(Reuters) – Fourteen more people fell ill from an E. coli outbreak linked to romaine lettuce, U.S. health officials said on Friday, bringing the number of people affected to 98 across 22 U.S. states.

The reported strain of E. coli, which produces poisonous substances known as Shiga toxins, can cause severe abdominal cramps, bloody diarrhea and vomiting.

The outbreak that began last month is now the largest multi-state Shiga toxin-producing outbreak since 2006, the U.S. Centers for Disease Control and Prevention (CDC) said.

Forty-six people have been hospitalized, including 10 who had developed a type of kidney failure, the CDC said in its latest update on the outbreak. No deaths have been reported.

Three more states — Mississippi, Tennessee, and Wisconsin — reported people falling sick.

“We do expect more reports of illnesses since there is a two-to-three week delay between the time that a person is sick and between the time they can be confirmed as part of the outbreak,” Matthew Wise, deputy branch chief for Outbreak Response at the CDC, said at a media briefing.

Eight cases in Alaska were linked to a farm in Yuma, Arizona, the CDC said.

“Most of the illnesses linked to the Romaine outbreak are not linked to the Romaine lettuce from (the Yuma) farm. We are investigating dozens of other fields as potential sources of the chopped Romaine lettuce,” a U.S. Food and Drug Administration official said at the briefing.

The CDC repeated its advice that people not eat or buy romaine lettuce, which is commonly used in salads, unless they can confirm it is not from the Yuma growing region.

(Reporting by Manas Mishra in Bengaluru; Editing by Sai Sachin Ravikumar)