Five confirmed cases and four suspected cases of E. coli O157 infection were reported Wednesday by Michigan officials, the day after the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced a recall of ground beef in the state.

That’s an increase of six patients from the initial FSIS report. Those sickened range in age from 15 to 88 and reside in Lapeer, Genesee, Isabella and Sanilac counties. Their llness onset dates range from July 18-30.

The Michigan departments of Community Health (MDCH) and Agriculture and Rural Development said the nine case patients ate ground beef that was traced to McNees Meats and Wholesale of North Branch, MI.

“It is concerning that two-thirds of the confirmed and probable cases in this outbreak had to be hospitalized,” said Dr. Dean Sienko, interim medical director for MDCH, in the news release. “People who shop at McNees Meats are advised not to eat ground beef they have purchased there and to throw out any McNees ground beef that may be in their refrigerators or freezers.”

McNees Meats has recalled 360 pounds of ground beef sold in 10-lb. bags to restaurants in Armada, Lapeer and North Branch. It also sold ground beef from its own retail store.

State authorities said they are working with local health departments and FSIS to determine how widely the products were distributed.