Severe cases of monkeypox are being reported in Alabama and state health officials are asking people at risk to get screened.

The Alabama Department of Public Health reports “at least” 139 cases of monkeypox in the state as of Tuesday. The Centers for Disease Control and Prevention said some of the cases reported have been “severe.”

“While anyone can be infected with the contagious rash illness, male-to-male sexual contact has been a risk factor,” the Alabama health department said.

“Monkeypox is usually transmitted through close, intimate, skin-to-skin contact or through broken skin, respiratory droplets or mucous membranes.”

Monkeypox causes a rash that starts as flat spots, which then become raised and finally appears pustular. Some people have reported only a rash, but the health department said other symptoms include fever, chills, enlarged nymph nodes, muscle aches and headaches.

“Monkeypox can spread from the time symptoms begin until the rash has fully healed and a fresh layer of skin has formed,” the health department said. “This can take two to four weeks.”

Not all cases require treatment, but people with the disease need to isolate and follow infection control steps to reduce spread of the disease.

A two-dose vaccination series is available to persons at higher risk. Monkeypox testing continues to be offered at county health departments, and clinical testing is available through the ADPH Bureau of Clinical Laboratories at no charge to the patient.