Four more people have died from an E. coli outbreak linked to romaine lettuce, the Centers for Disease Control and Prevention announced on Friday. According to the agency’s update, the death toll from the outbreak is now up to five. Twenty-five more people have been infected with E. coli since the last update in mid-May, bringing the total number to 197 patients across 35 states. Those who died were from Arkansas, California, Minnesota, and New York, Reuters reported. The CDC states that some of the affected did not eat any tainted romaine from the Arizona region, but they “had contact with those who fell ill after consuming the popular salad plant.” This particular strain of E. coli is said to cause “severe stomach cramps, bloody diarrhea and vomiting” due to the Shiga toxins the bacteria produces.