Health officials warned people not to eat romaine lettuce from Salinas, Calif., because it is likely the source of an E. coli outbreak.

A USDA public health alert also advised people to avoid wraps, sandwiches, packaged salads or any other product with romaine harvested in the Salinas growing region. In a jump from health officials’ last update, 40 people became ill in 16 states.

E. coli O157:H7 was discovered in a salad bowl kit, leading to a recall of a variety of packaged salads by Missa Bay LLC.

The FDA says evidence from illness tracking, lab tests and traceback efforts indicates the bacteria like came from the Salinas area.

The FDA has asked industry to help ensure the contaminated lettuce is removed from the market efficiently by voluntarily withdrawing Salinas romaine for the remainder of the area’s growing season. The Salinas region includes: Santa Cruz, Santa Clara, San Benito and Monterey counties in California.

“Currently, the FDA does not have enough traceback information to identify the specific source of the contamination that would allow us to request a targeted recall from specific growers,” the agency’s announcement says.

Most romaine lettuce products are labeled with a harvest location. The FDA says you should not eat romaine if:

• Salinas is listed alone or with other locations on the package or a sticker.
• It doesn’t carry any information about the growing region.
• The label doesn’t say that the lettuce was grown indoors. There’s no warning against eating hydroponic and greenhouse-grown lettuce.

People with lettuce that fits one of those descriptions should throw it out or return it to the store. If you buy a salad at a restaurant or elsewhere, ask the staff if the romaine came from Salinas.

The USDA’s Food Safety and Inspection Service says establishments it regulates should not serve, ship or sell all types of romaine from the region, including whole heads, hearts, precut lettuce packages or salad mixes.

Romaine harvested outside of the Salinas area has not implicated in the outbreak, so people do not need to avoid it, according to the FDA announcement.

This outbreak is caused by the same strain of E. coli O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018, health officials say.

Since the initial investigation notice, authorities received reports of 23 more ill people. Of the 40 people infected, 28 had to go to the hospital. States with cases:  AZ (2), CA (4), CO (1), ID (3), IL (1), MD (3), MI (1), MN (1), MT (1), NJ (1), NM (2), OH (5), PA (3), VA (1), WA (1), WI (10).

People infected with the bacteria reported that their illnesses started on dates from Sept. 24 to Nov. 10.