Two San Diego County children under 5 are sick with E. coli linked to Sierra Nevada Graziers raw milk cheese. County health officials are urging residents to discard the product immediately.

The County of San Diego Health and Human Services announced the warning Friday, Sept. 25, after county epidemiologists identified the connection between the cheese and a multistate outbreak of E. coli O26:H11, a Shiga toxin-producing strain.

Sierra Nevada Cheese Company, based in Willows, California, initiated a voluntary recall. The FDA said the company began the recall Thursday, Sept. 24, after the agency contacted the company about the outbreak. The county announced the recall Friday, Sept. 25. The recall covers all four Graziers raw milk cheese varieties: medium cheddar, sharp cheddar, jalapeño jack and Monterey jack. No lot numbers or date codes are excluded. Every package is recalled.

The cheeses were sold in 8-ounce and 16-ounce packages at retail stores nationwide and online, and in 5-pound loaves to food service customers and wholesalers. County health officials said they have shared recall information with local retailers, though no specific stores in the Del Mar, Solana Beach or Rancho Santa Fe area have been publicly identified as carrying the product. The FDA noted the cheese has a long shelf life and urged consumers to check refrigerators and freezers.

Nationally, the outbreak has sickened 13 people across nine states, according to the FDA. Eight have been hospitalized. Three developed hemolytic uremic syndrome, a serious condition that can cause kidney failure. No deaths have been reported. The average age of those sickened is 5 years old.

Of nine patients interviewed by public health officials, all nine reported eating the cheese.

San Diego County Public Health Officer Sayone Thihalolipavan said the county's epidemiology team identified the outbreak. "Raw milk products like unpasteurized cheese can carry dangerous bacteria, including Shiga toxin-producing E. coli," Thihalolipavan said. "These infections can cause severe illness, especially in young children, pregnant women, older adults and people with weakened immune systems."

County health officials recommend residents take these steps:

• Do not eat, serve or sell the recalled cheese.
• Throw away any Sierra Nevada Graziers raw milk cheese in your possession.
• Clean and sanitize all surfaces and utensils that touched the cheese with hot, soapy water.
• Seek medical attention if you develop bloody diarrhea, severe abdominal cramps or signs of dehydration.

Consumers who purchased the recalled cheese may return it to the store where they bought it for a refund. The FDA's investigation into the source of contamination is ongoing as of Sept. 25.