Four more people in England have been diagnosed with monkeypox.

The UK Health Security Agency says the risk to the public remains very low, although it appears the individuals caught it in the UK.

Monkeypox is usually associated with travel to West Africa.

The new cases – three in London and one in north-east England – do not have any known links with two other cases confirmed on 14 May or another case announced on 7 May.

The UKHSA says investigations are under way to establish links between the latest four cases, who all appear to have been infected in London.

Currently, common contacts have been identified for two of the four latest cases. All four self-identify as gay, bisexual or other men who have sex with men.

The UKHSA says anyone with concerns that they could be infected should see a health professional, but make contact with the clinic or surgery ahead of a visit.

UKHSA chief medical adviser Dr Susan Hopkins said: “This is rare and unusual. UKHSA is rapidly investigating the source of these infections because the evidence suggests that there may be transmission of the monkeypox virus in the community, spread by close contact. We are particularly urging men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.

“We are contacting any potential close contacts of the cases to provide health information and advice.”

Those patients needing medical care are all in specialist infectious disease units at the Royal Free Hospital, Royal Victoria Infirmary in Newcastle upon Tyne and Guys’ and St Thomas’.