The number of confirmed cases of monkeypox in Ontario has risen by 47 per cent in the past five days, health officials say, with the bulk of cases still appearing in Toronto.

There are now 230 confirmed cases in Ontario, up from 156 on July 14, 133 on July 11, and 101 on July 6.

Public Health Ontario says all but one confirmed case are in men, and 172 of the cases confirmed so far involve residents of Toronto.

There are eight other probable cases in the province which remain under investigation.

Elsewhere in Ontario, Ottawa is now reporting 16 confirmed cases, Halton is reporting 7, Middlesex-London is reporting 9 and Hamilton is reporting 5 confirmed cases.

Nine people have required hospitalization from infection and all made full recoveries.

All cases in Ontario identified so far involved people between 69 and under 20 years of age.

The most commonly reported symptoms include rash, oral/genital lesions, swollen lymph nodes, headache, fever, chills, myalgia and fatigue.

Monkeypox typically spreads through sustained close contact between people breathing, talking, coughing or sneezing.

It can also spread through skin-to-skin contact with rashes or bodily fluids and can also remain on items such as clothing or bedsheets that have made contact with an infected person.

Symptoms can present anywhere between five to 21 days after exposure.

Infected persons can remain contagious through skin contact for up to four weeks.

Ontario is now testing anyone who shows up to a healthcare provider or emergency room with an “unexplained acute rash or lesion(s).”

Federal guidelines indicate the smallpox vaccine is most effective if administered within four days of exposure to a case, but can help if administered up to 14 days after exposure.

The City of Toronto continues to offer the Imvamune smallpox vaccine to people considered to be at high risk of exposure.

There is also a therapeutic known as TPoxx which has shown to be helpful in cases where patients suffered severe complications from infection.

The World Health Organization (WHO) now says it is aware of 13,436 confirmed cases of monkeypox in 59 countries around the world, including three deaths.

The Public Health Agency of Canada (PHAC) says it is aware of 539 cases across Canada, with most in Ontario and Quebec.