A listeria outbreak connected to recalled ready-to-eat pasta meals has killed six and left many others hospitalized across the United States. According to People, the U.S. Food and Drug Administration and the U.S. Department of Agriculture’s Food Safety and Inspection Service found that a total of 27 people have been infected with the outbreak strain of the bacteria, with 18 states reporting cases of infection.

Here’s what to know about the outbreak.

Pasta meals from Nate’s Fine Food tested positive for Listeria monocytogenes in June

In June, epidemiologic, laboratory and traceback data found that the chicken fettuccine alfredo meals produced by FreshRealm were contaminated with Listeria monocytogenes that were making people sick. FreshRealm tested ingredients used in the meals, which were supplied by Nate’s Fine Food, a ready-to-eat foods manufacturer based in Roseville, California, with products sold at major grocery chains nationwide, including Trader Joe’s, Sprouts Farmers Market, Kroger and Walmart, News 4 San Antonio reported.

After FreshRealm’s investigation, a recall was issues on more than 245,000 pounds of prepared pasta dishes. According to the U.S. Centers for Disease Control and Prevention, it was later confirmed that ingredients used by Nate’s Fine Foods in its pasta dishes tested positive for Listeria monocytogenes. 

As state and local health officials continue to “gather information of what ill people ate before getting sick,” they’re urging customers to return or discard recalled meals, People reported.

In total, there have been 27 reported cases of listeria infection, though the CDC suspects the number of people who are sick because the outbreak is higher, as it takes three to four weeks to determine if an illness is tied to listeria, People reported. Of the 26 cases of infection that had information available, 25 were hospitalized and six deaths have been reported in Hawaii, Illinois, Michigan, Oregon, Texas and Utah.

The outbreak has also seen one pregnancy-associated illness, which resulted in a fetal loss.

Symptoms of listeria typically manifest two weeks after exposure

The CDC describes listeria as “a bacteria that can contaminate many foods,” with those infected experiencing symptoms as early as the same day or as late as 10 weeks after infection, per People. Those infected usually experience symptoms two weeks after exposure.

According to News 4 Antonio, listeria is especially dangerous to people aged 65 or older, women who are pregnant or people with compromised immune systems, as the bacteria is more likely to spread beyond their gut to other parts of their body, oftentimes leading to a severe condition known as invasive listeriosis.

Symptoms may include fever, muscle aches and tiredness, and those infected may also experience headaches, stiff neck, confusion, loss of balance or seizures. Pregnant women may experience fevers, muscle aches and tiredness.