Thursday morning July 7th health officials reported the first case of monkeypox in Nashville. This morning, exactly one week later, the Metro Nashville Public Health Department has identified a fourth presumptive case of monkeypox in Davidson County.

The department has not identified where this fourth Davidson County resident was infected, but the other three patients were most likely exposed outside of Tennessee.  None of the four have required hospitalization, said a health department spokesperson.

Investigators are reaching out to all people who have may have had close contact with them. For now, it’s unclear if the virus is spreading throughout the state.  Monkeypox is a rare disease in the same family of viruses as smallpox, according to the CDC. Symptoms are similar to smallpox but milder. The disease is rarely fatal.

According to the World Health Organization, monkeypox is often transmitted from animals to humans and has usually appeared in central and west Africa, commonly near rainforests. Prior to this year’s outbreak, monkeypox was largely seen only in individuals who had traveled to countries where the virus was spreading.

     The CDC says the virus can spread from person to person through:

• direct contact with the infectious rash, scabs, or body fluids

• respiratory secretions during prolonged, face-to-face contact or during intimate physical contact

• touching items like clothing or linens that previously touched the infectious rash or body fluids