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Jennie-O Turkey Store Sales, Inc., is recalling approximately 164,210 pounds of raw ground turkey products due to the possibility of salmonella contamination, the United States Department of Agriculture’s Food Safety and Inspection Service said Friday.

The recall was announced as the US Centers for Disease Control and Prevention reported 52 new cases of illness associated with the outbreak. This brings the total number of illnesses to 216 people across 38 states since the outbreak began in November 2017. Eighty-four people have been hospitalized and one death has been reported.

In addition, the Public Health Agency of Canada said Friday there have been 22 cases of illness in four provinces. All of the illnesses there occurred between April 2017 and November 2018, but nearly half of the illnesses began in October and November of this year. Five patients have been hospitalized and one person died.

“Based on the investigation findings to date, exposure to raw turkey and raw chicken products has been identified as the likely source of the outbreak. Many of the individuals who became sick reported eating different types of turkey and chicken products before their illnesses occurred,” a public health notice from the agency said.

According to the CDC, the cases in Canada have the same strain of salmonella as the cases in the US outbreak.

Health investigators have identified the outbreak strain of salmonella in samples of raw turkey pet food, raw turkey products and live turkeys, according to the CDC.

The recalled raw ground turkey products were produced at the Jennie-O’s Faribault, Minnesota facility between October 22 and October 23 of this year. The recalled packages are marked on the side with establishment number P-579 and were sold in 1 pound, 2.5 pound and 3 pound packages.

On November 15, the company issued a recall of more than 91,000 pounds of raw ground turkey products from its Barron, Wisconsin facility.

Patients who were interviewed by outbreak investigators reported buying a variety of different brands of raw turkey products from many different stores. “A single, common supplier of raw turkey products or of live turkeys has not been identified that could account for the whole outbreak,” the CDC said.

The investigation is ongoing. “The outbreak strain of Salmonella Reading is present in live turkeys and in many types of raw turkey products, indicating it might be widespread in the turkey industry,” the CDC said, adding that “CDC and USDA-FSIS have shared this information with representatives from the turkey industry and asked about steps that they may be taking to reduce Salmonella contamination.”

In the meantime, consumers should not eat any recalled products and should take steps to prevent salmonella illness. That includes hand washing and thoroughly cooking turkey to an internal temperature of 165 degrees Fahrenheit, as measured by a food thermometer. Washing raw turkey is not recommended because it can spread germs. And pet owners should not feed raw food, including turkey, to pets — the investigation for this outbreak identified three infected patients who live in homes where pets were fed raw turkey pet food.

Salmonella is to blame for 1 million cases of foodborne illness in the United States every year, according to the CDC.

Symptoms usually begin 12 to 72 hours after consuming the bacteria and can last four to seven days. They include diarrhea, fever and stomach cramps, according to the CDC. Most people recover on their own. Patients who experience severe diarrhea may require hospitalization. If severely ill patients are not treated, the illness can be deadly.