TAMPA, Fla. (WFLA) — The U.S. Centers for Disease Control and Prevention is urging Americans who own and care for birds such as chickens or ducks in their backyards to wash their hands as a Salmonella outbreak spreads to the majority of mainland U.S. states.

“Backyard poultry, like chickens and ducks, can carry Salmonella germs even if they look healthy and clean. These germs can easily spread to anything in the areas where the poultry live and roam,” the CDC said.

Already reported in 38 states, the CDC said there have already been 219 confirmed cases as of June 2, with 27 people hospitalized and one person, from Tennessee, dead from the outbreak.

The CDC said “sick people range in age from less than 1 to 89 years, with a median age of 29 years, and 56 (26%) are young children under 5 years. Of 213 people with information available, 116 (54%) are female. Of 95 people with information available, 27 (28%) have been hospitalized.”

Owners of what the CDC calls backyard flocks are encouraged to wash their hands with soap and water “immediately after touching backyard poultry, their eggs, or anything in the area where they live and roam.” If soap and water is not available, owners are encouraged to use hand sanitizer instead.

Symptoms of Salmonella include diarrhea, bloody diarrhea, vomiting, fever, and stomach cramps, and dehydration or dizziness. Signs of infection can start between six hours to six days after swallowing the bacteria.

The CDC said most people recover without needing treatment after four to seven days. However, children younger than 5-years-old and adults 65 and older may be at higher risk for severe illness, and may need medical treatment or hospitalization.

So far, the states with the largest number of infected individuals are Minnesota, Wisconsin, Illinois, Pennsylvania, Texas, and Iowa, all of which have 10 to 15 cases. Florida has had a reported seven cases so far, according to the CDC’s surveillance of the outbreak.

The earliest reported case for this particular outbreak of Salmonella was February 15, though the CDC said some other recent cases “may not yet be reported as it usually takes two to four weeks to determine if a sick person is part of an outbreak. The true number of sick people in an outbreak is also likely much higher than the number reported.” May 5 was the day with the largest number of reported cases, a total of 12, according to the CDC.

“Of the 87 people interviewed, 61 (70%) reported contact with backyard poultry before getting sick. Of 56 people with information available, 16 reported eating eggs from backyard poultry and 2 reported eating meat from backyard poultry,” the CDC reported.