MIAMI, Florida (AFP) – A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Listeria monocytogenes is caused by a bacteria and can cause life-threatening illness. It is particularly dangerous for children, the elderly and pregnant women, in whom it can cause miscarriage.

A total of 83 per cent of those interviewed so far (15 of 18 people) said they had recently eaten caramel-coated apples.

“Out of an abundance of caution, CDC recommends that US consumers do not eat any commercially produced, prepackaged caramel apples, including plain caramel apples as well as those containing nuts, sprinkles, chocolate, or other toppings, until more specific guidance can be provided,” the US Centers for Disease Control and Prevention said in a statement.

Of the 28 infected, 26 were hospitalised and five people died.

“Listeriosis contributed to at least four of these deaths,” said the CDC.

Nine of the cases were pregnancy-related and involved either mothers-to-be or their newborn infants.

Three cases of meningitis – a dangerous complication of listeriosis – among otherwise healthy children aged five to 15 were also reported.

The illnesses have spread across 10 states.

Listeria can cause fever, muscle aches, nausea, and diarrhoea, and symptoms typically begin within a few days to a couple of months after eating a contaminated product.

The bacteria is found in soil, water and animal faeces.

Listeria can infect raw vegetables, animal meat, unpasteurised milk, and processed foods such as cheese dips and deli meats.