Almost three weeks after health officials in Upstate New York announced they were investigating a Shigella outbreak affecting 25 people, the estimated victim count has grown to 45.

The outbreak is affecting residents of Onondaga County, which includes the city of Syracuse and is located in the northern central part of the state.

“There are currently 45 cases of Shigella,” reported the Onondaga County Health Department in a statement to Food Safety News. “This includes confirmed, probable, and what New York State Department of Health is considering suspect (cases). We continue to investigate each and every case for linkages but the source remains unknown.”