Four people in the United States are suspected of having been exposed to an E. Coli outbreak in Germany after returning from travels to Hamburg, U.S. health officials said.

[I]nfections have been identified in persons who recently traveled to Hamburg, Germany, where they were likely exposed, the U.S. Centers for Disease Control and Prevention said in a June 3 Update.

One case of HUS has been reported in each of three states: Massachusetts, Michigan, and Wisconsin. Additionally, one case of Shiga toxin-positive diarrheal illness is still under investigation. All four cases are pending laboratory confirmation, the CDC reported.

A spokeswoman for the center told Reuters on Sunday that there are no reports of any additional suspected cases.

German Response

German health officials are still warning consumers in northern Germany that they should not eat raw cucumbers, tomatoes, and lettuce to prevent cases. On Sunday, state authorities in Lower Saxony said bean sprouts had been identified as the most likely source of the E. Coli outbreak which has mostly been restricted to northern Germany.

While there is no definite proof so far, a connection has been found involving all the main outbreaks, said Gert Lindermann, agriculture minister for the state of Lower Saxony, according to Deutsche Welle.

He advised Germans to not eat any bean sprouts right now, noting final lab results would be available on Monday.

The Numbers Overall

The World Health Organization reported a total of 21 fatalities related to the outbreak in Germany. There are a total of 2163 cases within the country.

There have been a total of 102 cases in countries outside of Germany.

2 Main Types of Cases

The Robert Koch Institute, a German government's institution responsible for disease control and prevention, is breaking down the infections into two categories.

HUS, or Hemolytic-uremic syndrome, has so far been found in 627 people in Germany. It occurs when an infection causes kidney injury when an infection in the digestive system produces toxic substances.

EHEC, or enterohaemorrhagic E. coli has been found in 1536 cases in Germany. EHEC can cause severe foodborne disease and is transmitted through eating contaminated foods. EHEC produces toxins known as verotoxins. Symptoms and diseases include abdominal cramps and diarrhea that can turn bloody in some cases.

In a small portion of patients, the infection can lead to the life-threatening HUS.

Economic Impact

Meanwhile, German Chancellor Angela Merkel is considering European Union compensation to Spain after the outbreak was wrongly blamed on Spanish cucumbers.

Lost sales are costing 200 million euros ($290 million) per week and cold put 70,000 people out of work, Spain said.