SHELBY, N.C. (AP) -- Health officials say one child has died and 37 others have been sickened in an E. coli outbreak tied to a North Carolina county fair.

The state Department of Health and Human Services said Monday that 22 children and 16 adults who attended the Cleveland County Fair have gotten sick. Spokeswoman Julie Henry says officials haven't identified the specific source of the bacteria.

Officials say a North Carolina child died last week and seven people have needed hospital treatment. Gaston County Health Director Chris Dobbins says three people are on dialysis and four developed a type of kidney failure.

The nine-day fair ended Oct. 7. Health officials say symptoms of E. coli infection could come up to 10 days after exposure and can include diarrhea, abdominal cramps, nausea and vomiting.

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