An outbreak of hepatitis A virus (HAV) has so far sickened 70 people in seven states, according to a recent emergency report by the U.S. Centers for Disease Control and Prevention (CDC). 

Health authorities say the cases are linked to tainted frozen strawberries shipped to the United States from Egypt and served by a popular smoothie chain with locations nationwide, Food Safety Magazine reports.

To date, 55 people in Virginia, six people in Maryland, five in West Virginia and one person each in New York, North Carolina, Oregon and Wisconsin have been sickened in the outbreak; all of them reported drinking smoothies containing strawberries. Of those diagnosed with hepatitis A, 32 people have been hospitalized, but no deaths have been reported.

The strawberries appear to have been served in several Tropical Smoothie Cafe locations, a chain with more than 500 stores across the country. After hearing news about the hepatitis A outbreak in Northern Virginia in early August, the company contacted the Virginia Department of Health to inform it of a potential link and immediately removed all the affected strawberries from their cafés. A later statement on the company’s website promised it would no longer source strawberries from overseas.

CDC health officials say the number of cases may be higher than reported, as symptoms of hepatitis A—which include dark urine, fatigue and abdominal pain, particularly on the right side, near the liver—often don’t appear until a few weeks after a person contracts the virus. HAV is generally spread through contaminated fecal matter, which can find its way into food via improper handling. The liver virus is highly contagious and can also be spread through close contact with another person who’s infected.