Unlike spinach, which is often cooked, romaine - and lettuce in general - is more common as a culprit in E.coli outbreaks because it's eaten raw.
Romaine lettuce from the Yuma growing region in Arizona is thought to be the source of the latest E. coli outbreak.
The growing season there ended six weeks ago, and it's unlikely any tainted lettuce is still in stores or people's homes, given its short shelf life.
According to the latest statement from the CDC, numerous people affected fell ill two to three weeks ago, when the contaminated lettuce was still on shop shelves. The four additional deaths were reported from Arkansas, Minnesota and NY. On Friday, health officials said they had learned of four more - one in Arkansas, one in NY, and two in Minnesota.
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Romaine lettuce grown in the Arizona region was last harvested in mid-April.
The reported strain of E. coli, which produces poisonous substances known as Shiga toxins, can cause severe stomach cramps, bloody diarrhea and vomiting.
Almost half of those who became ill had to be hospitalized.
Officials also noted that some of the individuals who became ill never actually consumed the contaminated lettuce but were in close contact with someone else who had done so.
The recent E. coli outbreak is the most severe to hit the USA since 2006, when three people died in an outbreak linked to uncooked spinach. Of 187 people with information available, 89 (48 percent) have been hospitalized, including 26 people who developed hemolytic uremic syndrome, a type of kidney failure.
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