Mississippi is one of seven states in the U.S. where no known cases of monkeypox have been identified.

On Monday, the Centers for Disease Control reports that 43 states have identified at least one case of the disease. The disease has emerged in more than 50 other countries.

On Friday, Alabama public officials said that they’d identified the state’s first known cases of monkeypox.

The Alabama Department of Public Health said in news releases that two cases have been identified. The first was in Mobile County and the second in Jefferson County.

Most monkeypox patients experience only fever, body aches, chills and fatigue. People with more serious illness may develop a rash and lesions on the face and hands that can spread to other parts of the body.

State health officials said a symptom in the current outbreak is a rash that starts out as flat spots, followed by raised spots, then vesicles that are deep-seated, have a tiny spot in the middle of the vesicle, and may be itchy or painful.

Cases began emerging in Europe and the United States this spring. Most of the roughly 1,000 cases reported in the U.S. have been among men who have sex with men, but health officials stress that anyone can get the disease.

Dr. Rendi Murphree, an epidemiologist with the Mobile County Health Department, said monkeypox can be transmitted through close person-to-person contact.

“The patient had no known contact with a monkeypox patient — so did not know if they had skin-to-skin contact with someone who had monkeypox— which emphasizes the importance of raising awareness for our community in general, but in particular, raising awareness for our healthcare community and those that are at most risk for infection,” Murphree said during a news conference about the case in Mobile County.

An effective vaccine against monkeypox exists. The federal Centers for Disease Control and Prevention recommends the vaccine for people who have already been exposed to the virus and their presumed contacts.