MADRID, Spain (AP) — Spain has reported a second death in as many days from monkeypox, its health ministry said Saturday.

These are believed to be the first confirmed deaths from monkeypox since its outbreak in the European Union. The ministry gave no details on the deceased. It reported its first death from the disease on Friday.

The global monkeypox outbreak has seen more than 21,000 cases in nearly 80 countries since May. There have been 75 suspected deaths in Africa, mostly in Nigeria and Congo, where a more lethal form of monkeypox is spreading than in the West. Brazil also reported a death linked to monkeypox on Friday.

On Friday, Spain’s health ministry reported 4,298 people were infected with the virus, making it the leading European country for monkeypox cases. Of that total, some 3,500 cases were of men who had had sex with other men. Only 64 were women.

The ministry said 120 have needed hospital attention.

Health authorities are administering 5,300 vaccines that Spain received from the joint EU vaccine purchase scheme. Health workers say that’s far fewer than the number needed to cover the at-risk groups.

Monkeypox has been endemic to parts of Africa for decades. Its leap to Europe and North America was linked by experts to two raves in Belgium and Spain.

It spreads mainly through skin-to-skin contact, but it can also be transmitted through bed sheets used by someone with monkeypox. Symptoms include fever, body aches, chills, fatigue and hives. The illness has been relatively mild in many men. But people can be contagious for weeks, and the lesions can be extremely painful.