NEW YORK (AP) — Health officials in the U.S. and Canada on Tuesday told people to avoid eating romaine lettuce because of a new E. coli outbreak.

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

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

FDA Commissioner Scott Gottlieb says the agency didn't have enough information to request suppliers issue a recall, but he said supermarkets and restaurants should withdraw romaine products until the contamination can be identified.

No deaths have been reported, but 13 of the people who became sick in the U.S. were hospitalized. The last reported 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. That can mean the entire industry becomes implicated in outbreaks, even if not all products are contaminated.

Washing lettuce won't ensure that contaminated lettuce is safe, Sorscher said.

Most E. coli bacteria are benign but some can cause illness, with symptoms including severe stomach cramps, diarrhea and vomiting. Most people recover within a week, but some illnesses can last longer and be more severe.

The following information is from the CDC website

CDC is advising that U.S. consumers not eat any romaine lettuce, and retailers and restaurants not serve or sell any, until we learn more about the outbreak. This investigation is ongoing and the advice will be updated as more information is available.

  • Consumers who have any type of romaine lettuce in their home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick.
    • This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.
    • If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away.
    • Wash and sanitize drawers or shelves in refrigerators where romaine was stored. Follow these five steps to clean your refrigerator.
  • Restaurants and retailers should not serve or sell any romaine lettuce, including salads and salad mixes containing romaine.
  • Take action if you have symptoms of an E. coli infection:
    • Talk to your healthcare provider.
    • Write down what you ate in the week before you started to get sick.
    • Report your illness to the health department.
    • Assist public health investigators by answering questions about your illness.