The agency has worked with the Centers for Disease Control and state and local health authorities for several weeks to try and track down the ingredient making people sick. Health officials have now determined that the “most likely vehicle” for the virus appears to be a common shipment of pomegranate seeds from Goknur Foodstuffs Import Export Trading of Turkey that were used by Townsend Farms to make Organic Antioxidant Blend, a mix of frozen berries, sold to Costco and Harris Teeter stores.

FDA is now barring Goknur from shipping pomegranate seeds into the United States. It is not clear how much product is impacted, but an FDA official noted that Turkey is a “minor player” compared to countries like India, Iran, China, and Thailand, when it comes to providing pomegranate to the U.S. market.

“This outbreak highlights the food safety challenge posed by today’s global food system,” said Michael Taylor, deputy commissioner for foods and veterinary medicine, in a press release over the weekend. “The presence in a single product of multiple ingredients from multiple countries compounds the difficulty of finding the cause of an illness outbreak. The Hepatitis A outbreak shows how we have improved our ability to investigate and respond to outbreaks, but also why we are working to build a food safety system that more effectively prevents them.”

The Townsend Farms blend has been linked to the multistate outbreak affecting mostly western states. According to CDC, about half of the reported Hepatitis A cases are in California.

Colorado has reported 25 and Arizona 17. Hawaii is reporting 7, New Mexico and Nevada have 5 cases and Utah and Wisconsin have 2 each. The cases reported in Wisconsin, however, resulted from exposure to the product in California, according to health officials.

Nearly 60 percent of those sickened are women. The ages in the outbreak range from 2 to 84 and include 6 children under the age of 18. CDC said none of the children had been vaccinated. More than half of those ill required hospitalization.

The outbreak strain of hepatitis A virus, belonging to genotype 1B, is rarely seen in the Americas but circulates in North Africa and the Middle East, according to CDC.

The outbreak has sparked several large recalls. In early June, Townsend Farms recalled more than 300,000 four pound packages of the frozen berries sold at Costco and then issued another recall of berries sold at Harris Teeter. Last week, Scenic Fruit Company recalled over 60,000 bags of Woodstock Frozen Organic Pomegranate Kernels because their product, imported from Turkey, has the potential to be contaminated with Hepatitis A.

On Sunday, FDA announced the Townsend Farms frozen berry recall has been expanded again. The company is now recalling Townsend Farms Organic Antioxidant Blend, 3 lb. bag with UPC 0 78414 40444 8. The codes are located on the back of the package with the words “BEST BY” followed by the code T122114 sequentially through T053115, followed by a letter. All letter designations are included in the voluntary recall, according to the expanded recall announcement.

The announcement also said that the epidemiological evidence “does not support an association between the illness outbreak and the four other berry products (raspberry, blueberry, strawberry and dark cherry) in the Frozen Organic Antioxidant blend,” which were also used in other Townsend Farms products, so consumers do not have reason to be concerned about those berries.

Townsend Farms said an FDA inspection of the company’s frozen fruit repacking operations has been completed. “The FDA found no evidence linking either the Townsend Farms, Inc.’s repacking facility or any food handler who had possible contact with the product to the source of the illness outbreak,” according to the release.

Hepatitis A, a liver disease, can range from mild to severe and can last anywhere from a few weeks to several months. Symptoms usually occur within 15 to 50 days of exposure and include fatigue, abdominal pain, jaundice, abnormal liver tests, dark urine and pale stool.

If a person has been exposed to the Hepatitis A virus within two weeks or less, they may be able to prevent the disease by receiving a vaccine. Consumers who may have eaten recalled product or have Hepatitis A symptoms should consult with their healthcare provider or their local health department.