With the victim count at more than two dozen and expected to increase, lab reports show little doubt that I.M. Healthy brand soy nut butter products are implicated in an ongoing E. coli outbreak, but corporate and government officials are still not saying what other products might also be contaminated.

Three states — Oregon, Washington and California — have confirmed the outbreak strain of E. coli O157:H7 in open containers of the peanut butter substitute collected from sick people’s homes. California has also confirmed the outbreak strain in unopened containers collected from retailers, according to updates Tuesday from the Centers for Disease Control and Prevention and the Food and Drug Administration.

However, neither FDA nor the SoyNut Butter Co. that markets the I.M. Healthy products will name the company that actually manufactured the soy paste. The Glenview, IL, SoyNut Butter Co. has not responded to requests for comment. It’s most recent post on its website, from March 9, states “samples from our contract manufacturer are still being tested, and we will updat as soon as we can.”

It is not known if the manufacturer, Dixie Dew Products Inc., sold soy paste to other companies or if it produced any products under other brands using it. Such information is considered “confidential corporate information,” which FDA does not publish. Kentucky-based Dixie Dew was named as the manufacturer Monday in a civil action filed by the parents of a Seattle child sickened by the soy nut butter.

Outbreak hits children hard
Of the 23 confirmed outbreak victims across nine states, 20 reported eating I.M. Healthy brand products from the SoyNut Butter Co. in the days before becoming ill. Children are particularly hard hit by the outbreak, with 20 of the 23 victims younger than 18. The victims range from 1 to 48 years old, with a median age of 8 years old.

Ten of the victims have had symptoms so severe that they required hospitalization. Seven of them developed hemolytic uremic syndrome (HUS), a type of kidney failure that is life-threatening.

In addition to the 23 confirmed victims, two other people either developed HUS or had a diagnostic test showing they were infected with STEC bacteria.

“In interviews, both of these ill people reported eating I.M. Healthy brand SoyNut Butter in the week before becoming ill. However, CDC is not including these people in the outbreak case count because no bacterial isolates, or samples, were available for DNA fingerprinting. Public health investigators use DNA fingerprinting to identify illnesses that are part of outbreaks,” according to the Tuesday updat from CDC.

The outbreak has more than doubled in size since the CDC announced on March 3 that a dozen people in five states were sick with the same strain of E. coli O157:H7. Illnesses started on Jan. 4, with the most recent onset date being March 5.

However, illnesses that occurred after Feb. 24 might not yet be reported because of the time it takes between when a person becomes ill and when the illness is reported. This takes an average of two to three weeks, according to the CDC.

Advice to consumers
Anyone who has eaten I.M. Healthy brand or Dixie’s Diner’s Club brand soy nut butter products or anything containing the products and developed symptoms of E. coli infection should immediately seek medical attention and tell their doctors about the possible exposure to the bacteria.

“The symptoms of STEC infections vary but often include severe stomach cramps, diarrhea — often bloody — and vomiting,” according to the CDC.

“Most people get better within 5 to 7 days, but some infections are severe or even life-threatening. Very young children and the elderly are more likely to develop severe illness and HUS than others, but even healthy older children and young adults can become seriously ill.”

The CDC advises people to watch for diarrhea that lasts for more than three days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.