The Pennsylvania Department of Agriculture on Monday said the Your Family Cow raw milk dairy may resume production and bottling of unpasteurized milk, as the number of confirmed illnesses connected to milk sold by the farm earlier this month rose to 43.

According to the Pennsylvania Department of Health, there have been 36 cases of Campylobacter infection in that state, four in Maryland, two in West Virginia and one in New Jersey in people who drank raw milk from the Your Family Cow farm.

Nearly have of those sickened are under 18, health department officials said.

Last week, Maryland public health officials say lab tests confirmed Campylobacter jejuni bacteria in two unopened containers of unpasteurized milk collected from the homes of Your Family Cow customers. The farm owners have acknowledged that the milk they sold was contaminated and sickened customers. “It was us,” owner Ed Shank wrote in an open letter of apology on the dairy’s website.

The state agriculture department said the Your Family Cow dairy in Chambersburg passed a final inspection Monday afternoon. Since the dairy voluntarily closed last month, after the first illnesses were reported, the owners say they have made a number of safety improvements, including hotter water for washing its milk tank and bottler and a new computerized system to monitor its equipment.

Raw milk, which is milk not heated to kill many harmful bacteria, can become contaminated with a wide variety of germs, including E. coli O157:H7, Salmonella and Campylobacter, primarily from cow feces. Campylobacteriosis is most often associated with drinking unpasteurized milk or untreated surface water, or eating undercooked poultry, according to the Centers for Disease Control and Prevention.

Most people who become ill with campylobacteriosis get diarrhea, cramping, abdominal pain and fever that typically lasts one week. Some infected persons do not have any symptoms.

About one in every 1,000 reported Campylobacter illnesses leads to Guillain-Barré syndrome, and can result in paralysis. The CDC estimates that as many as 40 percent of Guillain-Barré syndrome cases in the U.S. may be triggered by campylobacteriosis.