Nigeria has recorded its first death from monkeypox this year in a patient with underlying medical conditions, the diseases control agency said.

The Nigeria Centre for Disease Control and Prevention announced Sunday that in 2022 it has confirmed 21 out of 66 suspected cases of the disease, which is usually endemic in Nigeria and other parts of West and Central Africa.

“The death was reported in a 40-year-old patient who had underlying co-morbidity and was on immunosuppressive medications,” the Nigeria CDC said.

Nigeria has not had an outbreak of monkeypox since September 2017 but it continues to report sporadic cases of the disease. At least 247 have been confirmed in 22 of its 36 states since then with 3.6% fatality rate, the disease control agency said.

A spike in monkeypox cases reported in Europe and the U.S. has generated concerns among those countries, many of whom have not recorded a single case of the disease in years. Nearly 200 cases of the disease have been reported in more than 20 countries not usually known to have outbreaks, the World Health Organization said.

Monkeypox has not previously triggered widespread outbreaks beyond Africa, where it is endemic.

One of the new cases in the U.K. was recorded in a man days after his arrival from Nigeria on May 4. Nigeria has recorded six confirmed cases of the disease the British citizen left the country.

Dr. Ifedayo Adetifa, head of the country’s Center for Disease Control, told The Associated Press that nothing shows the British citizen contracted the disease in Nigeria and that the country remains prepared to respond to an outbreak of monkeypox.

“The biggest challenge that you have with a disease such as monkeypox is that it is uncommon and the perceived risk by the population about how dangerous this condition is has been very low … that is why ... we have conducted awareness training and advocacy training to increase the level of awareness of health care workers,” Adetifa said.