After a weeks-long stretch of reporting no new monkeypox cases, the Hawaii Department of Health this week added one, bringing the total in the state to 40.

No new monkeypox cases had been reported in the state for more than a month, but in an update Monday, one new case was added to the “out of state” category on the DOH’s dashboard.

The tally now includes 27 cases in Honolulu, four on Hawaii island, three on Kauai, two on Maui, and four among residents out of state.

“With monkeypox still circulating in the United States, it’s expected that additional cases will be diagnosed in Hawaii residents,” said Dr. Nathan Tan, deputy state epidemiologist, in a statement. “Vaccinations are available in all counties, and we continue to encourage those at risk to get vaccinated now.”

To date, 4,663 doses of the Jynneos vaccine have been administered in Hawaii, including more than 1,700 second doses.

The Jynneos vaccine is now available at 14 sites statewide, and listed at health.hawaii.gov/docd/disease_listing/monkeypox.

Current eligibility is limited to Hawaii residents who have had close contact in the last 14 days with a person with known or suspected monkeypox infection, and those who are gay, bisexual, or other men who have sex with men and transgender individuals who have multiple or casual sex partners.

Nationally, the seven-day average of daily monkeypox cases has declined steeply, from a daily average of above 400 in early August to 15 on Tuesday.

In the U.S., there have now been more than 29,000 confirmed monkeypox and orthopoxvirus cases and 12 deaths as of today, while there are more than 80,000 cases globally, according to the Centers for Disease Control and Prevention.

In its latest technical report released Oct. 27, CDC said the vast majority of cases thus far have occurred in adult men and among those reporting sexual contact with other men, and that few cases of transmission to household and nonsexual contacts have been observed to date.

The growth rate of the monkeypox outbreak is slowing, CDC said, likely due to a combination of factors, including vaccination, behavior change, and “possibly increases in infection-acquired immunity among a segment of affected sexual networks.”

Cases are expected to continue slowing and to fall significantly over the new few months, the report said, with moderate confidence. Vaccination remains an important tool in the outbreak.