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There are delays in reporting and confirming cases linked to this specific strain of E. coli, and the CDC noted that cases involving people who became sick on or after April 11 may not be reported.

MI is included in the multi-state recall with two known infections, the CDC reports that the death was reported in California in its latest update.

Since an update last week, 23 more people have fallen ill and three more states have been affected: Kentucky, Massachusetts and Utah. OH has three. New York, Massachusetts, Connecticut and Colorado each have two.

The source of the whole head romaine was traced back from the prison to Harrison Farms Inc.in Yuma, AZ.

The CDC reports its investigation points to chopped romaine lettuce from the Yuma, Arizona region as the potential culprit.

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Last week, the CDC said the strain identified in this outbreak is particularly virulent and known to be associated with higher hospitalization and complication rates. Numerous people sickened across the country consumed chopped lettuce that had been sold in bagged form to restaurants. Of the 121 infections, information for 102 cases are available, and among those 102 cases there are 14 individuals who developed a type of kidney failure called hemolytic uremic syndrome.

Federal health officials are still investigating exactly where and how the romaine was contaminated with the bacteria, as the reach expands in an outbreak that has hospitalized half of the people it has sickened.

Additional outbreak illnesses are expected to be reported in the coming weeks, according to the CDC.

The Food and Drug Administration said most people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. CDC's warning applies to whole heads and hearts of romaine, chopped romaine, baby romaine, organic romaine, and salads and salad mixes containing romaine lettuce. Restaurants and retailers are also being advised to ask their suppliers about where their lettuce comes from.


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