UK health officials said on Friday that there were 11 more confirmed cases of the rare monkey virus in the country, bringing the total to 20.

The announcement came after France, Belgium and Germany reported the first cases of monkeypox, and Italy confirmed that it now has three related cases of the disease, endemic in some parts of Africa.

Cases of monkeypox have also been found in Portugal, Spain and Sweden, as well as in the United States and Canada, leading to fears that the disease, commonly concentrated in Central and West Africa, may spread.

The UK Health Agency (UKHSA) said that “11 new cases of monkeypox have been detected in England” out of nine.

“Most cases are mild, and I can confirm that we have purchased additional doses of vaccines that are effective against monkeypox,” Health Minister Sajid Javid wrote on Twitter.

UKHSA Chief Medical Adviser Susan Hopkins said she expects “this increase will continue in the coming days and more cases will be detected in the general public.”

She particularly urged gays and bisexuals to pay attention to the symptoms, saying that a “significant proportion” of cases in the UK and Europe come from this group.

The UKHSA stated that monkeypox had not previously been described as a sexually transmitted infection.

The World Health Organization (WHO) said it is also investigating the fact that many of the reported cases were people who identify themselves as gay, bisexual or men who have sex with men.

Symptoms of the disease include fever, muscle aches, swollen lymph nodes, chills, exhaustion and a rash similar to chickenpox on the hands and face.

It can be transmitted through contact with damaged skin and droplets of an infected person, as well as common items such as bedding and towels.

The first case in the UK was announced on May 7 in a patient who recently traveled to Nigeria.

Two more cases were reported a week later in people in the same family. They had nothing to do with the first case.

UKHSA said four more cases were announced on May 16, all identified as gay, bisexual or other men having sex with men and appearing to have been infected in London.

It says two new cases reported on May 18 also did not travel to countries where the virus is endemic, and “so it is possible they became infected through community transmission.”

No details of the latest cases reported on Friday have been reported.

On Thursday, Italian health authorities announced the country’s first case of monkeypox in a young man who had recently returned from the Canary Islands. On Friday, they said two more “zero patient” cases had been confirmed.

According to the WHO, monkeypox usually passes in two to four weeks.

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