Image: JoNel Aleccia
By JoNel Aleccia Health writer
updated 10/4/2011 5:19:03 PM ET 2011-10-04T21:19:03

At least 100 people are sick and 18 have died after eating listeria-tainted cantaloupe in an ongoing food poisoning outbreak that has spread to 20 states, federal health officials reported Tuesday.

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Officials with the Centers for Disease Control and Prevention have said they expect the number of illnesses from four outbreak strains of listeria to rise through October and beyond, but the toll could well surpass a listeria outbreak in hot dogs and deli meat that claimed 21 lives in 1998.

Federal Food and Drug Administration officials said they are still working to determine the cause of the contamination that led to the recall of more than 300,000 cases of whole fruit grown and shipped by Jensen Farms of Holly, Colo.

"We have to ensure that we do a thorough job of collecting the data and the analysis," said spokesman Doug Karas. "It's complicated because there are so many factors that have to be considered."

Investigators are examining potential problems with everything from agricultural practices to harvesting techniques and storage, Karas added.

The Jensen Farms Rocky Ford-brand melons were recalled Sept. 14 after being shipped directly to two dozen states and likely distributed to more. Because cantaloupe has a shelf life of only about two weeks, the fruit is likely no longer edible.

People in this outbreak became ill starting July 31. However, people can become ill weeks or even months after eating food contaminated with listeria, health officials said. In addition, some people might have kept the fruit under refrigeration, not knowing that listeria monocytogenes bacteria can survive cold temperatures.

In the current outbreak, most of those who became ill are older than 60, with an average age of 79. Of 93 people for whom information is available, 91 were hospitalized.

Listeria infections are particularly dangerous for older people, those with weak immune systems and pregnant women. Two of the victims in the outbreak are pregnant, and the outcome of the pregnancies is being monitored.

The reported deaths include five in Colorado, five in New Mexico, two each in Texas and Kansas and one each in Maryland, Missouri, Nebraska and Oklahoma, according to the CDC. Officials in several states are continuing to investigate reports of illness.

Consumers are urged to throw away any Jensen Farms cantaloupe and to clean and sanitize all kitchen surfaces, including the refrigerator, where tainted fruit may have been used or stored.

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