The governors of California and Illinois issued their declarations Monday, as the number of confirmed monkeypox cases nationwide surpassed 5,800, based on CDC counts. They followed New York, which declared a state disaster emergency on Friday.

Nearly every state in the U.S.—with the exception of Montana and Wyoming—has reported at least one confirmed monkeypox case. The three states with emergency orders now in place are also the ones reporting the highest number of cases. Others that have higher case rates relative to their population, such as Georgia, are expanding testing and vaccinations but have yet to announce similar statewide measures.

Monkeypox typically starts with flu-like symptoms such as fever and muscle aches that progress into a widespread rash. But in the current outbreak, some have experienced only the rash or more subtle lesions that are confused for other illnesses. It spreads from person to person through close physical contact, usually prolonged, and touching infected surfaces.

New York became the first state to announce a statewide order related to the disease after its health department called monkeypox an “imminent threat to public health.” Gov. Kathy Hochul said the executive order would expedite the state’s response to the monkeypox outbreak, including getting more New Yorkers vaccinated. 

"After reviewing the latest data on the monkeypox outbreak in New York State, I am declaring a State Disaster Emergency to strengthen our aggressive ongoing efforts to confront this outbreak,” Hochul said in a statement. “More than one in four monkeypox cases in this country are in New York State, and we need to utilize every tool in our arsenal as we respond.”

Then over the weekend, officials in New York City declared their own public health emergency and estimated that the city is “currently the epicenter of the outbreak” with nearly 150,000 residents at risk for monkeypox exposure. As of Monday, New York, the most populated state in the country, confirmed nearly 1,400 monkeypox cases, per CDC data. It leads the rest of the states as having the highest case rate relative to population, The Hill reported. 

Calling a state of emergency often allows governors and local government agencies to mobilize resources to affected areas more quickly. When declared for the COVID-19 pandemic, these orders gave officials access to stockpiles of medical equipment. Governors can also temporarily suspend certain rules and regulations in a health emergency, which allowed them to enact mask mandates, lockdown orders, and other restrictions during the pandemic.

In the context of monkeypox, New York’s emergency extends who can administer the monkeypox vaccine to include EMS workers, pharmacists, and midwives, according to Hochul.

When Illinois Gov. J.B. Pritzker declared a public health emergency Monday, he referenced that it will “expand the resources” needed to respond to the outbreak. Illinois is the state with the third-highest number of monkeypox infections reported, at 520, following California, which has more than 820 cases.

“The Monkeypox Virus is a rare, but potentially serious disease that requires the full mobilization of all available public health resources to prevent the spread,” Pritzker said in a tweeted statement Monday. 

California issued its alert later Monday to bolster the state health department’s education efforts, seek additional monkeypox vaccines, and allow EMS staff to administer doses like in New York.  

"California is working urgently across all levels of government to slow the spread of monkeypox, leveraging our robust testing, contact tracing and community partnerships strengthened during the pandemic to ensure that those most at risk are our focus for vaccines, treatment and outreach,” California Gov. Gavin Newsom said in a statement.