Ruth Hartnup / Via Flickr: ruthanddave

Consumer Reports is advising people to avoid romaine lettuce after an E. coli outbreak that sickened at least 17 people in the US and 41 people in Canada since November. One person in the US and one in Canada have died.

Canadian health authorities said “exposure to romaine lettuce has been identified as the source of the outbreak.” While the US Centers for Disease Control and Prevention has “not identified a source of the infections,” it said, “preliminary results show that the type of E. coli making people sick in both countries is closely related genetically, meaning the ill people are more likely to share a common source of infection.”

James Rogers, director of Food Safety and Research at Consumer Reports, a consumer advocacy group, said in a post, “Even though we can’t say with 100% certainty that romaine lettuce is the cause of the E. coli outbreak in the US, a greater degree of caution is appropriate given that lettuce is almost always consumed raw.”

E. coli infections are commonly linked to raw vegetables. The bacteria live in the intestines of livestock like cattle and poultry and can contaminate fruits and vegetables through soil, water, animals, or manure, as well as during the handling, storing, and transporting process, or during meal prep. Symptoms include severe stomach cramps, diarrhea (often bloody), and vomiting, and the worst infections can cause kidney failure and death.

Last year, there was an E. coli outbreak linked to I.M. Healthy brand SoyNut Butter, and in 2016, Gold Medal brand flour was blamed for sickening 63 people. In 2015, an outbreak was traced back to the burrito chain Chipotle.