Health officials have confirmed at least 76 cases of salmonella in four states as part of an outbreak linked to alfalfa sprouts.

Cases of salmonella in Nebraska, Iowa, Kansas and South Dakota have been tied to SunSprout Enterprises’ sprouts that were distributed to grocery stores and restaurants.

The Omaha company voluntarily recalled its products. Shipments were resumed after an inspection found no cause of salmonella.

Nebraska health officials say at least 45 cases of Salmonella saintpaul have been confirmed near Omaha, Lincoln and Kearney.

Iowa officials confirmed 21 cases. South Dakota and Kansas officials have both confirmed at least five cases in their states.

Salmonella can cause diarrhea, abdominal pain and vomiting.