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Health officials are investing a multistate outbreak of E. coli infections that’s sickened at least 23 people. The Centers for Disease Control and Prevention (CDC) is not advising that people avoid any particular food at this time because they have not discovered the item that is making people sick.

The illnesses have been reported in California, Washington state, Utah, North Dakota, Kansas, Missouri, Illinois, Wisconsin, Michigan, Tennessee, Ohio and Pennsylvania. Kansas and North Dakota have reported the most cases, with at least four individuals becoming ill in each state.

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The CDC said authorities have interviewed 13 people thus far, and they all reported eating various types of leafy greens such as iceberg lettuce, romaine lettuce, mixed bag lettuce and spinach.

The illnesses date back as far as Aug. 17 and have been reported through Oct. 8. The impacted consumers range in age from 5 to 81 years, with 67% of those infected being female. At least 10 illnesses have resulted in hospitalization, including two people who developed hemolytic uremic syndrome, which is a type of kidney failure. No deaths have been reported thus far.

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E. coli typically causes illness within two to eight days of eating a contaminated product and is usually diagnosed through stool sample. Symptoms may include stomach cramps, diarrhea and vomiting. Others may develop a fever. While infections can be very mild, others may develop into severe illness or life-threatening situations.

The CDC advises contacting a health care provider if you have diarrhea that lasts more than three days or blood in the stool, or excessive vomiting.

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Ways to prevent E. coli infection including frequent handwashing after using the restroom or changing diapers, and before and after preparing or eating food and after contact with animals. Cooking meats thoroughly can also kill off the infection and avoiding any cross-contamination while preparing food. Also wash fruits and vegetables and avoid raw milk or other unpasteurized dairy products and unpasteurized juices.