There have been no confirmed or suspected cases of E. coli sickness from spinach in Kansas, but health departments should continue to watch for problems, state officials said Tuesday.

“We continue to put the word out to local heath care providers,” said Sharon Watson, a Kansas Department of Health and Environment spokeswoman.

The state issued a second alert to health departments Tuesday, reminding officials to keep a lookout for E. coli symptoms in residents who recently have consumed bagged spinach that may have carried the bacteria.

The second alert came the same day Colorado officials reported their first confirmed case of spinach-based E. coli sickness. Federal officials suspect the outbreak started in California spinach farms and packing plants.

E. coli infection symptoms include severe abdominal pain followed by watery or bloody diarrhea, all caused by intestinal inflammation that the bacteria’s toxins trigger.

To stop the spread of the bacteria – which has now reached 22 states – Kansas health officials have urged stores and restaurants to pull spinach from their shelves and menus.

And until federal health officials can better understand which brand or brands of spinach contains the bacteria and the stores that sell it, the de facto spinach ban will remain in place, Watson said.

Many, if not all, local grocery stores pulled bagged spinach off shelves late last week.

“Yesterday we were notified to get rid of our fresh spinach as well,” said Mike Smith, store director at Checkers Foods, 2300 La.

Smith said all spinach would remain off the shelves until the Food and Drug Administration completed its investigation.

At Rudy’s Pizza, 724 Mass., spinach pizza was off the menu Tuesday. “We have not heard anything,” manager Josh Reese said. “We’re just waiting to hear what’s next.”

Reese said customers had been understanding about the unavailability of the popular, but banned, topping.

“Anybody in their right mind wouldn’t complain about something like this,” he said.