As the tally of those stricken in a nationwide listeria outbreak tied to recalled Boar’s Head deli meat rises, federal health officials are urging Americans to check their refrigerators for the products, some with sell-by dates into October.

The largest such outbreak since one linked to cantaloupes more than a decade ago has killed at least nine people and hospitalized 57 in 18 states, the Centers for Disease Control and Prevention said in an update on Wednesday. 

The Sarasota, Florida-based deli meat and cheese company last month expanded its recall to include more than 3,600 tons of ready-to-eat meat and poultry products sold under the Boar’s Head and Old Country brands.

Records released by the U.S. Department of Agriculture disclosed unappetizing conditions at the Boar’s Head plant in Jarratt, Virginia, where the implicated products were produced. USDA inspectors found mold, mildew and insects throughout the facility, which has suspended operations for now. 

Here’s a rundown of what happened and what people should know:

When and where

A Boar’s Head liverwurst sample tested positive for the outbreak strain of listeria in testing last month by the Maryland Department of Health, prompting the expanded recall. 

The 18 states where the 57 cases in the latest outbreak took place include Arizona, Florida, Georgia, Illinois, Indiana, Maryland, Massachusetts, Minnesota, Missouri, New Jersey, New Mexico, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Virginia and Wisconsin. 

The first case was reported on May 29, 2024, and the last occurred on Aug. 16, 2024. 

Some people are suing Boar’s Head after eating the company’s products, according to the Associated Press. That includes lifelong liverwurst lover Sue Fleming, 88, who was hospitalized for more than a week with a listeria infection; and Ashley Solberg, who claimed in a lawsuit that she had “nearly lost her unborn child” after contracting the illness.

Still, recent illnesses may have yet to be reported as it typically takes three to four weeks to determine if an illness is part of an outbreak, according to the CDC. Further, the real number of sick people in the outbreak is likely higher than the number reported, as some recover without medical care or being tested for listeria. 

What is listeria?

According to the CDC, listeria is a hardy germ that can remain on surfaces such as meat slicers and foods, even when refrigerated. It can take up to 10 weeks for some people to develop symptoms of listeriosis. Listeria spreads easily among equipment, surfaces, hands and food. 

The bacteria can contaminate many foods, and listeria infection is the third leading cause of death from foodborne illness in the U.S. Each year an estimated 1,600 Americans are infected with listeria and 260 die from it. 

An outbreak in 2011 linked to cantaloupes inflected 147 people and killed 33 across 28 states, according to the CDC.

Who should worry

People who are pregnant, 65 and older or those with weakened immune systems are at a higher risk of serious illness or death from a listeria infection. Those with symptoms including fever, muscle aches, tiredness should call a health care provider. Other symptoms include headache, stiff neck, confusion, loss of balance or seizures.

Listeria can cause pregnancy loss or premature birth, as well as serious illness or death in newborns.

The infection is typically diagnosed with a sample from an ill person’s body fluid or tissue, and treatment depends on the severity of the illness. 

People with diarrhea should drink lots of fluids to prevent dehydration. Those with an invasive illness are treated with antibiotics. 

What to do

Do not eat recalled deli meats. Refrigeration does not kill listeria, but reheating to a high enough temperature before eating will kill any germs that may be on these meats. 

People who are generally healthy and not at a higher risk of serious infection should throw recalled items away or return them to the store. 

Clean your refrigerator, containers and any surfaces that may have come in contact with the recalled meats. 

What was recalled

Boar’s Head ready-to-eat liverwurst products:

• Produced between June 11, 2024, and July 17, 2024, with a 44-day shelf life
• “Boar’s Head Strassburger Brand Liverwurst made in Virginia”
• 3.5 pound loaves in plastic casing, or various weight packages slided in retail delis
• Sell by days ranging from July 25, 2024, to Aug. 30, 2024

Also recalled

All deli products, including prepackaged items, from the Virginia facility. Look for ‘EST. 12612″ or “P-12612” inside the USDA inspection mark on the product labels.

The complete list of recalled products can be found here. Recalled product labels can be seen here.

In a statement, a Boar’s Head spokesperson said the company deeply regrets the impact of the recall, and that food safety is their “absolute priority.”