A second person have died of monkeypox, health officials in Spain has confirmed.
This Brings the death outside of Africa to three, since the virus began to spread further afield earlier this year.
Spain reported its first death on Friday, shortly after Brazil confirmed the first monkeypox-related fatality of the current epidemic.
In its latest report on Saturday, the Spanish Health Ministry said 4,298 cases had been confirmed in the country.
Of the 3,750 patients on which it had information, 120 or 3.2% had been hospitalised, and two had died, it said without providing further details.
The Brazilian patient was a 41-year-old man who also suffered from lymphoma and a weakened immune system.
The World Health Organisation has dubbed the outbreak a global health emergency and governments around the world are racing to contain it.
Experts believe the virus, which passes from human to human during close contact, is being primarily transmitted sexually, with the bulk of cases being found in men who have sex with other men.
UK health officials said there are more than 2,500 confirmed and suspected cases as of Thursday, with all but a few dozen in England.
Governments are buying up doses of the smallpox vaccine, which has been shown to provide protection against the virus.