Health officials continue to investigate the source of the local patients' sickness and urge people across the state to stay away from romaine lettuce unless they can confirm it was not grown in Yuma, Arizona — where national health experts believe the national outbreak began.

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Five people in Washington state have reported sickness from E. coli food poisoning, as part of the widespread outbreak linked to romaine lettuce that has sickened nearly 100 people in about two dozen states.

Physicians reported three cases in King County and two in Spokane County, the Washington State Department of Health announced Friday. Two of the patients, including a child under the age of 5, were temporarily hospitalized.

Health officials continue to urge people to stay away from romaine lettuce, including in bags of chopped and washed salads, at stores and restaurants unless they can confirm it was not grown in Yuma, Arizona — where national health experts believe the bacteria originated.

“This is a very bad bug that can make people very, very ill with potential renal failure and potentially even death,” said Marguerite Pappaioanou, of the University of Washington School of Public Health. “It is here.”

The child in King County who was briefly hospitalized has a young sibling who also caught a nasty strain of the bacteria, though did not receive hospital treatment, according to the department of Public Health — Seattle & King County. Members of their family also reported sickness and ate romaine lettuce, though were not tested for E. coli.

Neither child developed a type of kidney failure that some patients of severe cases of E. coli suffer, called hemolytic uremic syndrome, the department reported in a blog post, outlining its investigation into the cases.

“The family reported that they have not traveled out of state recently, suggesting that the family’s exposure to E. coli was local,” the blog says.

Also in King County, health professionals hospitalized a woman in her 50s who had eaten romaine lettuce while traveling outside of Washington, the blog says.

The two patients in Eastern Washington, both of whom are children under the age of 10, did not go to the hospital, the state health department reported.

Further details on the patients’ health status, as well as their genders and identities, are unknown.

They are among 98 people, ranging from toddlers to seniors, across 22 states reported illness from this particular strain of E. coli, 0157:H7 — which produce toxins that can disrupt liver functions since — in mid-March, health officials report.

Forty-six people have been hospitalized, including 10 with kidney failure, which is an unusually high number of hospitalizations.

Pappaioanou, an affiliate professor of environmental and occupational health sciences at the university, said the country’s food system relies on the Arizona area, which is near the Colorado River and U.S. border, for most of its lettuce during winter months. Then, when spring hits and Arizona becomes too hot, farms in California’s Central Valley take over.

“Lettuce that’s grown there gets harvested and shipped to several harvesting companies. They clean it, bag it and distribute it across the country — that’s how we get that multiple-state outbreak,” Pappaioanou said.

At this time of year, lettuce from both parts of the country may be on grocery store shelves or restaurant plates.

“We’re in this transition period. It’s coming to an end in Arizona,” Pappaioanou said, so the average person may have a hard time figuring out from which area a lettuce meal came. “You just have to be extremely careful.”

Before moving to Seattle, Pappaioanou served as the Centers for Disease Control and Prevention (CDC)‘s liaison to the Food and Drug Administration (FDA) for food safety.

She said both agencies are actively investigating, a process that includes interviewing patients, to determine “which companies or distribution channels led to the contaminated produce.”

There have been larger outbreaks in recent years, but they have been geographically limited. In 2016, for example, 96 people in Illinois were sickened by E. coli linked to cilantro. A 2006 episode, the last multi-state outbreak larger than the current one, was traced to spinach and linked to 238 illnesses and five deaths, according to the CDC.

Overall, outbreaks like the present are rare but more common in certain types of foods. CDC data suggest that leafy greens cause roughly one-fifth of all food-borne illnesses.

Dr. Scott Lindquist, state epidemiologist for communicable disease, emphasized the severity of this particular strain of E. coli and that people should seek medical help if they notice symptoms including bloody diarrhea, abdominal cramping and vomiting.

Washington and local public-health officials continue to investigate the patients’ sickness in King and Spokane counties.

“If you have romaine lettuce at home and you do not know where it was grown, do not eat it and throw it away,” the state health department said.

Follow updates from the state health department on its website, or via Facebook or Twitter at @WADeptHealth. And call 206-263-9566 for questions related to the E. coli outbreak in King County.

Material from news wires contributed to this report.