SALINAS (CBS SF) – Federal health officials continued to warn consumers to avoid romaine lettuce grown in the Salinas area, as the number of infections associated with an E. coli outbreak linked to the region increase.

The agency reported Tuesday that 67 people in 19 states, including California, have become infected with E. coli O157:H7, up from 40 cases reported late last week. Thirty-nine people have been hospitalized, and six people developed hemolytic uremic syndrome, a type of kidney failure.

At total of four people in California have been infected. No deaths have been reported.

Investigators said the evidence indicates Salinas-grown romaine lettuce may be contaminated with the E. coli strain and is making people sick. No grower, supplier, distributor or brand has been specifically linked with the outbreak. The investigation is ongoing.

The CDC said all types of romaine lettuce grown in the Salinas area, including whole heads of romaine, organic romaine, hearts of romaine, along with packages of precut lettuce and salad mixes containing romaine should be avoided.

Meanwhile, hydroponically grown and greenhouse grown romaine lettuce, which is labeled as “indoor grown” appear not to be linked to the outbreak, officials said.

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Most romaine lettuce products are labeled with the growing location and any product that is labeled “grown in Salinas,” whether alone or with the name of another location, or has no location should be thrown away. Refrigerator shelves where tainted romaine lettuce was stored should be washed and sanitized, officials said.

Officials said the outbreak is caused by the same strain of E. coli O157:H7 that caused outbreaks linked to romaine lettuce last year.

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