An additional 27 people have been infected with a strain of E. coli linked to romaine lettuce, the Centers for Disease Control and Prevention said Tuesday.
Days after announcing the outbreak and issuing a safety alert for lettuce harvested in Salinas, California, the CDC released an update saying 67 people have been sick from 19 states.
This is up from 40 people from 16 states in the Nov. 22 advisory, which led to a call from the health officials to pull romaine lettuce from the California region from stores across the nation, and for restaurants to not serve the lettuce.
The Food and Drug Administration and the CDC are investigating a multistate outbreak of E. coli O157:H7 infections linked to the lettuce "to determine the source of contamination and if additional products are linked to illness."
The CDC is advising consumers to not eat – and retailers not to sell – the lettuce harvested in the region, including "whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes which contain romaine, including baby romaine, spring mix, and Caesar salad."
E. coli outbreak alert:Do not eat any romaine lettuce from Salinas, California, CDC says
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Most romaine lettuce products are labeled with a harvest location showing where they were grown, according to the CDC. If it isn’t labeled with a growing region, don’t eat it, the CDC advises.
A total of 39 hospitalizations have been reported, the CDC said. Six people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.
E. coli symptoms vary and can include abdominal cramps, nausea, fatigue and diarrhea. Symptoms usually begin within three to four days after eating or drinking items containing the bacteria. However, the CDC states that symptoms can start anywhere from one to 10 days after exposure.
The illnesses started Sept. 24 and cases have been reported through Nov. 14, the CDC said, noting 67% of people sick were female. The ages of those sickened range from 3 to 89 years, with a median age of 25.
Wisconsin has the most cases with 21 up from 10 previously reported, followed by Ohio with 12, and California and Maryland had four cases.
Arizona, Idaho and Minnesota and Pennsylvania each has three cases. New Mexico, Texas and Virginia had two cases a piece.
The following eight states had one reported case each as of the Tuesday report: Colorado, Illinois, Michigan, Montana, Nebraska, New Jersey, Oregon and Washington.
“We are concerned about the potential for contaminated lettuce on store shelves and in people’s refrigerators," said Dr. Robert Tauxe, director of the CDC's Division of Foodborne, Waterborne and Environmental Diseases, in a statement sent to USA TODAY. "Heading into the Thanksgiving holiday, it is critically important to avoid buying or eating romaine lettuce from the Salinas growing area so you can protect yourself and your family.”
Follow USA TODAY reporter Kelly Tyko on Twitter: @KellyTyko