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A third person has died and more than 40 people have been hospitalized in a multistate listeria outbreak stemming from deli meat, according to new numbers released by the Centers for Disease Control and Prevention.

A third death has been reported in the outbreak that began in May, the CDC said in a press release Thursday. The deaths have been in Illinois, New Jersey and the latest one in Virginia. 

Meanwhile, nine more illnesses have been reported since the last update July 31, bringing the total number of sickened patients from the outbreak to 43 across 13 states. The agency noted the true number of sick people is likely higher as all the documented ill patients were hospitalized, and some people may recover without medical care.

The ill patients ranged from 32 to 94 years in age, with a median age of 77.

“Epidemiologic, laboratory, and traceback data show that meats sliced at deli counters, including Boar’s Head brand liverwurst, are contaminated with Listeria and are making people sick,” the CDC said in a statement Thursday. 

Boar’s Head had already issued a recall for more than 7 million pounds of deli and poultry items produced at its Jarratt, Virginia, facility over concerns they may contain the bacteria Listeria monocytogenes following the outbreak.

View the recalled product labels here.

The investigation remains underway.

The CDC said that the Maryland Department of Health and the Baltimore City Health Department collected an unopened Boar’s Head liverwurst product from a retail store and identified Listeria monocytogenes. Further, a New York State Food Laboratory identified the bacteria from a previously collected sample of unopened Boar’s Head Liverwurst products collected from retail stores. Authorities determined both to be the same strain as the strain making people sick in this outbreak. 

A majority of patients interviewed by state and local public health officials reported in interviews to eating a variety of meats sliced at deli counters in the month prior to falling ill.

Of 33 patients asked if they ate liverwurst, 55% said they ate deli-sliced liverwurst before getting sick and 13 reported eating Boar’s Head brand. 

Listeria infection is a food borne bacterial illness, most commonly caused by eating improperly processed deli meats and unpasteurized milk products, according to the Mayo Clinic. It’s the third-leading cause of death from food poisoning in the U.S.

Symptoms usually appear within two weeks of eating contaminated food, and include fever, muscle aches, tiredness, stiff neck and confusion. In severe cases, the bacteria may cause a blood infection or meningitis. The infection is dangerous for those who are older, those with weakened immune systems and pregnant women, and those who fall into such categories are advised by the CDC to avoid deli meats.

The CDC estimates that around 1,600 people get listeriosis each year, and about 260 die.

The Boar’s Head recall, which includes more than 70 products, was distributed to stores nationwide and the Cayman Islands, the Dominican Republic, Mexico and Panama.

People who bought the recalled products should throw them away or return them to the store, and also clean out their refrigerators as the bacteria can grow in cold temperatures and spread to other foods.

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