The Centers for Disease Control and Prevention (CDC) is investigating the source of an E.coli outbreak that is spreading across the midwest.

As of August 17, 29 illnesses, 10 hospitalizations, and zero deaths have been reported, according to the latest investigation report.

Cases have now been reported in Michigan, Ohio, Pennsylvania and Indiana.

To avoid getting sick, health experts recommend washing all foods and countertops well and cooking meat thoroughly.

“This outbreak is associated with a particular subtype of E. coli that can cause abdominal pain, vomiting and bloody diarrhea. If someone believes they have contracted this infection, they should seek medical attention to have it confirmed and for supportive care.” Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security and an infectious disease expert, told Healthline.

In an update posted on August 19, CDC officials reported that 22 of the 26 people interviewed by health officials had recently eaten at Wendy’s the week before they became ill. Officials said most sick people reported eating a sandwich with romaine lettuce at the restaurant.

Wendy’s is taking precautionary measures and removing the romaine lettuce being used for sandwiches in that region, according to the CDC. Salads are not being affected because they use a different type of romaine lettuce.

CDC officials stressed that they are not advising people to stop eating at Wendy’s restaurants or to stop eating romaine lettuce.

Most strains of E. coli are harmless, however, certain strains can produce a toxin called Shinga toxin.

These strains — known as Shiga toxin-producing E.coli (STEC) — live in the intestines of many types of animals and can be transmitted to people when they consume foods that contain the bacteria.

Approximately 265,000 STEC infections occur in the United States each year. According to the CDC, STEC causes an estimated 3,600 hospitalization and 30 deaths annually.

It typically takes a few weeks for a case to be linked back to an outbreak. Many cases likely go unreported in an outbreak since many people with E.coli infections do not seek medical care.

The food source behind the current outbreak is unknown and it may take several weeks before the food source is identified, says Adalja.

Sometimes the source of an E.coli outbreak is never identified, says Dr. Nupur Garg, an emergency physician in North Haven, CT.

Contaminated produce and meat are the typical sources of E.coli outbreaks, Garg added.

“The ultimate source is usually fecal contamination of some food product. This could be some sort of vegetable, ground beef, or a fruit,” says Adalja.

The vast majority of people infected with E.coli recover within a week.

Common symptoms include diarrhea, which may be bloody, along with abdominal cramps and vomiting.

“Usually, symptoms start within two to five days of ingesting contaminated food source,” says Garg.

According to Garg, it’s important to stay hydrated. Some people may need to be admitted to the hospital for IV hydration and symptom control.

Immunocompromised individuals, older adults, pregnant people, and children younger than five years of age have a heightened risk of developing a food-borne illness.

Approximately 5 to 10 percent of people with a type of STEC infection called STEC 0157 infection develop kidney failure and may require dialysis.

Most people who develop this kidney complication will recover within a few weeks, however, a small percentage will suffer permanent kidney damage.

Proper hygiene, including good hand-washing, can help prevent the spread of E. coli.

According to the CDC, washing fruits and vegetables well and cooking meats thoroughly can kill harmful germs, too.

“E. coli dies at 160 Fahrenheit. Cook long enough to ensure the whole food item reached that temperature,” Garg said.

When preparing foods, avoid cross-contamination and wash all countertops and food preparation stations.

“To avoid this infection, people should eat fully cooked ground beef, wash vegetables and fruits, and engage in hand washing when preparing food,” Adalja said.

An E.coli outbreak that has caused 37 illnesses and 10 hospitalizations in four states is being investigated by the CDC. Officials are investitgating if romaine lettuce could be the cause of the outbreak.

Most people recover from an E. Coli infection within 7 days, however, some may require IV hydration and a small percentage may need to be hospitalized for kidney complications.

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