A total of 10 people have died from monkeypox in Africa this year as outbreaks of the virus grow across the world and health officials struggle to understand its origins outside of West and Central Africa.

Africa’s Congo has reported nine deaths from monkeypox in 2022, while Nigeria has seen its first death from the disease this year, the Associated Press reported.

At least 20 countries, including the U.S., have reported cases of monkeypox in their region. No deaths outside of Africa have been confirmed from the virus to date.

Dr. Aime Alongo, chief of the Sankuru health division in Congo, told the Associated Press on Monday that with 465 cases of the disease reported in the country, it is one of the worst-hit in West and Central Africa.

Monkeypox is considered an endemic disease in West and Central Africa, where it is typically spread from animals to humans. In Congo, monkeypox is prevalent due to the consumption of dead monkeys and other animals, Dr. Alongo told the AP.

“The residents enter the forest, pick up the corpses of monkeys, bats and rodents which are the reservoirs of monkeypox,” Dr. Alongo added.

Nigeria’s first death was in a 40-year-old person who had underlying health conditions and was on immunosuppressive medications, according to the Nigeria Centre for Disease Control and Prevention.

The country currently has 21 confirmed cases of the virus, the agency said. It has not seen an outbreak of monkeypox since September 2017 but does have a small number of cases that arise each year.

Elsewhere around the world, over 250 cases of monkeypox have been reported in more than 20 countries that do not typically have outbreaks of the disease, according to the World Health Organization.

Health officials are grappling with the spread of monkeypox worldwide, seeing a rise in cases among gay and bisexual men.

Monkeypox is typically spread through “direct contact with infectious sores, scabs, or body fluids” of an infected person or animal or through contaminated bed linens or clothing, the Centers for Disease Control and Prevention said.

Symptoms of monkeypox include fever, chills, exhaustion, headache, and muscle weakness , followed by lesions that can develop on the hands and soles of the feet, spreading to the rest of the body.

An image created during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo, 1996 to 1997, shows the arms and torso of a patient with skin lesions due to monkeypox, in this undated image obtained by Reu
An image created during an investigation into an outbreak of monkeypox, which took place in the Democratic Republic of the Congo, 1996 to 1997, shows the arms and torso of a patient with skin lesions due to monkeypox, in this undated image obtained by Reuters on May 18, 2022. Reuters / CDC/BRIAN W.J. MAHY