through close, intimate contact with body fluids, lesion material, or items used by someone with monkeypox.

Nationwide, the current cases are primarily spreading among social networks of gay, bisexual, and other men who have sex with men. In Hawaii, at least some of cases have been reported among gay or bisexual men.

However, DOH said, anyone who has close contact with someone with monkeypox is at risk of infection, regardless of sexual orientation or gender identity.

Anyone with monkeypox symptoms, including flu-like symptoms, swollen lymph nodes, or new or unexplained rash or sores, should immediately contact their health care provider for testing and treatment.

DOH, meanwhile, has expanded eligibility for the Jynneos vaccine to those who are immunocompromised and have a household member or sex partner at high risk for monkeypox.

Vaccination eligibility includes those ages 18 and older:

>> Who has had close contact in the last 14 days with a person with known or suspected monkeypox infection;

>> Who are gay, bisexual, and other men who have sex with men and transgender individuals who have multiple or anonymous sex partners;

>> Persons with severe immune compromise (e.g., advanced or poorly controlled HIV infection, active cancer treatment, high-dose steroids) or certain skin conditions, such as eczema; AND who have a household member or sex partner at high risk for monkeypox.

DOH has received approximately 4,400 doses of Jynneos — a two-dose series administered 28 days apart — and continues to order Hawaii’s full allocation from the federal government. Nearly 1,800 doses have been administered so far.

Individuals eligible for a second dose are encouraged to make an appointment.

Individuals eligible for vaccination can make an appointment by calling DOH at 808-586-4462 or online at health.hawaii.gov/docd/mpxvax. On Kauai, residents can also call 808-241-3495.

The following community partners are also offering the vaccines:

>> On Oahu, the Waianae Coast Comprehensive Health Center (Waianae and Kapolei sites). Call 808-427-0442.

>> On Oahu, Hawaii Health & Harm Reduction Center (Honolulu), 808-521-2437.

>> On Maui, Malama I Ke Ola is offering the vaccines. Call 808-871-7772.