A rare U.S. outbreak of typhoid fever has been linked to a frozen tropical fruit product used to make smoothies, health officials reported Thursday.

Seven cases have been confirmed — three in California and four in Nevada. Two more California cases are being investigated. Five people were hospitalized, according to the Centers for Disease Control and Prevention said.

The CDC said five of the victims drank milkshakes or smoothies made with frozen mamey fruit pulp. Four of them used pulp sold by Goya Foods Inc. of Secaucus, N.J.

Mamey is a sweet, reddish tropical fruit grown mainly in Central and South America. It is also known as zapote or sapote. It is peeled and mashed to make pulp, the CDC said.

The company has recalled packages of the pulp, sold in mostly western states. A sample from one package found in Las Vegas tested positive for the bacteria that causes typhoid, the Food and Drug Administration reported Wednesday.

A phone call to Goya seeking comment was not immediately returned Thursday.

No other food was linked to the illnesses, which occurred between April and July. The victims range in age from 4 to 31, said CDC spokeswoman Arleen Porcell-Pharr.

Typhoid fever is a life-threatening illness caused by a type of bacteria called Salmonella typhi. It’s become rare in the United States. There are only about 400 cases annually, and most people caught it while traveling abroad.

Three food-related outbreaks have been reported in the last 12 years. One, also linked to frozen mamey pulp, caused three illnesses in Florida in 1999. One, linked to Gulf Coast oysters, sickened six in Texas in 2006. The third, linked to a Maryland restaurant, caused four illnesses.

Symptoms include a sustained fever as high as 103 to 104 degrees, along with headache. weakness, stomach pains or loss of appetite. Some patients have a rash of flat, rose-colored spots. It can be treated with antibiotics.

It’s not clear if there will be additional cases, said Dr. Ezra Barzilay, the CDC epidemiologist supervising the investigation. It can take between three days to eight weeks for an infected person to develop symptoms, he noted.

The disease is still common in the developing world. The bacteria passes through the intestinal tract and often spreads to others through feces-tainted food or water. Freezing does not kill it.

The recalled mamey pulp was sold in 14-ounce plastic packages in Alaska, Arizona, California, Colorado, Hawaii, New Mexico, Nevada, Oregon, Texas, Utah and Washington.

CDC report: http://www.cdc.gov/salmonella/typhoidfever/

FDA recall: http://www.fda.gov/Safety

/Recalls/ucm222223.htm

The CDC said a New York adult with underlying medical conditions had died and another possibly related death in New Hampshire was under investigation. State officials attribute the New Hampshire death to the O157:H7 E. coli bacteria.

All but three of the 28 cases listed by the CDC were in the U.S. Northeast and 18 were in the New England states. Sixteen hospitalizations were reported, said a CDC spokeswoman. The bacteria involved were from a common strain, so tests were under way to see if all of the reported cases were related.

Over the weekend, Fairbank Farms of Ashville, New York, recalled 545,699 lbs (248,450 kg) of ground beef products.

The Agriculture Department, which oversees meat safety, said an investigation led it to conclude “there is an association between the fresh ground beef products and illnesses in Connecticut, Maine and Massachusetts.” USDA worked with state and federal officials in examining a cluster of E. coli O157:H7 illnesses.

A potentially deadly bacteria, E. coli can cause bloody diarrhea, dehydration and, in severe cases, kidney failure. The very young, the elderly and people with weak immune systems are the most susceptible to foodborne illness.

A string of food-borne safety scares led the U.S. House of Representatives to pass legislation this summer to require more inspections and oversight of food manufacturers and would give the government new authority to order recalls.

Fairbank Farms announced the recall on Saturday. The beef was produced in mid-September and probably was labeled for sale before the end of the month, said USDA.

It went to retailers including Trader Joe’s, Price Chopper, Lancaster and Wild Harvest, Shaw’s, a unit of Supervalu (SVU.N), BJ’s (BJ.N), Ford Brothers and Giant, a unit of Ahold (AHLN.AS), in eight states — Connecticut, Maryland, Massachusetts, New Jersey, New York, North Carolina, Pennsylvania and Virginia.

A complete list of products is available at:

link.reuters.com/vyx27f

The beef was produced Sept. 14 to 16, and the company urged consumers to check their freezers for products listed in the recall. Labels of the recalled packages will say EST 492 inside the USDA