The federal government says there are now as many as 40 cases of E. coli infections linked to contaminated romaine lettuce — and one of them has been fatal.

A total of 16 people, ranging in age from four to 85, had to be hospitalized.

The Public Health Agency of Canada announced last week that an outbreak of infections had caused people to be sick or even hospitalized.

Since then, 10 new cases have been reported. The affected provinces are:

Quebec (13 cases).

Newfoundland and Labrador (13 cases).

Ontario (eight cases).

New Brunswick (five cases).

Nova Scotia (one case).

Health officials at the agency are warning people in those provinces to "consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination," according to a statement issued late Thursday.

That includes not ordering romaine lettuce in fast food chains or restaurants as well.

E. coli are bacteria that live naturally in the intestines of cattle, poultry and other animals. Fruits and vegetables can become contaminated if they come into contact with the feces from infected animals.

Most E. coli strains are harmless to humans, but some varieties cause illness.

Most people with an E. coli infection will become ill for a few days and then recover fully.

The following is information from the Public Health Agency of Canada on how to protect against E. coli infection and how to identify symptoms.

What you should do to protect your health?

The following food safety tips for lettuce will help you reduce your risk of getting an E. coli infection.

Wash your hands thoroughly with warm water and soap for at least 20 seconds, before and after handling lettuce.

Discard outer leaves of fresh lettuce.

Wash your unpackaged lettuce under fresh, cool running water. There is no need to use anything other than water to wash lettuce. Washing it gently with water is as effective as using produce cleansers.

Keep rinsing your lettuce until all of the dirt has been washed away.

Don't soak lettuce in a sink full of water. It can become contaminated by bacteria in the sink.

Ready-to-eat lettuce products sold in sealed packages and labelled as washed, pre-washed or triple washed do not need to be washed again.

Use warm water and soap to thoroughly wash all utensils, countertops and cutting boards before and after handling lettuce to avoid cross-contamination.

Store lettuce in the refrigerator for up to seven days. Discard when leaves become wilted or brown.

Bagged, ready-to-eat, pre-washed lettuce products should also be refrigerated and used before the expiration date.

What are the symptoms?

People infected with E. coli can have a wide range of symptoms. Some do not get sick at all, though they can still spread the infection to others. Others may feel as though they have a bad case of upset stomach. In some cases, individuals become seriously ill and must be hospitalized.

The following symptoms can appear within one to 10 days after contact with the bacteria: