The Hawaii Department of Health on Wednesday 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 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.

To date, the tally includes 16 on Oahu, including a nonresident, two nonresidents on Kauai, two on Maui and two on Hawaii island.

“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 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 rashes or sores, should immediately contact their health care provider for testing and treatment.

DOH, meanwhile, has expanded eligibility for the Jynneos vaccine to include the immunocompromised living with a high-risk individual, and people in certain occupational risk groups.

Vaccination eligibility includes those ages 18 and older that meet the following criteria:

>> Close contact in the past 14 days with a person with known or suspected monkeypox infection.

>> Gay, bisexual and other men who have sex with men and transgender individuals who have multiple or anonymous sex partners.

>> People 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.

>> People in certain occupational risk groups, including research laboratory workers performing diagnostic testing for monkeypox virus and members of health care worker response teams.

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 going online at health.hawaii.gov/docd/mpxvax. On Kauai, residents also can call 808-241-3495.

The following community partners also are offering the vaccines:

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

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

>> On Maui, Malama I Ke Ola. Call 808-871-7772.