The first death due to smallpox in South Africa has been confirmed after five cases of the viral infection were reported in the past month, the health minister said on Wednesday. The 37-year-old man died at Tembisa Hospital on Monday, Health Minister Joe Phaahla said at a press conference. Smallpox spreads through close contact, causing flu-like symptoms and pus-filled lesions. Most cases are mild, but the disease can be deadly. Phaahla said all smallpox cases in South Africa involved men aged 30 to 39 who had not traveled to countries currently experiencing an outbreak, suggesting local transmission of the infectious disease. “The five cases have been classified as severe requiring hospitalization. They have comorbidities and have been identified as key populations, men who have sex with men,” he told reporters. One patient has been discharged from the hospital, another has been discharged to isolate at home, and two others are still hospitalized. Sequencing of three of the cases revealed the presence of the mpox clade IIb strain, which began spreading globally in 2022. The Republic of Congo declared an mpox outbreak in April after recording 19 cases of the virus. According to the World Health Organization, mpox was first detected in humans in the neighboring Democratic Republic of Congo in 1970.