The Hawaii Department of Health has identified three additional cases of monkeypox, bringing the total number of cases in Hawaii to 11.

Two are Oahu residents, while the third is a non-resident diagnosed on Kauai whose case is associated with travel outside of Hawaii. DOH has established a connection to a previously reported case for one Oahu resident, and is investigating possible connections for the second Oahu resident.

“Monkeypox cases continue to increase across the country — and we expect to see more cases in Hawaii,” said Deputy State Epidemiologist Dr. Nathan Tan in a news release. “We continue to take action to support individuals diagnosed with monkeypox, conduct contact tracing, vaccinate close contacts and those with high-risk exposure, and educate the community.”

The first case in Hawaii was reported June 3 in an adult Oahu resident who had recently traveled to an area with confirmed monkeypox cases.

DOH said the risk to most Hawaii residents still remains low.

Monkeypox is a rare disease caused by the monkeypox virus, which is in the same family of viruses as smallpox, according to the Centers for Disease Control and Prevention.

Infection often begins with flu-like symptoms such as fever, headache, muscle aches, chills, exhaustion and swollen lymph nodes in the neck, underarm or groin area, and this is oftentimes followed by rashes or sores on the hands, feet, chest, face, or genitals.

However, some people get a rash first, followed by other symptoms, according to CDC, while others only experience a rash.

Individuals generally become ill within 21 days of exposure.

While most people diagnosed with monkeypox experience mild to moderate illness, the rash and sores can be itchy and painful, health officials said.

DOH said it is using Hawaii’s limited vaccine allocation of Jynneos to vaccinate close contacts of people known to have monkeypox, and for people who may have had high-risk exposures in venues or areas where monkeypox is actively spreading. It has pre-positioned vaccine in all counties and is coordinating distribution and administration.

The vaccines are not available through health care providers at this time, health officials said, but availability is expected to increase in the coming weeks and months.

Monkeypox is mainly spread through close, intimate contact with body fluids, rashes and sores, or items used by someone with monkeypox.

Monkeypox may also be spread through large respiratory droplets, health officials said, but these droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required.

Nationwide, monkeypox cases also continue to grow. CDC as of today listed more than 2,800 confirmed monkeypox and orthopoxvirus cases across the U.S., the District of Columbia and Puerto Rico.

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

However, 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 contact their health care provider immediately.