Health officials late last week expanded a health advisory related to a multi-state E. coli outbreak, now stating that consumers should throw out all types of romaine lettuce sourced from Yuma, Arizona.

Previously, Montana Department of Public Health and Human Services recommended disposing of store-bought chopped romaine lettuce, whether in a salad mix or on its own, that was grown in that region — even if some of it had been eaten and had not sickened anyone

Now, the Centers for Disease Control and Prevention is advising consumers to dispose of whole heads and hearts of romaine lettuce as well, according to an April 20 news release.

Health officials also updated case statistics. As of April 20, Montana had seven confirmed cases across four counties — one in Lincoln County, two in Missoula, one in Ravalli and three in Flathead. In addition, they identified “additional suspect cases from Missoula County.”

Lincoln County Public Health Nurse Riley Black said Monday via email that she did not expect a new update to be released that day.

Altogether, the Centers for Disease Control and Prevention reported more than 53 cases from 16 states.

Officials have asked consumers to confirm the source of romaine lettuce, and not to purchase or eat any if the source cannot be confirmed.

Symptoms of E. coli infection vary, but include severe stomach cramps, diarrhea and vomiting, a previous news release states.

“Some people may have a low fever,” it continues. “Most people get better within five to seven days. Some infections are very mild, but others are severe or even life-threatening. Most people start feeling sick three to four days after eating or drinking something that contains the bacteria. However, illnesses can start anywhere (within) 10 days after exposure.”

For more information, visit dphhs.mt.gov.