According to the Centers for Disease Control and Prevention’s outbreak report posted Friday, a total of 28 people infected with the outbreak strains of Listeria monocytogenes and five deaths have been reported in connection with commercially produced, prepackaged caramel apples. The 28 ill people included in this outbreak investigation have been reported from 10 states: Arizona (4), California (1), Minnesota (4), Missouri (5), New Mexico (5), North Carolina (1), Texas (4), Utah (1), Washington (1), and Wisconsin (2). Illness onset dates range from Oct. 17, 2014, to Nov. 27, 2014. Nine illnesses have been associated with a pregnancy (occurred in a pregnant woman or her newborn infant). No miscarriages or fetal losses have been reported. Among people whose illnesses were not associated with a pregnancy, ages ranged from 7 to 92 years, with a median age of 64 years, and 32 percent were female. Three invasive illnesses (meningitis) occurred among otherwise healthy children aged 5-15 years. Of the 26 ill persons for whom information is available, all have been hospitalized, and five deaths have been reported. Listeriosis contributed to at least four of these deaths. CDC is collaborating with public health officials in several states and with the U.S. Food and Drug Administration to investigate. To date, 15 of the 18 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill. Out of an abundance of caution, CDC recommends that U.S. consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided. Although caramel apples are often a fall seasonal product, contaminated commercially produced, prepackaged caramel apples may still be for sale at grocery stores and other retailers nationwide or may be in consumers’ homes. Investigators are working quickly to determine specific brands or types of commercially produced, prepackaged caramel apples that may be linked to illnesses and to identify the source of contamination. The Minnesota cases purchased caramel apples from Cub Foods, Kwik Trip, and Mike’s Discount Foods, which carried Carnival brand and Kitchen Cravings brand caramel apples. These two brands are no longer available for purchase at retail locations; however, health officials are concerned that persons who purchased them may still have them in their homes. At this time, no illnesses related to this outbreak have been linked to apples that are not caramel-coated and not prepackaged or to caramel candy. The outbreak can be visually described with an epidemic curve showing the number of persons who were diagnosed each day. Illnesses that started after Dec. 3, 2014, might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported.