Most of the rest are clustered in the Midwest (11 among Illinois, Michigan, Ohio and Wisconsin) and Northeast (11 in New York, New Jersey, Connecticut, Maryland, Massachusetts and New Hampshire).
In this photo illustration, Romaine lettuce is displayed on May 2, 2018, in San Anselmo, California. No common grower, supplier, distributor, or brand of romaine lettuce has yet been identified.
The alerts, issued as millions of Americans plan their Thanksgiving Day menus, covered all forms of romaine, including whole heads, hearts, bags, mixes and Caesar salad.
The CDC says stores and restaurants should also not serve or sell any until more about the outbreak is known.
The strain identified is different than the one linked to romaine earlier this year but appears similar to last year's outbreak linked to leafy greens.
Sheila Lowrie, a spokeswoman for the Kansas grocer says "romaine lettuce and products containing romaine are being removed from sale as soon as possible until further notice".
But he acknowledged that it is "frustrating and unfortunate" that the alert has to be so broad, covering all romaine lettuce. An outbreak lasting several weeks in the spring killed five people and sickened 210 people in 36 states.More news: Disturbing details emerge in Jarryd Hayne sexual assault case
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"Symptoms of Shiga toxin-producing E. coli (STEC) infection vary for each person, but often include severe stomach cramps, diarrhea (often bloody), and vomiting".
The Canadian Food Inspection Agency says it's working with USA authorities to determine the source of the romaine lettuce those who got ill were exposed to. Those most at risk for developing serious complications are pregnant women, people with weakened immune systems, young children and seniors. "We're not sure what", said Luke LaBorde, Ph.D., from Penn State's College of Agricultural Sciences.
The Canadian individuals caught the illness between October and November.
Assist public health investigators by answering questions about your illness.
Go here for more information from the CDC.
In all 50 states, the CDC has the capacity to do genomic testing on samples from infected patients (such as blood samples). Fifteen cases of the illnesses were in Quebec and three were in Ontario.
Food safety is a matter that Kroger takes very seriously.