U.S. health officials are warning people not to eat romaine lettuce grown in Salinas, California, after an E. coli-linked food poisoning outbreak reached 67 cases across 19 states. 

The Centers for Disease Control and Prevention on Tuesday said 39 people had been hospitalized after contracting E. coli O157:H7, which can cause diarrhea, vomiting and fever. No deaths have been reported. 

The CDC urged people not to eat romaine lettuce if it’s labeled with “grown in Salinas” or if doesn’t say where it was grown. The warning applies to all types of romaine from the Salinas region, including whole heads, hearts of romaine and pre-cut salad mixes that have romaine. 

People should also wash and sanitize parts of their refrigerator where the lettuce was stored, the CDC says. 

The reported cases occurred in: Arizona, California, Colorado, Idaho, Illinois, Maryland, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, Ohio, Oregon, Pennsylvania, Texas, Virginia, Washington and Wisconsin.

Investigators are continuing to trace the source of the outbreak. Click here for more information on the outbreak from the CDC.