UPDATE: The number of E. coli cases linked to the Cleveland County Fair jumped to 21 on Sunday, according to health officials.

So far, there are 20 cases in North Carolina and one in South Carolina. Seven adults and 14 children have been impacted and one child died from complications.

There are 10 cases in Cleveland County, five in Gaston County, five in Lincoln County and one in York County, S.C.

State and local health department officials are interviewing people sickened as part of the outbreak, and people who attended the fair by did not get sick. They are still trying to determine a cause of the outbreak.

Gage Lefevers, 2, died Friday night at Levine Children’s Hospital from complications from an E. coli infection. The Gaston County toddler is one of 20 people who got sick after going to the Cleveland County Fair.

Health officials updated their numbers Saturday to include six adults and 14 children.

Cleveland County has nine possible cases, up from seven on Friday. Lincoln County has five, up from three. Gaston County stands at five and York County has one.

Gage would ocassionaly join his grandparents for church at Trinity Church of the Living God in Kings Mountain.

They prayed he would recover from E. coli. Church members prepared Saturday to comfort his grieving family.

“It saddens me for a little boy that young,” said church secretary Claudine Cobb. “But he’s with Jesus now. We know where he’s at.”

His death is also a blow to health officials.

“We are deeply saddened by his death,” said Gaston County Health Director Chris Dobbins.

There was another conference call Saturday afternoon between health officials from the state and the four affected counties.

They learned the number of reported cases linked to the Cleveland County Fair has grown. There were four on Tuesday. By Saturday, there were 20.

"We are trying to back everything up so we can try to locate the source of the outbreak," Dobbins said.

Four patients have the life-threatening strain of E. coli that infects the kidneys.

The latest is 5-year-old Hannah Roberts.

Jordan McNair, 12, is one of the three already on dialysis.

His family is convinced he got sick from something he came in contact with at the fair.

"The fair should have been a safer place," said Bennie McClannon, McNair’s grandmother.

Health officials said all 20 patients got sick after visiting the fair, but got have not deemed it the source of the outbreak.

Wednesday will mark 11 days since the fair ended and the end of the incubation period for E. coli.

Investigators said there should be no more new direct cases then. However, officials added it can be transmitted person-to-person, so they may not be completely out of the woods.