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The recent E. coli outbreak tied to romaine lettuce grown in Salinas has sickened at least 67 people, health officials said Tuesday.

That’s 27 more cases announced by the U.S. Centers for Disease Control just four days ago. Most of the people sickened live in Wisconsin, which reported 21 patients, and Ohio, which reported 12.

The number of cases in California stayed the same at four since the CDC’s previous update.

Federal officials had urged consumers across the U.S. not to eat romaine lettuce from Salinas, a major grower of the produce from April to about November. The warning applies to whole heads and hearts of romaine, organic romaine, salad mixes, packages of precut lettuce and wraps.

The CDC said most lettuce products should have a label indicating where they were harvested, but those that don’t should be thrown away. Washing or cooking them won’t prevent infections, according to the agency. More information is available on the CDC’s website.

A similar romaine lettuce outbreak made people ill around Thanksgiving in 2018. Experts say it’s unclear why such outbreaks happen often, though some note the popularity of lettuce and the difficulty of preventing contamination in raw produce and growing it in open fields.