The latest E. coli outbreak linked to romaine lettuce from the Salinas region of California has sickened 102 people in 23 states, the Centers for Disease Control and Prevention said Wednesday.

E. COLI OUTBREAK UPDATE: 102 ill people now reported from 23 states. CDC’s advice remains the same: Do not eat, sell, or serve romaine lettuce from the Salinas growing region. If you don’t know or can’t tell where the lettuce is from, don’t eat it. https://t.co/sZvP3yMmqV pic.twitter.com/r74BwWSkbh — CDC (@CDCgov) December 4, 2019

There have been 58 people hospitalized and 10 have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

The illnesses began on Sept. 24 and were last reported on Nov. 18, according to the CDC.

There may be other cases not yet reported because it can take several weeks between the time a person becomes ill and the infection is identified.

People usually get sick from E. coli infection about three to four days after eating or drinking something contaminated with the bacteria.

Symptoms include stomach cramps, diarrhea and vomiting.

People are urged not to eat the leafy green if the label doesn’t say where it was grown. Supermarkets and restaurants were also urged not to serve or sell the lettuce, unless they’re sure it was grown elsewhere.

The warning applies to all types of romaine from the Salinas region, include whole heads, hearts and pre-cut salad mixes.

“We’re concerned this romaine could be in other products,” said Laura Gieraltowski, lead investigator of the outbreak at the U.S. Centers for Disease Control and Prevention.

The preliminary investigation indicates that some of the ill people ate lettuce grown in Salinas, California, although no common grower, supplier, distributor or brand of romaine has been identified.

The current outbreak is caused by the same strain of E. coliO157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.

After last year’s pre-Thanksgiving outbreak tied to romaine, the produce industry agreed to voluntarily label the lettuce with harvest regions. Health officials said that would make it easier to trace romaine and issue more specific public health warnings when outbreaks happen.

Officials never identified exactly how romaine might have become contaminated in past outbreaks. But another outbreak in spring 2018 that sickened more than 200 people and killed five was traced to tainted irrigation water near a cattle lot. E. coli is found in the feces of animals such as cows.