LISBON/MADRID, May 19 (Reuters) – The health authority in Portugal, the country with the most monkeypox cases, said on Thursday it was worried about the spread of the disease but asked people to stay calm as the transmission risk was low.Portugal has reported 14 cases of monkeypox and there are around 20 suspected infections, the spokesperson for the country’s monkeypox working group, Margarida Tavares, told Reuters in a video interview.Monkeypox is a usually a mild viral illness, characterised by fever and a distinctive bumpy rash. The outbreaks in Britain, Portugal, Spain, the United States and other countries raised alarm because the disease, which spreads through close contact and was first found in monkeys, mostly occurs in West and Central Africa, and only very occasionally elsewhere. “The health authority… is worried… It is important to act in the right way and make the right decisions to break transmission chains,” Tavares said. “(But) the risk for the population is low.””It is not a disease that is easily transmitted.”Tavares said cases in Portugal were all detected in sexual health clinics and those infected were men aged between 20 and 40 years old who self-identified as gay, bisexual or men who have sex with men.They all have mild symptoms and their health status is improving. No one has been hospitalised.There are two main strains: the Congo strain, which is more severe – with up to 10% mortality – and the West African strain, which has a fatality rate of about 1%. Portugal’s cases are of the West African strain.None of those infected have traveled to Africa and authorities have not been able to identify a link between the cases, she added.Neighbouring Spain reported on Thursday its first seven confirmed cases and 22 possible cases, all in the central region of Madrid.”It’s possible we will have more cases in the coming days,” said Madrid regional public health chief, Antonio Zapatero.The Portuguese health authority has asked those with symptoms to refrain from direct physical contact with others.In the United Kingdom, where nine cases of the West African strain have been reported, authorities will offer a smallpox vaccine to people may have been exposed.Tavares said vaccination was being discussed in Portugal, but it would not happen immediately as it must “very well thought out”.