Romaine lettuce E. coli outbreak prompts warning for areas of Canada, entire U.S.

Canada Health

The Public Health Agency of Canada is warning that there is another E. coli outbreak in some provinces related to romaine lettuce.

The government agency issued an alert Tuesday afternoon explaining that as of Nov. 20, there were 18 confirmed cases of the illness — three in Ontario and 15 in Quebec.

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READ MORE: Should Canadians keep eating romaine lettuce?

It said that residents of the two provinces should avoid eating romaine lettuce and salad mixes containing the produce until further notice. In an email to Global News, Health Canada said there is “no evidence” those living in the rest of the country are affected by the outbreak.

The U.S. Centers for Disease Control and Prevention issued a similar alert, advising all Americans to avoid eating romaine lettuce.

The Canadian individuals caught the illness between mid-October and November. Six had to be hospitalized. One of those cases involved hemolytic-uremic syndrome, which is a severe case of E. coli.

WATCH: Outbreak of E. coli contaminated lettuce now traced back to Arizona

“Most of the individuals who became sick in Ontario and Quebec reported eating romaine lettuce before their illnesses occurred,” the release read.

The individuals reported eating lettuce at home, prepared salads from grocery stores and at restaurants.

Related to previous outbreak

Several similar romaine lettuce E. coli cases have been reported across Canadian provinces in the past few months.

The public health agency explained the cause of the contamination in the current outbreak has not been determined, but health officials suspect it is “genetically related” to a December 2017 outbreak.

READ MORE: 5 deaths linked to romaine lettuce E.coli outbreak in U.S., nearly 200 illnesses

The release explained that it is the “same strain of E. coli” that caused illnesses last year, which means it could be the same or similar source of contamination.

“Investigators are using evidence collected in both outbreaks to help identify the possible cause of the contamination in these events,” it read.

Details on U.S. warning

The CDC’s release explained that U.S. consumers should not eat any romaine lettuce amid the ongoing investigation.

In the U.S., 32 people have been sick with the outbreak strain and 13 have been hospitalized. In one severe case, an individual developed kidney failure.

Individuals lived across the country in the following states: California, Connecticut, Illinois, Massachusetts, Maryland, Michigan, New Hampshire, New Jersey, New York, Ohio and Wisconsin.

WATCH: Should you be throwing out your Romaine lettuce?

E. coli symptoms

Symptoms of E. coli infection include nausea, vomiting, headache, fever, severe stomach cramps and watery or bloody stool.

Most people recover in a few days but some can develop life-threatening illnesses that can cause death.

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