Two possible cases of E. coli in Nebraska may have been passed from person to person, and not come directly from eating tainted spinach.

That brings the total confirmed Nebraska cases to seven, with four more possible cases.

The two secondary cases are people who live with someone who became ill after eating spinach according to the Associated Press

According to the Associated Press Nationally, the outbreak has sickened at least 146 people in 23 states. One person has died and 76 others have been hospitalized, some with kidney failure as a result of hemolytic uremic syndrome.