There are now almost two dozen children with reported adverse effects linked to applesauce pouches that have high levels of lead.

The 22 children impacted live across 14 states, with the state of residence for one of them being unknown. 

There are recalls for four products related to the illnesses:

• Recalled WanaBana apple cinnamon fruit puree pouches
• Recalled Schnucks-brand cinnamon-flavored applesauce pouches and variety pack
• Recalled Weis-brand cinnamon applesauce pouches

The WanaBana product has been distributed nationwide. The Schnucks and Weis brand products were distributed within those regional grocery store chains. The recall also includes markets outside of the United States. Customer information provided by the company shows that the product was also distributed to Cuba and the United Arab Emirates.

The Food and Drug Administration reported the situation on Oct. 28. The WanaBana company announced the recalls on Oct. 31.

“As part of this investigation, FDA and state partners are collecting and analyzing additional product samples of fruit puree and applesauce pouches. At this time, sample analyses have not shown elevated levels of lead in any non-recalled products,” according to the FDA’s updated alert on Nov. 13.

Federal investigators began working on the outbreak of “adverse reactions” after the North Carolina Department of Health and Human Services and the North Carolina Department of Agriculture & Consumer Services reported four children with elevated blood lead levels, indicating potential acute lead toxicity. 

The North Carolina investigators identified WanaBana Apple Cinnamon Fruit Puree pouches as a potential shared source of exposure. As part of their work, North Carolina investigators analyzed multiple lots of WanaBana Apple Cinnamon Fruit Puree, detecting high lead concentrations. The FDA has reviewed and supported those analytical findings and determined that levels of lead found in the analyzed pouches could result in acute lead toxicity.

Consumers are warned not to feed the recalled products to their children or eat them themselves. Lead is toxic to humans and can affect people of any age or health status, but children are particularly susceptible to lead toxicity. Lead poisoning can result in several long-term problems, including developmental disorders and brain damage.

“These products have a long shelf life. Consumers should check their homes and discard these products. Most children have no obvious immediate symptoms of lead exposure,” according to the FDA’s expanded alert. “If there’s suspicion that a child may have been exposed to lead, parents should talk to their child’s healthcare provider about getting a blood test.”

Short-term exposure to lead can result in the following symptoms: headache, abdominal pain/colic, vomiting, and anemia. Longer-term exposure could result in additional symptoms: irritability, lethargy, fatigue, muscle aches or muscle prickling/burning, constipation, difficulty concentrating/muscular weakness, tremors, and weight loss.

As of the Nov. 13 outbreak update, the FDA reported children with symptoms in Alabama, Arkansas, Louisiana, Maryland, Missouri, North Carolina, New Mexico, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Washington.