An international alert has been issued by Spain’s Ministry of Health after the country’s largest-ever listeriosis outbreak has sickened 150 people and caused the death of a 90-year-old woman and two miscarriages. An additional 523 suspected cases are being reviewed.

Most of the confirmed cases have occurred in Andalusia, Spain’s southernmost region. Magrudis—a pork packaging facility in the area—has been named in association with the outbreak, but other illnesses have been recorded more than 500 miles away in northeast Spain.

Magrudis underwent a health inspection after laboratory tests revealed Listeria contamination in one of the plant’s food products. Since May 1st, all food products manufactured by the Magrudis plant have been recalled. The specific product in question in relation to the elderly woman’s death is a packet of meatloaf, known as “mecha.” There is still worry that, despite the recall, contaminated products may still be on store shelves because smaller retailers may not be aware, and some consumers may still have contaminated products at home.

“Obviously there was a failure to follow the established procedures,” says Acting Health Minister Maria Luisa Carcedo. “Now we need to carry out the inspections and investigations to figure out exactly where this failure took place.”

The alert was issued to the EU as well as to the World Health Organization. Spain reportedly sees more than 80 million tourists each year, so fears of widespread infection prompted the alert.

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