CDC expands E. coli warning: All romaine lettuce should be tossed, chopped or not

A new outbreak of E. coli in 11 states has been linked by government investigators to bagged, chopped romaine lettuce grown in Yuma, Ariz. Consumer Reports is recommending—for the second time since January—that consumers avoid all romaine lettuce for Time

Federal health officials expanded their E. coli warning to all types of romaine lettuce from the Yuma, Arizona, region as they investigate the nationwide outbreak affecting dozens of people.

The U.S. Centers for Disease Control and Prevention said people in Alaska reported getting sick after eating whole heads of romaine lettuce from Yuma. Previously the warning only referred to chopped romaine. It's now expanded to all types, including hearts of romaine, salads and salad mixes.

That means all romaine lettuce originating from the Yuma region should be tossed. If you cannot confirm the lettuce is not from the Yuma area, do not order or buy it. If you already have romaine from Yuma, throw it away, even if it's already been eaten and no one has gotten sick, the agency said.

"Produce labels often do not identify growing regions," the CDC said in a Friday update. "So, throw out any romaine lettuce if you're uncertain about where it was grown."

The outbreak, which started March 13, has resulted in at least 53 cases in 16 states. The Alaska cases have not yet been added to the CDC's case total. Of the cases, 31 people were hospitalized including five people who developed a type of kidney failure. There have been no deaths.

Individual states, the CDC and the U.S. Food and Drug Administration are investigating the outbreak.

Pennsylvania is the hardest-hit state with 12 cases, followed by Idaho with 10. New Jersey, Montana and Arizona are among the other states affected. About 70% of those sick are women or girls.

No grower, supplier, distributor or brand has been identified as the source, although investigators have made it clear the outbreak is coming from the Yuma area.

More: What you need to know about the E. coli outbreak, now in 7 states

More: Report: New Jersey E. coli investigation may be tied to Panera Bread

More: 200 million eggs recalled over salmonella fears

Restaurants and retailers should not sell any romaine from the pinpointed region, the CDC said. They should also ask suppliers where the lettuce is from.

The E. coli spreading through the states is "toxin-producing," the CDC states — specifically a toxin known as Shiga. People get sick within two to eight days of swallowing the germ, which causes diarrhea, stomach cramps and vomiting. Although most recover in one week, it could lead to kidney failure.Most people take precautions to avoid contracting salmonella poisoning from raw chicken, but there are other foods that are surprisingly more likely to harbor the harmful bacteria. USA TODAY

To avoid E. coli, wash your hands regularly and thoroughly, cook meat completely, wash fruits and vegetables, avoid raw milk and don't prepare food when you're sick. If you find yourself sick, write down what you've eaten, contact your doctor and report your illness to your local health department.

Earlier in the week Consumer Reports issued its own warning.

“Consumer Reports is making this recommendation given the potentially fatal consequences of E. coli, the fact that there are still several unknowns about this outbreak and that no type of romaine has been ruled definitively safe by government officials,” said James Rogers, Ph.D., director of food safety research and testing at the Yonkers, N.Y.-based not-for-profit.

USA Today reporter Zlati Meyer contributed to this report.

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