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PITTSBURGH (KDKA) — The nationwide E. coli outbreak linked to romaine lettuce is growing, and Pennsylvania appears to be hit the hardest.

According to the Pennsylvania Department of Health, the state has 12 confirmed cases, most in the nation. Due to privacy concerns, the locations of the cases could not be announced.

The Centers for Disease Control and Prevention says there are now 53 confirmed cases nationwide in 16 states. Thirty-one people have been hospitalized, although no deaths have been reported. The source of the outbreak has not yet been confirmed, and everyone is advised to throw away any chopped romaine lettuce they may have.

The Pennsylvania Department of Health is working with the CDC and the Food and Drug Administration, among other federal agencies, as part of this investigation.

Giant Eagle confirmed tonight that the heads and hearts of romaine currently sold in its supermarkets are not sourced from the Yuma region, and thus not impacted by the expanded warning.

E. coli is a bacteria that can cause severe illness, including bloody diarrhea and hemolytic uremic syndrome, which is a type of kidney failure. Symptoms of an E. coli infection include bloody diarrhea, abdominal cramping and vomiting.

If you have had any of these symptoms lately, you should consult with a medical professional. If you currently have any of these symptoms, you should seek medical attention. You can also call the department at 1-877-PA-HEALTH.