although the total figure of hospitalised reduced to 53. In addition, eight miscarriages have been related to the outbreak. Spanish Minister of Health María Luisa Carcedo declared that the outbreak had expanded out of the Andalusian Autonomous Community, with one confirmed case in Extremadura, and five suspected cases in Extremadura and Madrid. The Minister specified that, although new cases could appear as a consequence of the long incubation period, the contaminated product had been withdrawn totally. As of 21 August 2019, 132 people were diagnosed and 23 pregnant woman in hospital. On 22 August an international alert was declared.