At least 37 people are now known to have been sickened in a hepatitis A outbreak linked to frozen berries. The case count stood at 30 at the end of last week, with illnesses in Colorado, New Mexico, Nevada, Arizona and California. Then over the weekend, Hawaii’s department of health reported two victims in that state, a number it raised to three Monday, according to Hawaii News Now. And while the Hawaiian cases were being added to the tally, the federal Centers for Disease Control and Prevention reported four more cases on the mainland, for a total of 37 ill. Of the 34 cases reported by CDC, 11 have resulted in hospitalization. No illnesses have been reported among children to date. The CDC has obtained illness information for 25 patients, of which 19 report eating the organic ‘Anti-Oxidant Blend’ from Townsend Farms of Oregon, which has been named as the suspected source of the virus. The berries were sold at Costco stores in the western United States. Costco has removed the product from its shelves and notified all customers who bought the berries via its automated voicemail system, but Townsend has yet to issue a recall of the berry mix. The strain of hepatitis A implicated in the outbreak is rarely seen in the United States, but is more common in northern Africa and the Middle East. However, the same strain was associated with an outbreak also linked to frozen berries in Europe earlier this year, and with an outbreak linked to pomegranates in British Columbia in 2012. Pomegranate seeds are also present in the organic mix linked to this ongoing outbreak. The pomegranate seeds and other ingredients in the mix were sourced from countries around the world, including the U.S., Argentina, Chile and Turkey. According to the farm’s website, they are certified organic by Oregon Tilth and the Washington State Department of Agriculture, as they own 44 acres of raspberry and blackberry farm in Washington’s Clark County. Because organic certification is standardizes throughout the world, the imported berries can be certified organic in Oregon and Washington as long as the conditions under which they were grown meet the certification standards. Consumers who have eaten the implicated berries within the past 14 days are urged to get the hepatitis A vaccine from their healthcare providers. Those without healthcare providers should contact their local health departments. The vaccine will not be effective for people who were exposed to the virus more than two weeks ago, but these people should watch for symptoms of a hepatitis A infection, which include nausea, cramping in the upper right abdomen, diarrhea, loss of appetite, fatigue, dark urine and jaundice. Symptoms usually appear between two and six weeks after exposure. Those who think they may have contracted a hepatitis A infection should contact their health care provider right away, advises CDC.