Monkeypox is presumed to have spread within the US, and nine cases have now been identified in seven states, according to the director of the Centers for Disease Control and Prevention, Rochelle Walensky.

In a press briefing Thursday, Walensky said the nine cases were from Massachusetts, New York, Florida, Utah, Washington, California, and Virginia. Most of the nine cases had recent international travel to areas with active monkeypox cases, but not all.

“We need to presume that there is some community spread,” Walensky said. “But there is active contact tracing that is happening right now to understand whether and how these cases might have been in contact with each other or with others in other countries.”