The death toll of the Havelock North gastroenteritis outbreak that shocked the region and the nation may rise.
The Hawke's Bay District Health Board is set to examine a number of deaths in the town at the time of the outbreak three years ago, to determine if they are related.
A Havelock North funeral director says his analysis of death certificates from the time suggests the toll may rise to seven people, three more than the widely-reported four.
More than 5000 people fell ill, 45 were hospitalised and three years on, an unknown number of people continue to suffer health complications.
At the time, it was widely reported that four deaths were linked to the crisis, including 89-year-old Jean Sparksman who was found dead on August 13, 2016, in the serviced apartment she lived in at the Mary Doyle aged care complex.
Coroner Peter Ryan found she died as a result of becoming infected with campylobacter on top of underlying health issues including coronary artery disease.
But that number has never felt right to the funeral directors at Terry Longley & Son, and most importantly, to the families of the three more people whose lives they believe were cut short as a result of campylobacter.
All but one were in the weeks following the outbreak.
The seventh, John Buckley, 78, died on August 29 last year after suffering from atrophibulation due to the campylobacter, his family say.
"For us, it was extremely hard to see so many people with their lives cut short from something that should have been safe," the funeral home's managing director, Shann Longley, said.
He did not want to upset the families involved but believes more needed and still needs to be done for them.
"They've already suffered from an unexpected loss of a loved one and it's not my intention to cause any more grief but I wonder sometimes how families are able to move on with so many questions.
"I also believe that with something that could have been prevented - and is such a big community issue - we need to have some sort of memorial for those who have died and in doing that we would honour their lives, and we certainly haven't done that so far."
He said in any other circumstance where there were up to seven or more deaths, they would be recognised.
Campylobacter is listed as a factor on the death certificates.
In one case, someone died after suffering from a stroke five days earlier. The stroke, and atrial fibrillation, which they had suffered for years, was listed as the cause of death.
"Extreme age" and campylobacter were also listed because the person had been struck down with the illness for the two weeks prior to their death.
Longley said that is related.
"The body was under stress and strain and then they had a stroke."
Another had campylobacter and dehydration as a result, 14 days before they died from heart failure. This death was referred to the coroner.
"Some people had existing conditions. Maybe some of it was from old age, but how do you justify the shortening of someone's life?
"Maybe they would still be alive today or have many years of life left if their life hadn't been taken away. And it left us with a feeling that if an illness was inflicted upon someone and shortened their life, that cause shouldn't be minimised."
This is the focus of one of a number of studies which are looking into the long-term implications of the country's largest waterborne contamination.
Medical Officer of Health Dr Nick Jones said they're hoping to have the research completed either late this year or early next year.
The frailty study is trying to measure the impact on elderly people who may have ended up needing more home care and support afterwards. Furthermore, it is trying to ascertain what increase in the number of people dying "really was".
"As you can imagine that's not something that we have reports on.
"Our information relies on doctors actually letting us know that they think on balance that that death was associated with the infection and that isn't always the case. That's why we are doing a more active study on that," Jones said.