A listeria outbreak linked to frozen nutritional milkshakes is to blame for 12 deaths and dozens of hospitalizations, the U.S. Food and Drug Administration confirmed Monday following an investigation that spanned years.

Twelve deaths have been reported as part of an outbreak of Listeria monocytogenes infections linked to frozen supplemental shakes, the US Food and Drug Administration said Monday. At least 38 people in 21 states had been infected,

An ongoing Listeria outbreak has mostly affected people living in long-term care facilities and people who were already hospitalized prior to becoming sick from the infection.