As of May 1, 2018, 121 people infected with the outbreak strain of E. coli O157:H7 have been reported from 25 states.
A major outbreak in the USA of E. coli linked to Arizona-grown Romaine lettuce is now affecting 29 states, according to the Centers for Disease Control (CDC).
If you do not know whether lettuce is romaine, do not eat it.
Two Canadians reported travelling to the US before getting sick and eating romaine lettuce while they were there.
"You're looking at more of a web", Dr. Stic Harris, director of the U.S. The Food and Drug Administration's Coordinated Outbreak Response and Evaluation Network, said at the time.
From the states with their first cases, Florida and Texas each have one case, but Minnesota has 10 and North Dakota has two. Most people develop bloody diarrhea and cramps for five to seven days.
Health officials have tied the outbreak to romaine lettuce grown in Yuma, Arizona, which provides most of the romaine sold in the US during the winter.
Of the 149 people who became ill, 102 of them reported eating romaine lettuce in the weeks leading up to their illness, according to the CDC report.
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The geographic disparity in the clusters has helped confound officials in tracking the source of the outbreak deeper than the Yuma region.
The restaurants interviewed by officials have told them they used bagged, chopped romaine lettuce in their salads and other dishes.
Although E. coli is typically to primarily pose a danger to elderly people and very young children, the median age of those affected in this outbreak is 29.
"This is a higher hospitalization rate than usual for E. coli O157:H7 infections, which is usually around 30 percent", the agency said.
The agency says if it is determined that contaminated romaine lettuce is in the Canadian market, the Canadian Food Inspection Agency will recall the product as required.
To explain the diverse geographical spread of this outbreak, the FDA said it is still investigating multiple points of origin and distribution. But the other 141 cases are still not linked to a farm, processor, distributor, grocery store, or restaurant. People also should avoid salad mixes that include romaine. Those heads were harvested between March 5 and 16 and are past their 21-day shelf life.