CLEVELAND — The Ohio Department of Health has reported 19 cases of E. coli. 

Health officials have not named a specific food as the source of the outbreak, but Wendy’s removed romaine lettuce from restaurants in Ohio, Michigan and Pennsylvania as a precaution.

Wood (7), Lorain (2), Cuyahoga (2), Lucas (2), Mahoning (2), Franklin (1) Clermont (1), and Summit (1) counties have reported outbreaks of E. coli. Many of the people affected reported eating burgers and sandwiches with romaine lettuce from Wendy’s, according to the Ohio Department of Health.

Four people across Ohio have been hospitalized. Those with symptoms are asked to recount their food history, 72 hours before they fell ill.

Cuyahoga County health officials said contact tracing is vital in getting the bacterial outbreak under control.

“By interviewing all these people and getting their food histories and gauging their symptoms and finding out if they all had all gone to the same place perhaps,” said Kevin Brennan, communications officer for the Cuyahoga County Board of Health. “All those factors go into influencing the investigation.”

E. coli symptoms can range from stomach cramps to vomiting and can lead to more serious conditions like kidney failure. The cause of E. coli can be undercooked meat, like ground beef, or unwashed produce.

“Animals can eat some of the food off of the ground or animals do their business in the same place that the fruit will fall so if that fruit is not properly cleaned the fecal matter that could be on the product that someone is eating could certainly be a cause for it,” said Brennan. 

The Cuyahoga County Board of Health said that the best thing to do is to be overly cautious when preparing and eating food.

“Before you prep, wash your hands, after the food goes on the grill, wash your hands, and before you eat, wash your hands,” said Brennan. “That can seem excessive but they’re absolutely best practices from a public health perspective. Get yourself a vegetable brush and brush those things and clean them for about a minute to two minutes before you eat them, so that’ll make sure that you’re getting them as clean as possible.”

Anyone experiencing symptoms of E. coli, experts recommend they contact their local health provider and local health department. The Ohio Department of Health has been assisting the Center for Disease Control on the investigation.