At least nine people have died after being infected with listeria from Boar’s Head deli meats tied to a massive recall last month, federal health officials said Wednesday.

The new food poisoning toll includes two deaths in South Carolina plus one each in Florida, New Mexico, Tennessee and New York, the U.S. Centers for Disease Control and Prevention said. Three deaths were previously confirmed in people who lived in Illinois, New Jersey and Virginia.

At least 57 people have been sickened and hospitalized in the outbreak. Illnesses were reported starting in late May and have continued into August, the agency said. It is the largest listeria outbreak in the U.S. since 2011, and Boar’s Head has recalled more than 7 million pounds of deli products.

Listeria infections are caused by a hardy type of bacteria that can survive and even thrive during refrigeration. An estimated 1,600 people get listeria food poisoning each year and about 260 die, according to the CDC. Infections can be hard to pinpoint because symptoms may occur quickly — or up to 10 weeks after eating contaminated food.

The infections are especially dangerous for older people, those who are pregnant or those with weakened immune systems.

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The problem was discovered when a Boar’s Head liverwurst sample collected by health officials in Maryland tested positive for listeria. Further testing showed that the type of bacteria was the same strain causing illnesses in people.

Boar’s Head officials originally recalled liverwurst and other products meant to be sliced in retail delis with sell-by dates from July 25 to Aug. 30. On July 29, the recall was expanded to include all foods produced at the firm’s plant in Jarratt, Virginia. The products included those sliced at deli counters as well as some prepackaged retail sausage, frankfurters and bacon.

All the recalled deli meats have been removed from stores and are no longer available, Boar’s Head officials said on the company’s website. The products were distributed to stores nationwide, as well as to the Cayman Islands, the Dominican Republic, Mexico and Panama, U.S. Agriculture Department officials said.

CDC officials urged consumers to check their refrigerators for the recalled products. Look for EST. 12612 or P-12612 inside the USDA mark of inspection on the product labels, some of which have sell-by dates that extend into October. Discard recalled foods and thoroughly clean and sanitize refrigerator and other surfaces they touched.

Many illnesses caused by food poisoning are short-lived, but listeria infections can have devastating effects.

In Virginia, Gunter “Garshon” Morgenstein, of Newport News, died on July 18 from a brain infection caused by listeria bacteria, an illness that was confirmed to be linked to the contaminated Boar’s Head products.

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Morgenstein, 88, was a German-born Holocaust survivor who moved to Canada and then the U.S. as a young man and later became a flamboyant hair stylist, according to his son, Garshon Morgenstein. During his 70-year career, his father styled celebrities such as the singer Tom Jones and was known for his funny, outgoing personality, Garshon Morgenstein said.

Gunter Morgenstein enjoyed liverwurst, usually spread on bagels, and bought it regularly, insisting on the Boar’s Head brand because he believed it was top quality, his son said.

He fell ill in early July and was hospitalized on July 8, eventually becoming so sick that doctors said he suffered permanent brain damage and was unlikely to recover. Family members withdrew life support, his son said.

After Morgenstein’s death, a review of receipts showed that he bought the recalled deli meat tied to the outbreak on June 30. The family has hired a lawyer, Houston-based Ron Simon.

“It’s really just a senseless accident and tragedy for something that just should not have ever happened,” his son said. “He still had many good years left.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.