The Centers for Disease Control and Prevention is investigating an E. coli outbreak in the Mountain West and Midwest that seems to link back to McDonald’s Quarter Pounders, although officials don’t know which specific ingredient might be involved. The CDC said McDonald’s has pulled ingredients and the burgers won’t be available in some states, including in Utah.

The public health agency told people who had Quarter Pounders and experienced symptoms to see their health care provider. So far, at least 49 illnesses have been documented and one person died. CDC said many others might be affected but not all cases are reported as most people recover on their own.

According to a CDC map, the outbreak has included 26 cases in Colorado including one death of an older adult, nine cases in Nebraska and cases in Iowa, Kansas, Missouri, Montana, Oregon, Utah, Wisconsin and Wyoming as well.

The announcement said to seek medical care if one recently consumed a Quarter Pounder and is experiencing severe symptoms, which includes diarrhea and a fever higher than 102°F, diarrhea that doesn’t improve within three days or is bloody, vomiting that prevents keeping liquids down, signs of dehydration like not urinating much or a dry throat and mouth or feeling dizzy when standing.

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E. coli comes from the Shiga bacterial toxin and the most common symptoms are severe diarrhea, cramps and fever.

The announcement notes that symptoms usually start a few days after swallowing the bacteria and most recover without treatment within a week.

The Associated Press reported that “a specific ingredient has not been identified as the cause, but investigators are focused on onions and beef. A preliminary FDA investigation suggests that slivered onions served on the burgers are a likely source of contamination. The USDA is investigating the hamburger patties.”

The strain of E. coli in the outbreak sickens about 74,000 people a year in the U.S. AP reported it leads to more than 2,000 hospitalizations and 61 deaths. Very young children are especially susceptible and one of the outcomes can be kidney failure.

McDonald’s responds

McDonald’s issued a statement in response to the outbreak. It said in part:

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“Across the McDonald’s system, serving customers safely in every single restaurant, each and every day, is our top priority and something we’ll never compromise on.

“It is why we are taking swift and decisive action following an E. Coli outbreak in certain states. The initial findings from the investigation indicate that a subset of illnesses may be linked to slivered onions used in the Quarter Pounder and sourced by a single supplier that serves three distribution centers. As a result, and in line with our safety protocols, all local restaurants have been instructed to remove this product from their supply and we have paused the distribution of all slivered onions in the impacted area.

“Out of an abundance of caution, we are also temporarily removing the Quarter Pounder from restaurants in the impacted area, including Colorado, Kansas, Utah and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma. We take food safety extremely seriously and it’s the right thing to do. Impacted restaurants are receiving a stock recovery notice today and should reach out to their field supply chain manager or distribution center with any questions.”

The company said it is working with suppliers to “replenish supply for the Quarter Pounder in the coming weeks” and noted that no other items are affected and they continue to be available.

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