All romaine lettuce consumption should be avoided while a multi-state E. coli outbreak is investigated, the Centers for Disease Control and Prevention advised Tuesday, Nov. 20, 2018.

There have been 32 reported cases of Shiga toxin-producing E. coli in 11 states - including one case in Wisconsin, though none in Minnesota - as of Nov. 19, the CDC says. An additional 18 cases have been identified in Canada.  

All types of romaine lettuce should be thrown out, including whole heads of romaine, hearts of romaine, and bags and boxes of pre-cut lettuce and salad mixes that contain romaine, the alert advises. Retailers and restaurants also are advised to not serve or sell any romaine lettuce.

The CDC advises against any romaine lettuce consumption because no common grower, supplier, distributor or brand of lettuce has been identified. 

Illnesses in the outbreak began in early October. 

Symptoms of E. coli infection typically begin two to eight days after ingestion. Common symptoms are stomach cramps, diarrhea and vomiting.

Those with symptoms of E. coli are advised to contact a health care provider as well as document foods eaten the week before symptoms began to report the illness to the health department.