CLEVELAND (WJW) — The U.S. Centers for Disease Control and Prevention is warning people to not get too close to pet turtles due to a salmonella outbreak affecting multiple states.

As of Friday, 26 people across 11 states have reportedly been infected, the CDC reported. Overall, nine people have been hospitalized.

With the exception of one case in California, all cases were reported in the East and Midwest. Tennessee has reported the most cases at six, followed by Pennsylvania at four. Here’s where all connected cases have been reported, according to the CDC:

The first cases of salmonella believed to be connected to turtles were reported in October 2022, with new cases reported nearly every month since. It can take three to four weeks to determine if a person who becomes ill is connected to an outbreak, the CDC explains.

The average age of those who became ill was 14, and 31% of patients are under the age of 5.

Last month, the Tennessee Department of Health determined samples from two turtles and their tanks collected from a sick person’s home had salmonella “closely related to bacteria from sick people.” Thirteen people who became ill said they purchased their turtle online, from stores, or from a reptile show but it’s unclear if there is a common source of the turtles.

The CDC said turtles of any size can transfer the bacteria to humans, but that turtles with shells smaller than 4 inches are more likely to do so, which is why those tinier reptiles are illegal to be sold as pets.

“Reputable pet stores do not sell turtles with shells less than 4 inches long,” the CDC warns.

People who have turtles are reminded to not eat around them and to wash their hands after touching and cleaning the pet. Also, the CDC says pet owners should refrain from snuggling or kissing their turtles.

Those with compromised immune systems are not advised to have a turtle in their home.

Salmonella infections are commonly associated with diarrhea, fever, and stomach cramps, according to the CDC. Symptoms can begin between six hours and six days after you’ve been infected by the bacteria. Most people are able to recover without receiving treatment within four to seven days.

Illnesses may be more severe for young children, the elderly, and those with weakened immune systems. Some may require medical treatment or hospitalization, the CDC explains.

Infections can only be diagnosed with a laboratory test of a person’s stool, body tissue, or fluids. Every year, salmonella causes roughly 1.35 million illnesses and 420 deaths. The CDC is currently investigating a salmonella outbreak linked to ground beef. Other recent outbreaks have been linked to raw cookie dough, alfalfa sprouts, raw salmon, and bearded dragons – all CDC investigations into these outbreaks have been closed.