At least nine people have died after being infected with listeria from Boar’s Head deli meats tied to a massive recall last month, federal health officials said Wednesday.

The new food poisoning toll includes two deaths in South Carolina plus one each in Florida, New Mexico, Tennessee and New York, the U.S. Centers for Disease Control and Prevention said. Three deaths were previously confirmed in people who lived in Illinois, New Jersey and Virginia.

At least 57 people have been sickened and hospitalized in the outbreak. Illnesses were reported starting in late May and have continued into August, the agency said. It is the largest listeria outbreak in the U.S. since 2011, and Boar’s Head has recalled more than 7 million pounds of deli products.

Listeria infections are caused by a hardy type of bacteria that can survive and even thrive during refrigeration. An estimated 1,600 people get listeria food poisoning each year and about 260 die, according to the CDC. Infections can be hard to pinpoint because symptoms may occur quickly – or up to 10 weeks after eating contaminated food.

The infections are especially dangerous for older people, those who are pregnant or those with weakened immune systems.

The problem was discovered when a Boar’s Head liverwurst sample collected by health officials in Maryland tested positive for listeria. Further testing showed that the type of bacteria was the same strain causing illnesses in people.

Boar’s Head officials originally recalled liverwurst and other products meant to be sliced in retail delis with sell-by dates from July 25 to Aug. 30. On July 29, the recall was expanded to include all foods produced at the firm’s plant in Jarratt, Virginia. The products included those sliced at deli counters as well as some prepackaged retail sausage, frankfurters and bacon.

All the recalled deli meats have been removed from stores and are no longer available, Boar’s Head officials said on the company’s website. The products were distributed to stores nationwide, as well as to the Cayman Islands, the Dominican Republic, Mexico and Panama, U.S. Agriculture Department officials said.

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CDC officials urged consumers to check their refrigerators for the recalled products. Look for EST. 12612 or P-12612 inside the USDA mark of inspection on the product labels, some of which have sell-by dates that extend into October. Discard recalled foods and thoroughly clean and sanitize refrigerator and other surfaces they touched.

Many illnesses caused by food poisoning are short-lived, but listeria infections can have devastating effects.

In Virginia, Gunter “Garshon” Morgenstein, of Newport News, died on July 18 from a brain infection caused by listeria bacteria, an illness that was confirmed to be linked to the contaminated Boar’s Head products.

Morgenstein, 88, was a German-born Holocaust survivor who moved to Canada and then the U.S. as a young man and later became a flamboyant hair stylist, according to his son, Garshon Morgenstein. During his 70-year career, his father styled celebrities such as the singer Tom Jones and was known for his funny, outgoing personality, Garshon Morgenstein said.

Gunter Morgenstein enjoyed liverwurst, usually spread on bagels, and bought it regularly, insisting on the Boar’s Head brand because he believed it was top quality, his son said.

He fell ill in early July and was hospitalized on July 8, eventually becoming so sick that doctors said he suffered permanent brain damage and was unlikely to recover. Family members withdrew life support, his son said.

After Morgenstein’s death, a review of receipts showed that he bought the recalled deli meat tied to the outbreak on June 30. The family has hired a lawyer, Houston-based Ron Simon.

“It’s really just a senseless accident and tragedy for something that just should not have ever happened,” his son said. “He still had many good years left.”

WASHINGTON — The U.S. surgeon general is calling for a “fundamental shift” in how the mental health and well-being of parents is supported and prioritized.

In a health advisory released Wednesday, Dr. Vivek Murthy, himself a father of two, said parents and caregivers are struggling amid a youth mental health crisis, financial difficulties, social media issues and more.

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“Parents typically don’t talk about this all the time,” Murthy said in an interview that aired Wednesday on “Good Morning America.” “They tend to focus on their kids’ health and well-being, but there’s also this sense of shame and guilt, sometimes around struggling as a parent.”

Citing statistics that show parents are consistently more likely to report high levels of stress than other adults, Murthy wrote in the advisory there needs to be a culture shift and an all-hands-on-deck approach to supporting parents from employers, government agencies, health care providers and local communities.

Parents in the U.S. are overwhelmed and burned out.

According to the advisory, 48% of parents say most days, their stress is completely overwhelming, compared to 26% of other adults without kids.

“Supporting parents and caregivers will require a series of thoughtful policy changes and expanded community programs that will help ensure parents and caregivers can get time off to be with a sick child, secure affordable child care, access reliable mental health care, and benefit from places and initiatives that support social connection and community,” Murthy wrote. “It will also require us to rethink cultural norms around parenting.”

He continued, “Part of that will involve shifting how we value parenting. The work of raising a child is work, no less valuable than the work performed in a paid job and of extraordinary value when it comes to the impact on the future of society.”

According to the advisory, more than 60 million parents in the U.S. live with children under the age of 18.

The U.S. is currently one of seven countries globally that does not have any guaranteed form of universal paid leave, according to a petition to pass paid leave on a federal level in the U.S. that was delivered to all members of Congress in July.

Data released by the U.S. Census Bureau earlier this year found that, on average, families pay between 8% to 19% of their income per child on child care.

Kaitlyn Niles, a 34-year-old working mom of two, told “GMA” that she feels the pressure to balance her career and family and to meet the often unattainable standard of parenting set by society.

“There’s so much pressure on parents to spend all of this quality time with your kids, like sit on the ground and play pretend with your 4-year-old, you know,” Niles said. “And when you think about it logically, it’s like, there’s no way my mom was able to do that with six kids.”

Meanwhile, Eric Martinez, a father of two from Colorado, said he has had to learn new strategies in limiting his kids’ access to technology and social media.

“Navigating those conversations can be challenging because it’s new. It’s new for all of us,” he told “GMA.” “You know, we didn’t share this experience growing up. We didn’t have access to this technology when we were 7, 8, 9, 10 years old, so we’re kind of figuring this out as we go along.”

Murthy stated in this week’s advisory that the stressors parents are experiencing have made them vulnerable to the nationwide epidemic of loneliness and isolation.

“It also turns out that parents are struggling with loneliness at a much higher level than other adults, particularly single parents,” Murthy said, speaking with “GMA.”

In his advisory, Murthy noted that parents and caregivers should remember that it’s OK to set healthy boundaries and take time for themselves, which in turn will make them better supports for their family.

In addition, parents and caregivers are encouraged to “nurture connections” with other parents and caregivers and to seek professional mental health support when needed.

If you or someone you know are experiencing suicidal, substance use or other mental health crises, please call or text 988. You will reach a trained crisis counselor for free, 24 hours a day, seven days a week. You can also go to 988lifeline.org.