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Two people have died and fourteen others are in the hospital after eating sandwiches during a botulism outbreak in Italy, local media report.

Tamara D’Acunto, 45, died after buying a sausage and turnip top sandwich from a food truck in Diamante, a town on the coast of Calabria. Italian news agency ANSA said the sandwich contained a vegetable similar to broccoli. Officials had previously ordered the recall of a commercial product thought to be broccoli in oil. D’Acunto’s funeral took place the day after her death on August 6.

Luigi Di Santo, 52, an artist and musician from Cercola near Naples, also died after eating a sandwich from the same truck, PEOPLE reported.

The outbreak, reported by the Italian National Institute of Health (ISS), has led to fourteen hospitalizations, up from nine. Five patients are in intensive care. The Paola Public Prosecutor’s Office has launched an investigation into the incident.

According to ISS, several foods from the truck tested positive for botulism. Prosecutors noted that the truck’s owner may have used just one kitchen tool for all the food, which could explain how the contamination spread.

Ten people are under investigation, including the street vendor, several doctors who treated the victims, and managers of the companies that made the suspected contaminated products.

Lawyer Francesco Liserre, representing the street vendor, said the products were stored in the refrigerator and opened only when needed. He added that his client believes the contamination was already present in the products and is “devastated” by the incident.

Autopsy results for the victims have not been released. Botulism was detected in early samples from patients admitted to Annunziata Hospital in Cosenza. Authorities have now ordered a nationwide seizure of the products linked to the outbreak.

The ISS confirmed there are botulism cases in the area but did not confirm victim identities. According to the U.S. Centers for Disease Control and Prevention (CDC), botulism is caused by a toxin that attacks nerves and can lead to breathing problems, muscle paralysis, and in rare cases, death. It often comes from improperly canned, preserved, or fermented foods, though store-bought foods can also be affected.

This outbreak comes about two weeks after a 38-year-old woman died from eating a taco with guacamole at a festival in Cagliari, Sardinia. An 11-year-old boy who ate the same guacamole was hospitalized in Rome.