Update: As of December 4, the CDC reports that the outbreak now spans across 23 states and the total number of people infected with E. coli is 102. Fifty-eight people have also been hospitalized. 

A recent E. coli outbreak across 19 states is linked to romaine lettuce grown in Salinas, California, according to the Centers for Disease and Prevention (CDC). So far, 67 cases of infection from E. coli—a group of bacteria with particularly nasty strains that can cause severe stomach cramps, diarrhea and vomiting—have been reported.

In 2017, this same species of E. coli caused outbreaks linked to leafy greens and to romaine lettuce the following year, the CDC says. A total of 39 people were hospitalized, six of whom developed a type of kidney failure known as hemolytic uremic syndrome. (As yet no deaths have been reported.)

“CDC continues to advise that consumers not eat and retailers not sell any romaine lettuce grown in Salinas, California,” said the federal health agency. “The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.”

All types of romaine lettuce grown in this region should be avoided. This includes whole heads of romaine, organic romaine, hearts of romaine, romaine in salad wraps, packages of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix and Caesar salad. (Hydroponically and greenhouse-grown romaine, which are labeled as “indoor grown,” do not appear to be related to the current outbreak.)

According to the CDC, most romaine lettuce products are identified with a harvest location. Those with romaine lettuce or packaged foods containing romaine should look for a label showing where the romaine lettuce was grown, possibly printed on the package or on a sticker. If “grown in Salinas” appears anywhere on the label or no growing region is listed, toss the produce immediately.

In addition, dispose of any lettuce—alone or in a salad mix or wrap—if you are unsure whether the greens are romaine. Also wash and sanitize drawers or refrigerator shelves where the lettuce was stored.

Consult your doctor if you believe you have symptoms related to an E. coli infection and write down what you ate during the week before you started to get sick. You should also report your illness to the local health department and answer all questions about your condition.

Additionally, the CDC advises folks to thoroughly wash their hands after changing diapers, using the toilet and before and after preparing food to lower the risk of passing the infection on to others.

Click here to read how popular dog treats were linked to a salmonella outbreak in 13 states.