An E. coli O157:H7 outbreak traced to fresh spinach from Josie’s Organics continues to grow with new patients and hospitalizations reported. Two more states are now involved.

Federal officials are reporting that four new patients bring the confirmed case count to 14 people, with two new states involved, bringing that total to nine. Of 12 patients with the information available, four have been so sick they had to be admitted to hospitals, according to the Centers for Disease Control and Prevention. 

Three of the hospital patients have developed a potentially fatal type of kidney failure called hemolytic uremic syndrome (HUS). Generally only about 5 percent of E. coli patients develop HUS, so this is considered a particularly virulent strain of the pathogen.

In addition to the CDC, the Food and Drug Administration is investigating the outbreak.

“FDA traced the supply chain for this positive product sample (from a patient’s home) back to a small number of farms in two different geographic regions and deployed investigators along the supply chains of interest. FDA continues tracing back reported spinach exposures to identify if spinach from additional farms could have been implicated,” agency officials reported in an outbreak update.

Minnesota public health officials tested the sample of Josie’s Organics from the patient’s home and found the outbreak strain of the E. Coli in it. The package had an expiration date of Oct. 23, so the company did not initiate a recall because the test was conducted after that date and it was believed none of the implicated baby spinach was still available to the public. The spinach was sold at grocery stores nationwide.

Of 12 people interviewed, 10 reported eating fresh spinach in the week before they got sick. Six of the 12 specified that the spinach was Josie’s Organics brand.

So far, illnesses started on dates ranging from Oct. 13 to Oct. 27. Sick people range in age from 2 to 76 years old, with a median age of 26. 

“The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak,” according to the CDC outbreak update.