Updated

An E. coli outbreak involving romaine lettuce from Arizona has sickened 53 people across 16 states, with 31 patients requiring hospitalization. While no deaths related to the outbreak have been reported, five patients have suffered from kidney failure.

“Consumers anywhere in the United States who have store-bought chopped romaine lettuce at home, including salads and salad mixes, should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick,” The Centers for Disease Control and Prevention (CDC) said. “If you do not know if the lettuce is romaine, do not eat it and throw it away.

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The outbreak has been traced to the Yuma, Ariz., growing region, but has not been pinned to a specific supplier or distributor. Several retailers have issued recalls related to the outbreak, including Sam’s Club, Schnucks, Fresh Foods Manufacturing Co. and Giant Eagle. Pennsylvania appears to have the highest number of illnesses, but cases have also been reported in Alaska, Arizona, California, Connecticut, Illinois, Louisiana, Michigan, Missouri, New York, Ohio, Virginia and Washington.

The CDC is also advising restaurants and retailers to stop selling or serving chopped romaine lettuce from the Yuma region.

“Before purchasing romaine lettuce at a grocery store or eating it at a restaurant, confirm with the store or restaurant that is not chopped romaine lettuce from the Yuma Arizona growing region. If you cannot confirm the source of the romaine lettuce, do not buy it or eat it,” the CDC said.

Symptoms of E. coli can present as diarrhea, severe stomach cramps and vomiting. It can take up to 3 to 4 days for symptoms to appear, meaning more cases may be forthcoming.