General Mills announced Friday that it was expanding its recall of Gold Medal flour, Wondra flour, and Signature Kitchens flour to include flour made earlier in the fall that may still be in consumers’ pantries. The company, based in Minneapolis, stated that the recall is being expanded due to a newly reported illness which “appears to have stemmed from the consumption of raw dough or batter linked to flour produced last fall.” (The expanded list of recalled flour products is toward the end of this story.)

The recalled flour has been linked to four new cases of infection with Shiga toxin-producing (STEC) E. coli O121 since June 1, according to an update posted Friday by the U.S. Centers for Disease Control and Prevention (CDC). There are now 42 cases in 21 states, with 11 related hospitalizations. One new state, Indiana, has been added to the list of states with ill people, the agency added. No one has developed hemolytic uremic syndrome, a dangerous type of kidney failure associated with E. coli infections, and no deaths have been reported, CDC noted. The company stated that it was cooperating with the outbreak investigation. The federal agency stated that STEC O121 was recently isolated from samples of General Mills flour collected from the homes of ill people in two different states. “In late June 2016, [the U.S. Food and Drug Administration] isolated STEC O121 from samples of General Mills flour collected from the homes of ill people in Arizona and Oklahoma. The flour collected in Oklahoma was not included in the initial General Mills recall,” CDC stated, adding, “In response to these laboratory findings, on July 1, 2016, General Mills expanded the recall to include additional lots of flour under the same brands from the initial recall.” (CDC posted a list of the recalled flour products and how to identify them here.)

Guidance from both FDA and CDC warns that consumers should not eat any raw products made with flour. E. coli O121 can be eliminated by heat through baking, frying, sautéing or boiling products made with flour. Also, all surfaces, hands and utensils should be properly cleaned after contact with flour or dough, batter and other food items containing raw flour. The expanded General Mills recall affects the following retail flour products. It includes eight SKUs (stock keeping units or UPC codes) of Gold Medal Flour, 1 SKU of Signature Kitchens Flour and 1 SKU of Gold Medal Wondra flour.

E. coli O121 is a potentially deadly bacterium that can cause bloody diarrhea and dehydration. Seniors, the very young, and persons with compromised immune systems are the most susceptible to foodborne illness. Anyone diagnosed by a physician as having an illness related to E. coli O121 is urged to contact state and local public health authorities. Anyone who has any of the recalled products is advised to throw them away. Consumers with additional questions or who want to request a replacement should contact General Mills at 800-230-8103. Additional recall information can also be found here. More information about the signs and symptoms of E. coli O121 infection can be found here.

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