At least 16 people have become sick, leading to one death, after the consumption of meat and cheese contaminated with listeria in several U.S. states, the Centers for Disease Control and Prevention (CDC) announced Wednesday.

The meat and cheese products were purchased in at least two separate NetCost Market grocery store locations. However, officials believed that there were other sites contaminated because some sick people did not shop at that retailer.

“A contaminated food likely introduced the outbreak strain of Listeria into delis in multiple states,” the agency stated on November 9.

People got sick in California, Illinois, Maryland, Massachusetts, New Jersey, and New York. The death was reported in Maryland.

Additionally, one woman’s illness resulted in the loss of a pregnancy, and most of the people who became ill were hospitalized. Investigators are also trying to figure out why 11 of those who became sick are of Eastern European descent or speak Russian, according to the CDC.

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Listeria is a stubborn germ that can be difficult to remove from surfaces and equipment. Listeria poisoning symptoms include fever, muscle aches, nausea, and diarrhea. It is especially hazardous to the elderly, pregnant women, and people with weakened immune systems.

Listeria bacteria spread from the gut to other body parts and can cause severe illness (invasive listeriosis). Symptoms of a severe sickness usually appear two weeks after eating Listeria-contaminated food, but they can appear as early as the same day or as late as 10 weeks later.

In addition to fever and muscle aches, people who are not pregnant may experience headaches, stiff neck, confusion, loss of balance, and convulsions.

Public health officials collected information on the affected people’s ages, ethnicities, and other demographics. They asked them about the foods they had eaten to help identify the outbreak’s source.

With a median age of 74 years, 62% of the sick people were male. Eleven of the 12 interviewees ate from deli counters. Five sick New Yorkers bought deli meat or cheese from NetCost Market.

The CDC explained, however, that “The true number of sick people in this outbreak is likely higher than the number reported, and the outbreak may not be limited to the states with known illnesses.”

The establishments with known listeria outbreaks were temporarily closed, cleaned vigorously, and then reopened after testing showed no remaining strains of listeria. Nevertheless, the CDC recommends “people at higher risk of severe Listeria illness to not eat meat or cheese from any deli counter, unless it is reheated to an internal temperature of 165°F or until steaming hot.”

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