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 Nov. 20, 2018, 8:12 PM GMT By Maggie Fox 
 
 Federal health officials are warning about a fresh outbreak of E.coli linked to romaine lettuce Tuesday and cautioned people not to eat any romaine lettuce. 
 
 At least 32 people are sick, and 13 hospitalized in the outbreak, the Centers for Disease Control and Prevention said. No one has died. 
 
 “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,” the CDC said in a notice on its website. 
 
 “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,” the CDC added. 
 
 “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.” 
 
 It’s the second outbreak of E. coli in romaine lettuce this year. An outbreak lasting several weeks in the spring killed five people and sickened 210 people in 36 states. It was eventually traced to contaminated canal water in a farming area in Yuma, Arizona. 
 
 This outbreak does not appear to be linked to the Yuma outbreak, the Food and Drug Administration said. 
 
 "While the strain of E. coli 0157:H7 seen in this outbreak is different than the one identified in the large outbreak in spring 2018 linked to romaine from the Yuma growing region, it does appear to be similar to the strain that caused a smaller outbreak linked to leafy greens that occurred in the fall of 2017 in both the U.S. and Canada," the FDA said. 
 
 "Since these prior outbreaks were identified, the FDA has been working closely with the leafy greens industry and other state and federal partners to implement safety practices that can help further reduce the risk of these types of outbreaks. As a direct response to the outbreaks we have seen, the agency will also begin a special effort to sample and test romaine lettuce for contamination throughout the market." 
 
 There's not enough information to identify a specific supplier yet, the FDA said, so it's safest to just thrown out all romaine lettuce for now. 
 
 E. coli is a common bacteria but there is a strain called 0157:H7 that can make people sick. Most patients suffer stomach cramps but the 0157 strain produces a toxin that can damage the kidneys and cause a potentially deadly condition called hemolytic uremic syndrome. ||||| CLOSE An E. coli outbreak has led to the CDC to warn Americans to avoid romaine lettuce and JBS USA to recall close to 100,000 pounds of ground beef. USA TODAY 
 
 Lisa Dennis of Regent Square selects a head of green lettuce from the vegetable shelves at the East End Food Co-op Federal Credit Union on Tuesday in Pittsburgh. Due to a recent consumer alert regarding a multi state E.Coli outbreak the Co-op has replaced their fresh and bagged romaine lettuce with blue signs reading, "The CDC has issued a Consumer Alert for romaine lettuce due to a multi state E.Coli outbreak." The most-recent outbreak affects mostly women and girls, according to the CDC. (Photo: Jessie Wardarski, AP) 
 
 Only romaine lettuce from certain parts of California is unsafe to eat, federal health officials announced Monday. 
 
 The multi-state outbreak of E. coli infections has been traced to the Central Coast regions of California, according to a statement from Food and Drug Administration Commissioner Scott Gottlieb. 
 
 “Romaine lettuce that was harvested outside of the Central Coast growing regions of northern and central California does not appear to be related to the current outbreak,” Gottlieb said. “There is no recommendation for consumers or retailers to avoid using romaine harvested from these sources.” 
 
 Romaine lettuce entering the market will now be labeled with information about when and where it was harvested, according to Gottlieb's statement. If a product does not have this information, consumers are advised not to eat or use it. 
 
 More: Romaine lettuce linked to E. coli scare likely came from California: FDA commissioner 
 
 More: Is it safe to eat romaine lettuce yet? Here are latest details about E. coli outbreak 
 
 The FDA also said the market appears to have been successfully purged of potentially contaminated romaine lettuce related to the outbreak thanks to the market withdrawal request of Nov. 20. 
 
 The vast majority of the romaine on the market was being grown in the Central Coast region of California at the time of the outbreak, according to the statement. Romaine harvesting has ended there for the year and has since shifted to winter growing regions including Florida, Mexico and desert regions in California and Arizona. 
 
 The FDA said it has no information to suggest that these growing areas are tied to the current E. coli outbreak. Hydroponic lettuce and lettuce grown in greenhouses also do not appear to be affected by the outbreak. 
 
 The outbreak has sickened 43 people in 12 states, plus 22 people in Canada, according to the FDA. 
 
 That's up from 32 people sickened, including 13 hospitalized, in 11 states last week, and there could be more cases coming. Twenty days is the average amount of time that passes between when a person falls ill and when the Centers for Disease Control and Prevention is alerted, according to the FDA. 
 
 More: Why women and girls bear the brunt of the romaine lettuce E. coli outbreak 
 
 More: Romaine lettuce: Why it's hard to keep it safe from E. coli and other bacteria 
 
 The most significant symptoms are severe stomach cramps and bloody diarrhea and while the majority of diners sickened get well in five to seven days, five to 10 percent develop a potentially life-threatening type of kidney failure called hemolytic uremic syndrome. Most at risk for Shiga toxin-producing E. coli infections are those younger than 5, older than 65 and with weakened immune systems. 
 
 The CDC has advised consumers to throw away any romaine lettuce they have in any form, such as whole heads, hearts or salad mixes containing it. If you don't know if your lettuce is romaine, play it safe and toss it, too. Also, sanitize drawers or shelves in refrigerators where romaine was stored using soapy water and, if desired, bleach. 
 
 Last week, the FDA said the strain of E. coli O157:H7 causing the current outbreak is genetically link to the strain the caused an outbreak last fall in the U.S. and Canada Twenty-five people got sick — including one death and two incidents of hemolytic uremic syndrome — in 15 states. 
 
 Federal investigators have found no connection between the current outbreak and the one that started this past spring. There were 210 cases, including five people who died and 96 who were hospitalized. 
 
 More: President Trump's Thanksgiving meal included Caesar salad amid romaine E. coli outbreak 
 
 More: Why washing romaine lettuce won't kill E. coli 
 
 CLOSE You've heard the warnings, but here's why this strain of E. coli is particularly hard to avoid. USA TODAY 
 
 Follow Zlati Meyer and N'dea Yancey-Bragg on Twitter: @ZlatiMeyer and @NdeaYanceyBragg 
 
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 By Maggie Fox 
 
 Romaine lettuce is safe to eat as long as it's not from California’s Central Coast growing region, federal health officials said late Monday. 
 
 So far, an outbreak of E. coli linked to romaine lettuce has made 43 people sick in 12 states, plus another 22 in Canada, the Food and Drug Administration said. 
 
 The FDA and Centers for Disease Control and Prevention said they had narrowed down the suspect lettuce to lettuce harvested in northern and central California. They still don’t have enough information to name a specific grower or distributor, but said consumers can begin to look for the popular lettuce again. 
 
 Last week, the CDC and FDA told people not to eat any romaine lettuce at all and said stores should take it off the shelves. 
 
 But, "over the Thanksgiving holiday, the FDA continued to investigate the outbreak. Our investigation at this point suggests that romaine lettuce associated with the outbreak comes from areas of California that grow romaine lettuce over the summer months, and that the outbreak appears to be related to 'end of season' romaine lettuce harvested from these areas," FDA commissioner Dr. Scott Gottlieb said in a statement. 
 
 "Knowing the growing origin of produce will continue to play an important role in allowing consumers to avoid contaminated products and facilitating market withdrawals and tracebacks," the head of the FDA said. AP 
 
 So people can eat some romaine confidently. “If you do not know where your romaine lettuce is from, do not eat it,” the CDC said in a statement. 
 
 “There is no recommendation for consumers or retailers to avoid using romaine lettuce that is certain to have been harvested from areas outside of the Central Coast growing regions of northern and central California,” the FDA added. 
 
 “For example, romaine lettuce harvested from areas that include, but are not limited to the desert growing region near Yuma, the California desert growing region near Imperial County and Riverside County, the state of Florida, and Mexico, does not appear to be related to the current outbreak. Additionally, there is no evidence hydroponically- and greenhouse-grown romaine is related to the current outbreak.” 
 
 There’s been a "clean break" from romaine, so product that could have been contaminated is probably gone from stores, Gottlieb said. 
 
 He said the FDA was working with the food industry to come up with better ways to label the origin of lettuce and other fresh produce. That will help identify the source of future food-borne outbreaks. 
 
 "Knowing the growing origin of produce will continue to play an important role in allowing consumers to avoid contaminated products and facilitating market withdrawals and tracebacks," Gottlieb said. 
 
 The FDA urged stores and distributors to label lettuce by origin. 
 
 “Based on discussions with producers and distributors, romaine lettuce entering the market will now be labeled with a harvest location and a harvest date or labeled as being hydroponically- or greenhouse-grown. If it does not have this information, you should not eat or use it," the FDA advised. 
 
 E. coli is normally harmless, but there is a strain called E. coli 0157:H7 that produces a compound called Shiga toxin that can make people very ill. The CDC says 16 people have been hospitalized in this outbreak and one has a serious kidney condition called hemolytic uremic syndrome. 
 
 This outbreak is linked to an outbreak one year ago that was not directly linked to romaine lettuce by U.S. authorities, but only to salad greens. Canadian authorities linked it to romaine at that time. 
 
 A separate outbreak of E. coli in romaine lettuce in the spring was traced to contaminated irrigation canal water in Yuma, Arizona. 
 
 Foodborne illnesses are very common. The CDC estimates that 48 million Americans get sick from a foodborne illness every year. Of them, 128,000 are hospitalized, and 3,000 die.
– One thing you'll want to avoid on Thanksgiving—or at any time in the near future—is romaine lettuce. The CDC issued an alert two days before the holiday warning that no romaine is safe to eat as an E. coli outbreak spreads, reports NBC News. It doesn't matter where the romaine is from or even if you or a loved one has eaten some and not gotten sick. The advice from the CDC is the same: Toss it. A bag of mixed salad that includes romaine? Toss it. In fact, the alert includes advice on how to clean your refrigerator if romaine has been inside it recently. So far, 32 people in 11 states have gotten sick, and 13 required hospitalization. No deaths have been reported. "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," the CDC said. "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." (Tainted water was blamed in a different outbreak involving romaine earlier this year.)