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New York -- Health officials in the U.S. and Canada told people on Tuesday to stop eating romaine lettuce because of a new E. coli outbreak.

The U.S. Food and Drug Administration said it is working with officials in Canada on the outbreak, which has sickened 32 people in 11 states, including seven in Michigan, and 18 people in the Canadian provinces of Ontario and Quebec.

In the United States, California has 10 illnesses. The rest are clustered in the Midwest (11 among Illinois, Michigan, Ohio and Wisconsin and Northeast (10 in New York, New Jersey, Connecticut, Massachusetts and New Hampshire).

The strain identified is different than the one linked to romaine earlier this year but appears similar to last year’s outbreak linked to leafy greens.

FDA Commissioner Scott Gottlieb said the agency doesn’t have enough information to ask suppliers for a recall, but he suggested that supermarkets and restaurants should withdraw romaine until the source of the contamination can be identified.

The contaminated lettuce is likely still on the market, Gottlieb told The Associated Press in a phone interview.

He said FDA wanted to issue a warning before people gathered for Thanksgiving meals, where the potential for exposure could increase.

“We did feel some pressure to draw conclusions as quickly as we could,” he said.

Most romaine sold this time of year is grown in California, Gottlieb said. The romaine lettuce linked to the E. coli outbreak earlier this year was from Yuma, Arizona. Tainted irrigation water appeared to be the source of that outbreak, which sickened about 200 people and killed five.

The FDA’s blanket warning in the current outbreak is broader and more direct than the ones issued in the earlier outbreak, said Robert Whitaker, chief science officer for the Produce Marketing Association. In the earlier outbreak, the warnings about romaine from Yuma might have been confusing, he said.

Whitaker said the industry group told members they should cooperate with the FDA and stop supplying romaine lettuce, especially since people have been told to stop buying it.

No deaths have been reported in the current outbreak, but 13 people in the U.S. and six in Canada have been hospitalized. The last reported U.S. illness was on Oct. 31.

Tracing the source of contaminated lettuce can be difficult because it’s often repackaged by middlemen, said Sarah Sorscher, deputy director of regulatory affairs at the Center for Science in the Public Interest.

Infections from E. coli can cause symptoms including severe stomach cramps, diarrhea and vomiting. Most people recover within a week, but some illnesses can last longer and be more severe.

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