The E. coli outbreak that sickened at least 41 people on Michigan and Ohio has spawned cases in three other states, US health officials announced on Tuesday.

The outbreak made the Kroger Food Store, the US’s largest grocery chain, voluntarily recall all ground beef products that were sold between May 21 and June 8 at its stores. The same outbreak prompted Nebraska Beef Ltd.'s recall of 5.3 million pounds of beef.

The other three states where E. coli has been spotted are New York, Kentucky and Indiana. Laboratory tests confirmed the same strain of E. coli, 0157:H7, which was blamed for sickening people in Michigan and Ohio, according to the Centers for Disease Control and Prevention.

If the Kentucky patient lives near Ohio, the New York and Indiana patients did not travel to either of the states where the outbreak began, which means E. coli was not being brought by people travelling from Ohio or Michigan to these states, Mark Sotir, a CDC investigator working on the outbreak, said, according to the Associated Press.

There are currently 44 cases of E. coli illnesses. The outbreak started between May 30 and June 24. The CDC says 21 of the infected people needed hospitalization and one developed kidney failure. No deaths have been reported so far due to E. coli.

E. coli is a potentially deadly bacterium that can cause diarrhea, stomach cramps, vomiting and in most severe cases kidney failure. Most of the infected persons get well in 15 days. People predisposed to the infection include children, seniors, and persons whose immune system is weakened.

The CDC estimates that there may be about 70,000 infections with E. coli annually in the United States, with many of these cases not seeking medical care.