Hawaii officials are investigating E. coli contamination in well water that has prompted the Mauna Loa Macadamia Nut company to recall more than 20 products.

“There is clear evidence that food produced at the Kea‘au facility may be contaminated and consumers may be at risk,” said Peter Oshiro, sanitation branch chief for the Hawaii Department of Health. “The Department of Health is working with the facility to ensure the safety of their drinking water and food production.”

No illnesses have been confirmed in relation to the recalled Mauna Loa nuts and cookies, according to state health officials and the U.S. Food and Drug Administration. Both agencies are warning the public to not eat any of the recalled products. They should be thrown away immediately or returned to the place of purchase.

Neither FDA nor the Hawaii health department reported whether the contaminated well water is used by any other food companies, retailers or restaurants.

“On Sept. 5, samples taken from facility’s water distribution system passed testing and showed no contamination,” according to a statement posted by the Hawaii health department. “On Sept. 21, the DOH was notified that a water distribution system sample at the production center tested positive for E. coli and the food production operations were closed by order of DOH.

  “The Mauna Loa macadamia nut facility will remain closed until it meets all DOH Sanitation Branch and Safe Drinking Water Branch requirements and standards.”

The Keaau company produced the recalled snacks between Sept. 6 and 21 and distributed them to retailers in Hawaii. Neither the state department nor the FDA posted any photos of the recalled products. The Mauna Loa company did not appear to have any information about the contaminated water or its recall on its website as of Sept. 27.

Products subject to the recall are as follows:

Anyone who has eaten or handled any of the recalled products and developed symptoms of E. coli infection should seek medical attention and tell their doctors about their possible exposure to the bacteria. It can take one to 10 days after exposure for symptoms to develop.

Symptoms often include severe stomach cramps, diarrhea (often bloody), and vomiting. Some people may have a fever, which usually is not very high, usually  less than 101 degrees F, according to the Centers for Disease Control and Prevention. Some infections are very mild, but others are severe or even life-threatening. Children younger than 5, elderly people, pregnant women and people with compromised immune systems are at much higher risk of developing severe illnesses.

About 5 percent to 10 percent of people who are diagnosed with E. coli infections develop a potentially life-threatening complication known as hemolytic uremic syndrome (HUS). HUS develops about 7 days after symptoms first appear, when diarrhea is improving. Signs that someone is developing HUS include decreased frequency of urination, feeling very tired, and losing pink color in cheeks and inside the lower eyelids. People with HUS should be hospitalized because their kidneys may stop working and they may develop other serious problems. Most people with HUS recover within a few weeks, but some suffer permanent damage or die.

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