U.S. health officials have identified a food-poisoning outbreak tied to alfalfa sprouts, affecting individuals across 15 states. State authorities recently reported more than 36 incidents in Minnesota and Wisconsin.

The Centers for Disease Control and Prevention (CDC) stated that there are 55 cases nationwide. Four of these individuals required hospitalization. Additional cases have been reported in states including Florida, Indiana, Iowa, Kansas, Michigan, New Hampshire, New York, Pennsylvania, North Carolina, South Carolina, North Dakota, South Dakota, and Washington.

Of the 34 people interviewed, 26 confirmed eating alfalfa sprouts, as noted by the U.S. Food and Drug Administration (FDA).

Food poisoning outbreaks usually involve a single germ. This outbreak, however, involves both salmonella and various strains of E. coli.

Shiga toxin-producing E. coli (STEC) can lead to stomach cramps and bloody diarrhea. Complications might include acute kidney failure. Salmonella infection often causes diarrhea, fever, severe vomiting, dehydration, and stomach cramps.

Officials have traced these cases to alfalfa sprouts grown by Everything Sprouts, a Minnesota company. Their products are sold under the Calco and Everything Sprouts brands in restaurants and grocery stores. As of now, the company has not issued a recall, according to the FDA.

Last year, the FDA sent a warning letter to Everything Sprouts, highlighting issues from previous inspections. Concerns included a leaking roof that dripped water onto bean sprouts and issues with workers’ smocks.

The Associated Press reached out to Everything Sprouts for comment, but responses have yet to be received.

The Associated Press Health and Science Department gets support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP maintains responsibility for the content.