Cases of food-borne illness linked to Wendy’s restaurants have spread, now sickening people across six states, according to the Centers for Disease Control and Prevention.

Illnesses were recently reported in Kentucky and New York, the public health agency said in an update Thursday. In all, 97 people nationwide have been sickened by an outbreak strain of E. coli believed to be linked to bad lettuce at the popular burger chain.

The CDC previously reported cases in Indiana, Michigan, Ohio and Pennsylvania.

“A specific food has not yet been confirmed as the source of this outbreak, but many sick people reported eating burgers and sandwiches with romaine lettuce at Wendy’s restaurants before getting sick,” according to the agency’s website.

Between one and five cases have been reported in Kentucky and New York, though public health officials said the true number of people who have fallen ill is likely higher because some recover and aren’t tested for the bacteria.

Wendy’s said it’s “fully cooperating” with the CDC’s investigation into the multistate outbreak and has removed lettuce from sandwiches in some states, according to a statement published Aug. 19.

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“The lettuce that we use in our salads is different, and is not affected by this action,” the restaurant said. “As a company, we are committed to upholding our high standards of food safety and quality.”

Reports of diners falling ill began in late July, the CDC said. At least 43 people have been hospitalized and 10 developed a severe illness.

No deaths have been reported.

Symptoms of E. coli infection include, stomach cramps, diarrhea, vomiting and fever.

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