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Two new cases of the human plague have been confirmed in Sante Fe County, New Mexico, according to health officials.

The Health Department says the two recent cases involve a 52-year-old woman and a 62-year-old woman. According to health officials, the first confirmed case of the plague this year occurred in June when a 63-year-old man contracted the plague.

According to TIME Health, this brings the total number of cases of human plague in the state to three - all of which have required hospitalization.

NMDOH workers are now investigating the environment around the plague patients' homes, to look for possible risk factors for plague and to ensure the safety of the neighbors and family in the area.

Typically, the plague is contracted through insect bites but humans can also become infected after coming into contact with either dead animals or live infected rodents. Symptoms include sudden onset of fever, chills, headache and weakness.

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While seen as a relic of the Middle Ages, the New Mexico DOH said in its statement that there were four cases of plague in 2016.

According to the Centers for Disease Control and Prevention, there are seven cases of plague on average each year. There have been 17 cases of plague documented in animals this year in New Mexico.

Although the plague can be treated using antibiotics, the CDC says the key is still recognizing the symptoms early and receiving treatment immediately. That was out of a total of 16 cases, the largest spike in human plague in the US since 2006.

The U.S. cases occur mostly in the Southwest, particularly in New Mexico, Arizona and Colorado.

Yersinia pestis, or plague, had been blamed for killing millions of people in Asia and Europe since the fall of the Roman Empire. (However, these symptoms can be caused by many other conditions.) People also may experience painful swelling in the groin, armpit or neck areas.