least 17 states with possible further distribution. On September 26, the Centers for Disease Control and Prevention reported that a total of 72 persons had been infected with the four outbreak-associated strains of Listeria monocytogenes which had been reported to the CDC from 18 states. All illnesses started on or after July 31, 2011. On September 30, 2011, a random sample of romaine lettuce taken by the U.S. Food and Drug Administration tested positive for listeria on lettuce shipped on September 12 and 13 by an Oregon distributor to at least two other states—Washington and Idaho. By October 18, the CDC reported that 12 states were linked to listeria in cantaloupe and that 123 people had been sickened. A final count on December 8 put the death toll at 30: Colorado (8), Indiana (1), Kansas (3), Louisiana (2), Maryland (1), Missouri (3), Nebraska (1), New Mexico (5), New York (2), Oklahoma (1), Texas (2), and Wyoming (1). Among persons who died, ages ranged from 48 to 96 years, with a median age of 82.5 years. In addition, one woman pregnant at the time of illness had a miscarriage. 2015 United States listeriosis outbreak On March 13, 2015, the CDC announced that state and local health officials, CDC, and Food and Drug Administration were collaborating to investigate an outbreak of listeriosis in Kansas. The joint investigation found that certain Blue Bell Creameries ice cream products, including bars, scoops and cookies, were the likely source for some or all of these illnesses. Upon further investigation the CDC said Blue Bell ice cream had evidence of Listeria bacteria in its Oklahoma manufacturing plant as far back as March 2013. The outbreak led to 3 deaths in Kansas. Blue Bell was the nation's third most popular ice cream brand. The items came from the company's production facility in Broken Arrow, Oklahoma . The CDC stated that all five of the sickened individuals, including the three older people who died, were receiving treatment at the same Kansas hospital before developing the listeriosis, suggesting their infections with the Listeria bacteria were nosocomial (acquired, while eating the products, in the hospital). Their pre-existing weakened conditions might help to explain the higher mortality rate in these cases (60%, versus the more normal 20–30%). On April 20, 2015, Blue Bell issued a voluntary recall of all its products, citing further internal testing that found Listeria monocytogenes in an additional