By JONEL ALECCIA, AP Health Writer

A listeria food poisoning outbreak that has killed three people and led to one pregnancy loss is linked to newly recalled heat-and-eat chicken fettucine alfredo products sold at Kroger and Walmart stores, federal health officials said.

The outbreak, which includes at least 17 people in 13 states, began last August, officials said late Tuesday.

FreshRealm, a large food producer with sites in California, Georgia and Indiana, is recalling products made before June 17. The recall includes these products, which were shipped to retail stores:

— 32.8-ounce trays of Marketside Grilled Chicken Alfredo with Fettucine Tender Pasta with Creamy Alfredo Sauce, White Meat Chicken and Shaved Parmesan Cheese with best-by dates of June 27 or earlier.

— 12.3-ounce trays of Marketside Grilled Chicken Alfredo with Fettucine Tender Pasta with Creamy Alfredo Sauce, White Meat Chicken, Broccoli and Shaved Parmesan Cheese with best-by dates of June 26 or earlier.

— 12.5-ounce trays of Home Chef Heat & Eat Chicken Fettucine Alfredo with Pasta, Grilled White Meat Chicken and Parmesan Cheese, with best-by dates of June 19 or earlier.

The strain of listeria bacteria tied to the outbreak has been detected in sick people from August through May, health officials said. The same strain that made people sick was found in a sample of chicken fettucine alfredo during a routine inspection in March. That product was destroyed and never sent to stores. Officials said they have not identified the specific source of the contamination.

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Officials with the U.S. Centers for Disease Control and Prevention said the agency is investigating the outbreak, and planned to release more details. It was not clear which states are involved or where the deaths and pregnancy loss occurred.

Consumers shouldn’t eat the products, which may be in their refrigerators or freezers. They should be thrown away or returned to place of purchase.

Listeria infections can cause serious illness, particularly in older adults, people with weakened immune systems and those who are pregnant or their newborns. Symptoms include fever, muscle aches, headache, stiff neck, confusion, loss of balance and convulsions.

About 1,600 people get sick each year from listeria infections and about 260 die, the CDC said. Federal officials in December said they were revamping protocols to prevent listeria infections after several high-profile outbreaks, including one linked to Boar’s Head deli meats that led to 10 deaths and more than 60 illnesses last year.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

By GEOFF MULVIHILL

OxyContin maker Purdue Pharma ’s latest plan to settle thousands of lawsuits over the toll of opioids could soon move forward after every U.S. state involved agreed to it.

A judge on Wednesday is being asked to clear the way for local governments and individual victims to vote on it next.

Government entities, emergency room doctors, insurers, families of children born into withdrawal from the powerful prescription painkiller, individual victims and their families and others would have until Sept. 30 to vote on whether to accept the deal, which calls for members of the Sackler family who own the company to pay up to $7 billion over 15 years.

The settlement is a way to avoid trials with claims from states alone that total more than $2 trillion in damages. Thousands of local governments and other groups have also sued Purdue.

FILE – Protesters who have lost love ones to the opioid crisis protest outside a courthouse in Boston, Aug. 2, 2019, where a judge heard arguments in a lawsuit against Purdue Pharma. (AP Photo/Charles Krupa, File)

Every state but Oklahoma is involved in the case. Oklahoma reached a separate settlement with Purdue in 2019.

If approved, the settlement would be among the largest in a wave of lawsuits over the past decade as governments and others sought to hold drugmakers, wholesalers and pharmacies accountable for the opioid epidemic that started rising in the years after OxyContin hit the market in 1996. The other settlements together are worth about $50 billion, and most of the money is to be used to combat the crisis.

In the early 2000s, most opioid deaths were linked to prescription drugs, including OxyContin. Since then, heroin and then illicitly produced fentanyl became the biggest killers. In some years, the class of drugs was linked to more than 80,000 deaths, but that number dropped sharply last year.

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The request of U.S. Bankruptcy Court Judge Sean Lane comes about a year after the U.S. Supreme Court rejected a previous version of Purdue’s proposed settlement. The court found it was improper that the earlier iteration would have protected members of the Sackler family from lawsuits over opioids, even though they themselves were not filing for bankruptcy protection.

Under the reworked plan hammered out with lawyers for state and local governments and others, groups that don’t opt in to the settlement would still have the right to sue members of the wealthy family whose name once adorned museum galleries around the world and programs at several prestigious U.S. universities.

Under the plan, the Sackler family members would give up ownership of Purdue. They resigned from the company’s board and stopped receiving distributions from its funds before the company’s initial bankruptcy filing in 2019. The remaining entity would get a new name and its profits would be dedicated to battling the epidemic.

Most of the money would go to state and local governments to address the nation’s addiction and overdose crisis, but potentially more than $850 million would go directly to individual victims. That makes it different from the other major settlements.

The payouts would not begin until after a hearing scheduled for Nov. 10, during which Lane is to be asked to approve the entire plan if enough of the affected parties agree.

By MARC LEVY

HARRISBURG, Pa. (AP) — Nippon Steel and U.S. Steel said Wednesday they have finalized their “historic partnership,” a year-and-a-half after the Japanese company first proposed its deal to buy the iconic American steelmaker for nearly $15 billion.

The pursuit by Nippon Steel for the Pittsburgh company was buffeted by national security concerns and presidential politics in a premier battleground state, delaying the transaction for more than a year after U.S. Steel shareholders approved it. It also forced Nippon Steel to expand the deal, including adding a so-called “golden share” provision that gives the federal government a say in some matters.

“Together, Nippon Steel and U.S. Steel will be a world-leading steelmaker, with best-in-class technologies and manufacturing capabilities,” the companies said.

The combined company will become the world’s fourth-largest steelmaker, and bring what analysts say is Nippon Steel’s top-notch technology to U.S. Steel’s antiquated steelmaking processes. In exchange, Nippon Steel gets access to a robust U.S. steel market, strengthened in recent years by tariffs under President Donald Trump and former President Joe Biden, analysts say.

Nippon Steel and U.S. Steel did not list the full terms of the deal, and did not release a national security agreement struck with Trump’s administration.

But in a statement Wednesday, the companies said the federal government will have the right to appoint an independent director and “consent rights” on specific matters. Those include reductions in Nippon Steel’s capital commitments in the national security agreement, closing or idling of U.S. Steel’s existing domestic facilities and changing U. S. Steel’s name and headquarters.

Nippon Steel announced in December 2023 that it planned to buy the steel producer for $14.9 billion in cash and debt, and committed to keep the U.S. Steel name and Pittsburgh headquarters.

The United Steelworkers union, which represents some U.S. Steel employees, opposed the deal, and Biden and Trump both vowed from the campaign trail to block it.

Biden used his authority to block Nippon Steel’s acquisition of U.S. Steel on his way out of the White House after a review by the Committee on Foreign Investment in the United States.

After he was elected, Trump changed course and expressed openness to working out an arrangement and ordered another review by the committee. That’s when the idea of the “golden share” emerged as a way to resolve national security concerns and protect American interests in domestic steel production.

As it sought to win over American officials, Nippon Steel also made a series of bigger capital commitments in U.S. Steel facilities, tallying $11 billion through 2028, it said.

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By MARK SHERMAN

WASHINGTON (AP) — The Supreme Court on Wednesday upheld Tennessee’s ban on gender-affirming care for transgender minors, a stunning setback to transgender rights.

The justices’ 6-3 decision in a case from Tennessee effectively protects from legal challenges many efforts by President Donald Trump’s Republican administration and state governments to roll back protections for transgender people. Another 26 states have laws similar to the one in Tennessee.

Chief Justice John Roberts wrote for a conservative majority that the law does not violate the Constitution’s equal protection clause, which requires the government to treat similarly situated people the same.

“This case carries with it the weight of fierce scientific and policy debates about the safety, efficacy, and propriety of medical treatments in an evolving field. The voices in these debates raise sincere concerns; the implications for all are profound,” Roberts wrote. “The Equal Protection Clause does not resolve these disagreements. Nor does it afford us license to decide them as we see best.”

In a dissent joined by her liberal colleagues, Justice Sonia Sotomayor wrote that the majority “abandons transgender children and their families to political whims.”

The decision comes amid a range of other federal and state efforts to regulate the lives of transgender people, including which sports competitions they can join and which bathrooms they can use. In April, President Donald Trump’s administration sued Maine for not complying with the government’s push to ban transgender athletes in girls sports.

The Republican president also has sought to block federal spending on gender-affirming medical care for those under age 19 — instead promoting talk therapy only to treat young transgender people. In addition, the Supreme Court has allowed him to kick transgender service members out of the military, even as court battles continue. The president also signed another order to define the sexes as only male and female.

Trump’s administration has also called for using only therapy, not broader health measures, to treat transgender youths.

The justices acted a month after the United Kingdom’s top court delivered a setback to transgender rights, ruling unanimously that the U.K. Equality Act means trans women can be excluded from some groups and single-sex spaces, such as changing rooms, homeless shelters, swimming areas and medical or counseling services provided only to women.

Five years ago, the Supreme Court ruled that transgender people, as well as gay and lesbian people, are protected by a landmark federal civil rights law that prohibits sex discrimination in the workplace. That decision is not affected by Wednesday’s ruling.

But the justices on Wednesday declined to apply the same sort of analysis the court used in 2020 when it found that “sex plays an unmistakable role” in employers’ decisions to punish transgender people for traits and behavior they otherwise tolerate. Roberts joined that opinion written by Justice Neil Gorsuch, who also was part of Wednesday’s majority.

Tennessee Attorney General Jonathan Skrmetti on social media called the ruling a “Landmark VICTORY for Tennessee at SCOTUS in defense of America’s children!”

There are about 300,000 people between the ages of 13 and 17 and 1.3 million adults who identify as transgender in the United States, according to the Williams Institute at the UCLA School of Law. The Williams Institute is a think tank that researches sexual orientation and gender identity demographics to inform laws and public policy decisions.

When the case was argued in December, then-President Joe Biden’s Democratic administration and families of transgender adolescents had called on the high court to strike down the Tennessee ban as unlawful sex discrimination and protect the constitutional rights of vulnerable Americans.

They argued that the law violates the equal protection clause of the 14th Amendment.

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Tennessee’s law bans puberty blockers and hormone treatments for transgender minors, but it allows the same drugs to be used for other purposes.

Soon after Trump took office, the Justice Department told the court that its position had changed.

A major issue in the case was the appropriate level of scrutiny courts should apply to such laws.

The lowest level is known as rational basis review, and almost every law looked at that way is ultimately upheld. Indeed, the federal appeals court in Cincinnati that allowed the Tennessee law to be enforced held that lawmakers acted rationally to regulate medical procedures, well within their authority.

The appeals court reversed a trial court that employed a higher level of review, heightened scrutiny, which applies in cases of sex discrimination. Under this more searching examination, the state must identify an important objective and show that the law helps accomplish it.

Follow the AP’s coverage of the U.S. Supreme Court at https://apnews.com/hub/us-supreme-court.