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The Centers for Disease Control and Prevention has issued an alert after five cases of malaria have been reported in two Southern states – the first reported spread of the mosquito-transmitted disease in the U.S. in 20 years, according to The New York Times.

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Four people in Florida and one person in Texas have contracted the disease, the CDC said in the statement.

All five patients “have received treatment and are improving,” according to the CDC. “Despite these cases, the risk of locally acquired malaria remains extremely low in the United States,” the agency added.

Malaria is caused by several species of parasites transmitted by Anopheles mosquitoes.

Those infected with malaria will have flu-like symptoms, including fever and chills. If malaria is left untreated, symptoms could become severe, or a person may die from the disease.

According to the CDC, the cases reported were caused by Plasmodium vivax, which is less likely to cause severe disease.

A person gets malaria from the bite of an infected mosquito. While people do not pass the disease to each other, other insects can bite the infected person, become infected and pass the disease on to the next person it bites.

The cases found in Florida were in Sarasota County. The Texas case was reported in Cameron County.

Mosquito surveillance and control measures have been implemented in the areas in Florida and Texas where the cases were reported.