Health officials in North Carolina say the number of E. coli cases linked to the Cleveland County Fair has climbed to 46.

The state Department of Health and Human Services said Tuesday that 29 children and 17 adults have been affected by the outbreak. Ten people have been hospitalized, and officials said there are two cases from South Carolina.

A 2-year-old died of complications from the bacterial illness Friday night. He has been identified as Gage Lefevers, from Gaston County, and he attended the fair more than a week ago.

The nine-day fair ended Oct. 7. Health officials say symptoms of E. coli infection could come up to 10 days after exposure and can include diarrhea, abdominal cramps, nausea and vomiting.

Wednesday marks the 11th day since the fair ended, so the incubation period is likely over; however, E. coli can be transmitted by soiled hands that touched contaminated food or animals, according to State Health Director Laura Gerald.

The bacterium is found in the waste of animals such as cattle, sheep and goats.

Officials haven't yet determined the source of the outbreak.

The Associated Press contributed to this article.