LONDON, United Kingdom (AP) — British health authorities say they have identified four “rare and unusual” cases of the disease monkeypox among men who appear to have been infected in London and had no history of travel to the African countries where the smallpox-like disease is endemic.

Last week, Britain reported three earlier cases of monkeypox, including two people who lived in the same household and the other who had previously travelled to Nigeria, where the disease is endemic in animals.

“The evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact,” said Dr Susan Hopkins, the Chief Medical Adviser for the UK’s Health Security Agency.

The disease does not typically spread easily between people, but British health officials say it’s possible if there was extremely close contact with an infected person.