Four people have died and at least seven others are ill due to a flesh-eating bacteria, Vibrio vulnificus, spreading in Florida. Cases were reported in Bay, Broward, Hillsborough, and St. John counties. According to CBS News, Florida has had 448 cases and 100 deaths linked to the bacteria since 2016.

The CDC explains that exposure can occur through contaminated saltwater, brackish water, or eating raw shellfish like oysters, which can “concentrate” the bacteria inside. The infection can cause nausea, vomiting, and diarrhea. But if it enters an open wound or the bloodstream, it may lead to necrotizing fasciitis (flesh-eating disease), dangerously low blood pressure, or even amputations.

Health officials warn that people with open wounds—especially new tattoos or piercings—and those with weakened immune systems are at higher risk. The Florida Health Department says wearing proper footwear and avoiding warm waters with cuts can help prevent infection.

Peter Volpi Jr., a survivor, said the pain was “the most excruciating” he’s ever felt and left him bedridden for months.

Though infections are lower than last year, hurricanes like Ian and Helene previously increased exposure due to flooding.