The Centers for Disease Control and Prevention on Friday warned that monkeypox could be spreading from person to person in the U.S.

Some of the monkeypox cases in the U.S. have not been linked to recent travel to countries where the virus typically spreads, suggesting instead that the virus is spreading in the community, according to the CDC.

“There could be community level transmission that is happening, and that’s why we want to really increase our surveillance efforts,” Jennifer McQuiston of the CDC said on a call with reporters. As of Thursday, the CDC has confirmed 20 cases of monkeypox across 11 states. More than 700 cases have been reported globally.

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