The US Centers for Disease Control and Prevention is reminding the public to avoid eating recalled deli meats amid a listeria outbreak that has expanded to become the nation’s largest since 2011.

Boar’s Head issued a recall in late July for more than 7.2 million pounds of its ready-to-eat liverwurst and some other deli meat products due to concerns about potential listeria contamination, but the CDC says at least a dozen more listeriosis cases have been reported in recent weeks.

A total of 57 people have been hospitalized in 18 states, and nine people have died. The CDC says this listeria outbreak is now the largest since one linked to cantaloupe in 2011.

The agency has said that the true number of illnesses is probably higher than what’s been reported because some people may have had a milder case and were not tested for listeria. There’s also a lag time between when an illness happens and when scientists can connect it with an ongoing investigation.

The CDC advises consumers to check their kitchens for any remaining recalled products because they can have a long shelf life. Look for “EST. 12612” or “P-12612” inside the USDA mark of inspection on labels. Some of the products have sell-by dates into October 2024.

The recalled products include liverwurst, ham, bologna, sausage and roasted bacon. Most people who became sick reported eating turkey or liverwurst, and some reported eating ham.

However, Boar’s Head says any products now available at deli counters are not subject to recall.

Listeria bacteria is hardy and can stay on surfaces like countertops and meat slicers, so you don’t even have to eat a contaminated product to get sick. It can spread easily at delis, the CDC says, transferring from equipment to surfaces to hands and food. Refrigeration does not kill the bacteria, but heat can.

People who are pregnant, those who are 65 and older, and those with weakened immune systems are advised to avoid eating any deli meat unless it’s been heated until it steams or reaches an internal temperature of 165 F.

If you’ve had sliced deli meat at home, clean the refrigerator and any containers or surfaces that may have come into contact with it, and watch out for symptoms of listeriosis, which can take up to 10 weeks to develop.

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    Listeria bacteria causes listeriosis, the third leading cause of death from foodborne illness in the United States.

    Symptoms can include fever, muscle aches and fatigue. An infection can also cause a stiff neck, a headache, confusion or seizures.

    Anyone who develops symptoms of listeriosis should get medical care right away.

    The timeline of this outbreak stretches over several months, the CDC said, as the first person got sick at the end of May. The investigation is ongoing.

    The CDC is encouraging people who get sick with listeria to work with local public health officials, who may get in touch to find out what they ate in the previous month and may ask for receipts or leftover food to help pinpoint the root of the outbreak.

    This post appeared first on cnn.com

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