An outbreak of E. coli linked to romaine lettuce from fast food restaurant Wendy’s has spread to New York and Kentucky, parts of the six states where the disease was found.

According to the US Centers for Disease Control and Prevention, there have been at least 97 cases reported in Michigan, Ohio, Pennsylvania, Indiana, Kentucky and New York. More than half of the infections are in Michigan.

“The actual number of people sick in this outbreak is likely to be higher than the reported number, and the outbreak may not be limited to states with known disease,” the CDC warned in a statement.

Several cases had more severe outcomes, including 43 people who were hospitalized. Most of the disease occurred in Michigan, with only one each in New York and Kentucky.

Of the 97 reported cases, 43 were hospitalized and 10 developed hemolytic uremic syndrome (HUS), a severe complication that can lead to kidney failure. According to the CDC, no deaths have been reported yet.

wendy burger
This outbreak is linked to a chain restaurant’s romaine lettuce.
Corbis via Getty Images

E. Coli is a bacterium which live in the digestive tract of animals and humans while most varieties are harmless, some can cause severe disease. Symptoms include severe stomach cramps, diarrhea, and vomiting. Some people develop high fevers and many develop life-threatening conditions.

On August 21, Wendy’s removed lettuce from its restaurants in Michigan, Ohio, and Pennsylvania. The CDC notes that Wendy’s uses a different type of romaine lettuce for salads than in its sandwiches.

By Blanca

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