The Centers for Disease Control and Prevention is advising U.S. consumers not to eat any romaine lettuce and as it may be contaminated with E. coli.
Thirty-two people, including 13 who have been hospitalized, have been infected with the outbreak strain in 11 states, according to the CDC. One of the hospitalized people developed hemolytic uremic syndrome, a potentially life-threatening form of kidney failure. No deaths have been reported.
People have become sick in California, Connecticut, Illinois, Massachusetts, Maryland, Michigan, New Hampshire, New Jersey, New York, Ohio and Wisconsin.
The Public Health Agency of Canada has identified an additional 18 people who have become sick with the same strain of of E. coli in Ontario and Quebec.
The agency is also advising retailers and restaurants not to serve or sell any until more is learned about the outbreak. Consumers who have any type of romaine lettuce in their home should not eat it and throw it away, even if some of the lettuce was eaten and no one has gotten sick.
The advice encompasses all types and uses of romaine lettuce including whole heads of romaine, hearts of romaine and bags or boxes of precut lettuce and salad mixes that contain romaine. That includes baby romaine, spring mix and Caesar salad mixes. If you are unsure whether the lettuce is romaine or whether a salad mix contains romaine, CDC officials say you should throw the lettuce away.
Consumers are also being advised to wash and sanitize drawers or shelves in refrigerators where romaine was stored.
Symptoms of E. coli infection, which usually begin about three or four days after consuming the bacteria, can include watery or bloody diarrhea, fever, abdominal cramps, nausea and vomiting, according to the CDC. Most people infected by the bacteria get better within five to seven days, though this particular strain of E. coli tends to cause more severe illness.
Officials say anyone with symptoms of an E. coli infection should talk to a healthcare provider, write down anything eaten in the week prior to becoming ill and report illnesses to the health department.