Monkeypox has spread within the state of Texas, state health officials said.

Three Texas residents who contracted the virus reported they did not travel outside the state within three weeks before becoming sick, meaning they were exposed in Texas.

Twelve cases of monkeypox have been identified in Texas thus far, according to a news release from the Texas Department of State Health Services. The first six cases stemmed from international travel. Three residents who contracted monkeypox said they had traveled domestically before getting sick.

But those who did not travel before getting sick contracted monkeypox from other people in Texas. The virus is primarily transmitted through direct contact with infected wounds, scabs or bodily fluids from a sick person, state health officials said. It can also spread through physical contact, such as wrestling, cuddling, kissing or intimate sexual contact.

Officials recommend avoiding contact with people who are sick or have new rashes or wounds. Animals, such as prairie dogs, rabbits, rope squirrels, Gambian rats, wallabies and African tree squirrels can also expose humans to monkeypox. Not all of these animals are native to Texas.

Many of the monkeypox cases in the outbreak are among men who have sexual contact with other men, the health department said. However, Chris Van Deusen, the director of media relations for the DSHS, said having close contact with a large number of people is one of the primary risk factors of virus transmission.

“I would caution anybody, whether you're in that population or not—if you get sick or you develop a rash, to avoid that close contact with [others],” Van Deusen said.

Certain groups are also more likely to have more serious symptoms after contracting the virus. This includes very young children, elderly people, and people with pre-existing conditions or compromised immune systems.

Monkeypox is a severe acute illness, which typically begins with symptoms that include a fever, headache, muscle aches, swollen lymph nodes, chills and exhaustion. A rash soon appears on the face or inside the mouth and can spread to other parts of the body. The rash may look like pimples or blisters, according to the release.

The illness, which typically lasts for two to four weeks, can be confused with chickenpox, shingles or a sexually transmitted infection.

Texans are encouraged to notify their local health department about suspected cases of monkeypox. The monkeypox vaccine, called JYNNEOS, can prevent people from getting sick with the disease if administered within four days of exposure to the virus.

The first monkeypox case in Dallas County was identified June 6, with Travis County’s first presumptive case identified on June 24 and confirmed by Austin Public Health on June 30.

For more information about monkeypox, Texans can visit the health department’s website.

Editor's note: This story was updated to include the confirmation of the Travis County case.