About 50 cases from Iowa, Kansas, Nebraska, Missouri, and South Dakota have been linked to the outbreak, according to a recent press release from the South Dakota Department of Health.  Nebraska has identified 15 ill.  South Dakota has identified five cases from five of its southeastern counties and that more cases were pending. Iowa’s Department of Public Health (IDPH) said in a March 6 statement that it had confirmed 18 cases, along with two probable ones. On the same day, the Kansas Department of Health and Environment (KDHE) said it had identified five cases linked to the outbreak, along with one other pending case.

An epidemiological investigation has linked the Nebraska illnesses to sprouts. On March 3, SunSprout Enterprises, Inc, based in Omaha, voluntarily recalled its alfalfa, onion, and gourmet sprouts with "best if sold by" dates from Mar 2 to 14. The sprouts were mainly sold to food distributors who sent the products to restaurants and retail stores. The alfalfa sprouts were also packaged in 2.5- and 5-pound bulk cases for restaurants.