Nine states now have related cases of diarrheal illness caused by the microscopic cyclospora parasite, according to an official at the US Centers for Disease Control and Prevention who asked not to be named because they weren’t authorized to share the information.

Four more states — Illinois, Kansas, Oklahoma and Pennsylvania — have been added to the outbreak that already includes Indiana, Kentucky, Michigan, Ohio and West Virginia. The cluster is being investigated by federal and state health officials.

The additional states were first reported by the Washington Post.

Health departments in these nine states have reported over 12,000 cases of cyclosporiasis so far this summer, with the majority of those cases in Michigan. If all the cases are confirmed to be linked, it will be one of the largest outbreaks of foodborne illness in the US in three decades.

Detailed interviews with patients have helped health officials home in on iceberg lettuce sourced from Central Mexico as the likely source. Investigators with the US Food and Drug Administration, as well as health authorities in Mexico, are actively investigating what may have caused the contamination.