By Jamie Ducharme
Updated: April 12, 2019 4:31 PM ET | Originally published: April 5, 2019

An E. coli outbreak that has sickened at least 109 people in six states — and that originally stumped Centers for Disease Control and Prevention (CDC) investigators — appears to be related to ground beef, the CDC announced Friday.

When the CDC first announced the outbreak on April 5, it was unable to point to a food item, grocery store or restaurant chain that may have caused the 72 initial illnesses in five states. A week later, with nearly 40 more people sick in six states, the agency announced that ground beef might be the culprit, though it still wasn’t sure of a common supplier, distributor or brand of meat. Traceback investigations remain ongoing, the CDC says.

The outbreak is now the third-largest multi-state E. coli outbreak in 20 years, the CDC says. Illnesses have been reported in Kentucky, Ohio, Virginia, Tennessee, Georgia and Indiana, and 17 people have been hospitalized. No deaths or major complications have been reported.

The CDC is not recommending that consumers avoid all ground beef, according to the latest statement, but the agency emphasized the importance of handling and cooking raw meat safely. Ground beef should be cooked to at least 160 degrees to reduce the risk of transmitting food-borne illness, and cooks should wash their hands and any surfaces and kitchen tools that come into contact with raw meat. Raw beef should also be refrigerated or frozen within two hours of purchase, the CDC says.

Ground beef is a common source of the bacteria that can cause E. coli infection, along with raw vegetables — like romaine lettuce — and unpasteurized dairy products, according to the Mayo Clinic.

Many types of E. coli bacteria do not cause serious illness. But exposure to some strains can result in symptoms such as diarrhea, nausea, abdominal cramping or vomiting, the Mayo Clinic says. The majority of infected people recover on their own within a week, but serious cases — especially those involving children and the elderly — can result in a life-threatening kidney disease.

Write to Jamie Ducharme at jamie.ducharme@time.com.

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