Local retailers are removing products that contain peanut butter from their shelves, including cookies, energy bars and crackers, as a recall widens across the nation for products linked to a salmonella outbreak.

Since September, 488 people have become sick in 43 states, including three in Hawai'i and one in Canada, from a type of salmonella bacteria.

The three Hawai'i patients have recovered.

Federal health authorities are investigating products from the Peanut Corp. of America's Georgia facility that are used by other companies to make consumer food products.

The state Department of Health is advising people who are concerned to check the U.S. Food and Drug Administration Web site (www.fda.gov) for a list of products that are affected. Recalled items can be returned for a refund, said Janice Kubo, DOH spokeswoman.

"Otherwise it's always safest to throw it away if you have any concerns," Kubo said, adding that if people come down with symptoms such as diarrhea, cramping and fever they should see their doctor. "If it's confirmed the department will get that information and then we'll be doing a follow-up."

About 45 items appeared on the FDA list yesterday, including 10 new items. Dough-to-Go of Santa Clara, Calif., yesterday said it is recalling several cookie dough products that contain peanut butter, including dough sold under the Auntie Ono brand in Hawai'i.

Times, Safeway and Foodland supermarkets said they have removed items that appear on the list, although they do not carry all of the items.

The DOH said about one-third of the items can be found in Hawai'i and it is working on a list to fax to major retailers. Mom-and-pop shops rarely have fax machines so a DOH investigator will have to personally visit those types of stores, said Lynn Nakasone, program manager for the DOH Food and Drug Branch.

Sheryl Toda, Foodland spokeswoman, said the company started taking items off the shelf on Jan. 16, when Keebler recalled its Peanut Butter Sandwich Crackers and Soft Batch Peanut Butter Cookies. On Jan. 19 Foodland and its Sack 'N Save stores removed Clif, Luna and ZonePerfect energy bars.

The store doesn't carry many of the items, Toda said. "All of the other peanut butter products in our store including jar peanut butter, cereal, ice cream are not affected by the Peanut Corp. of America recall."

The store receives recall information by e-mail from the FDA and it is acted upon immediately, she said.

The Girl Scouts announced this week that their cookies, expected to be distributed in March, are not made with any product from Peanut Corp.

The Scouts have begun their annual cookie drive and wanted to ensure the public, said Tammy Yamanoha, Girl Scouts of Hawaii spokeswoman. "That's not even our source of peanut butter so it's not affecting any of the Girl Scouts cookies," she said.

The three cases in Hawai'i with possible link to the peanut butter consumption have recovered, according to Michele Nakata, chief for the DOH disease investigation branch.

The patients were all children who didn't know each other but all were peanut butter consumers, Nakata said. There was a 10-year-old boy, a 5-year-old girl and a 16-year-old girl.

Of the 488 people who became sick 60 percent could not be linked to the contaminated product, including the Hawai'i children, she said.

The process for determining that is extensive, including a 30-page questionnaire and genetic testing of the bacteria. There are other possible ways that they could be linked such as through other ingredients in a product, Nakata said.

And while the three children had similar type of salmonella strain as those on the Mainland, they had no connection to the products under investigation, Nakata said.

"There isn't anything that we've identified in their food history that definitely has a link with the products that have been identified as being positive," she said.