New York City health officials are reporting a total of seven cases of monkeypox, a rare illness that has become a growing concern in the U.S. following an outbreak in Europe.

The Department of Health announced late Friday that they had identified two additional cases, which still need to be confirmed by the Centers for Disease Control and Prevention (CDC).

Health officials said that individuals who recently traveled to Portugal, Spain, the U.K. Canada or Central and Western Africa may be more likely to have been exposed to monkeypox. They also cited men who have had sex with men as being at risk.

The alert from city health officials comes amid rising cases in the U.S. The CDC has found more than 20 cases so far across 11 states. Most have involved men who have had sex with other men. The disease is endemic in West and Central Africa, but an outbreak outside those areas of more than 700 cases, beginning in May, has caused the public health community to become alarmed.

During a briefing on Friday, CDC officials said they expected cases to rise.

“There could be community-level transmission that is happening, and that’s why we want to really increase our surveillance efforts,” said Jennifer McQuiston, a CDC official, according to a Politico story.

Nonetheless, the CDC is currently categorizing the risk to Americans as low. As part of its public health response, the Biden administration has distributed 1,200 vaccine doses to different states for those with high-risk exposure.

Symptoms for monkeypox include fever, headache and body aches followed by a tell-tale rash that includes lesions on the face or body, including the genitals.

The disease is related to smallpox, but less contagious. It is rarely fatal. Treatment can include an antiviral drug developed for smallpox, but most patients recover on their own.

Health officials are asking those with symptoms to isolate immediately and contact their health provider.