Health officials in Canada are confirming that 22 people have now tested positive for E. coli after eating contaminated romaine lettuce.

On Friday, the Public Health Agency of Canada said there were three new cases, which brings the total to 22 confirmed cases.

Officials said there were two new cases in Ontario and one new one in Quebec. They also said E. coli had now affected 17 people in Quebec, four in Ontario and one in New Brunswick.

In the U.S., there have been at least 32 reported illnesses across 11 states related to the outbreak.

When it came to a Canada-wide ban on romaine lettuce, deputy chief public health officer Howard Njoo said there was no need yet as they were dealing with the outbreak on a case-by-case basis.

But he said there would be “active surveillance” for future cases in other provinces or territories.

Canadian officials said there could be additional cases reported as the investigation continued.

“Well, the general sense is that when people become ill, they never seek medical attention,” Njoo said, adding there is always a delay as people typically don’t know they’re ill until well after consuming contaminated products.

In a tweet Friday, the commissioner of the FDA Scott Gottlieb said the current outbreak likely came from California based on “growing and harvesting patterns.” Gottlieb added that the government agency’s goal is to withdraw the product at risk of contamination from market and then “re-stock” the market.

However, officials from the Canadian Food Inspection Agency said they couldn’t confirm the FDA’s assessment yet, but that they were still investigating and working alongside them.

“That information would be integrated in our investigation process. We cannot say if this is the case for the Canadian illnesses,” Dr. Aline Dimitri, CFIA executive director of food safety science said.

But she said that could be confirmed as time goes by.

Most E. coli bacteria are benign but some can cause illness, with symptoms including severe stomach cramps, diarrhea and vomiting.

People typically recover within a week, but some illnesses can last longer and be more severe.

With files from The Canadian Press