As many as 190 confirmed cases of salmonella poisoning from eating contaminated fresh tomatoes were reported in four multi-state outbreaks last year, the U.S. Centers for Disease Control and Prevention said Thursday in its Morbidity and Mortality Weekly Report.

And because about 97.5 percent of salmonella infections are never confirmed by culture, the number of people sickened from contaminated tomatoes was probably substantially higher, the CDC said.

Last year’s outbreaks originated from producers in Florida, Ohio, and Virginia. Sources may have included feces from domestic animals, and contaminated ponds or drainage ditches, the agency said. About 5 billion pounds of fresh tomatoes are eaten each year in the United States.

To help lessen their risk of salmonella infection, consumers should avoid buying bruised or damaged tomatoes, the CDC said. All tomatoes, regardless of their source, should be thoroughly washed under running water just before eating. Tomatoes that appear spoiled should be thrown out, and cut, peeled, or cooked tomatoes should be refrigerated at 40 degrees F (4.4 degrees C) within two hours or discarded.

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