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Wilson County, Tennessee emergency officials are investigating a suspected foodborne illness outbreak at the Walmart Distribution Center in Lebanon, about 30 miles east of Nashville. Workers began falling ill late Thursday night, October 8, and into Friday morning, October 9, with nausea and vomiting, according to WKRN.

Early reports, citing the Wilson County Emergency Management Agency (WCEMA), put the count at roughly 120 sick and 30 hospitalized. In a statement released Sunday, however, WCEMA said its crews were initially called to the facility for a woman with symptoms of a possible food-related illness, then requested additional units after finding others sick. Between 25 and 30 patients were triaged on scene, and 19 were transported to area hospitals. Mount Juliet EMS and Rutherford County EMS assisted, according to WSMV. WCEMA said the incident remains under review.

Walmart told WKRN that the health and safety of its associates is its top priority, adding: “We’re working with local emergency management and health officials as they investigate.”

As of Sunday evening, neither the Tennessee Department of Health nor the Wilson County Health Department had issued a public statement, and no food, meal, vendor, or pathogen has been identified. It has also not been reported whether those sickened ate at an on-site cafeteria, a catered meal, or food brought in from outside. Food Safety News also reported on the outbreak.

The pattern so far – a workplace cluster, sudden onset over a few overnight hours, and predominantly vomiting – is what public health investigators typically see with illnesses caused by toxins already present in food, such as those produced by Staphylococcus aureus or Bacillus cereus, which can strike within one to six hours of eating. Norovirus, which spreads easily through food handled by an ill worker and through person-to-person contact, is another common cause of sudden mass vomiting illness. Investigators will need interviews, food histories, and stool and food testing before any cause can be confirmed.

Anyone who became ill after eating at or near the Lebanon Walmart Distribution Center should seek medical care if symptoms are severe or persistent, ask their provider about stool testing, and report the illness to the Wilson County Health Department or the Tennessee Department of Health.