Montana and county health officers are investigating reports of E. coli 0157 illnesses – including confirmed and suspected cases in Missoula, Flathead, Lincoln and Ravalli counties.

On Monday, they advised consumers to throw away and not eat any romaine lettuce, even if they’ve already eaten lettuce from the same container without becoming ill.

Three Montanans have been hospitalized because of the illness, which is most likely linked to chopped romaine lettuce grown in Yuma, Arizona.

So far, laboratory tests on three of the individuals link Montana’s cases to a multi-state outbreak of E. coli 0157. Tests are pending on four other Montanans.

The Centers for Disease Control and Prevention is reporting that an additional 35 cases, including 22 hospitalizations, in 11 states have been identified.

Symptoms of E. coli 0157 infection vary for each person, but often include severe stomach cramps, diarrhea (often bloody), and vomiting, according to the Montana Department of Health and Human Services.

Some people may have a low fever, (less than 101 degrees F). Most people improve within five to seven days. Some infections are very mild, but others are severe or even life-threatening.

Most people with a E. coli O157 infection start feeling sick three to four days after eating or drinking something that contains the bacteria. However, illnesses can start anywhere from one to 10 days after exposure.

On Monday, the Centers for Disease Control and Montana DPHHS issued these bullet points of advice to the state’s residents:

  • Consumers anywhere in the United States who have store-bought chopped romaine lettuce at home, including salads and salad mixes containing chopped romaine lettuce, should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick. If you do not know if the chopped lettuce is romaine, do not eat it and throw it away.
  • Before purchasing romaine lettuce at a grocery store or eating it at a restaurant, consumers should confirm with the store or restaurant that it is not chopped romaine lettuce from the Yuma, Arizona, growing region. If you cannot confirm the source of the chopped romaine lettuce, do not buy it or eat it.

Here is the advice for restaurants and retailers:

  • Restaurants and retailers should not serve or sell any chopped romaine lettuce, including salads and salad mixes containing chopped romaine lettuce, from the Yuma, Arizona, growing region.
  • Restaurants and retailers should ask their suppliers about the source of their chopped romaine lettuce.

In addition to working with providers to investigate possible illness, public health authorities are asking restaurants and retailers to determine the source of any romaine lettuce and not serve or sell it.