Hepatitis A cases rise in State

Widespread contamination of groundwater sources, huge gaps in sanitation and poor environmental public health in general has been driving explosive outbreaks of Hepatitis A in Kerala since the past several years.

This is exacerbated by epidemiological factors, such as the shift in the age group susceptible for infection, from early childhood to adolescence and young adulthood in Kerala, which means that there could be more outbreaks, increased mortality and morbidity.

Kerala’s recent Hepatitis A outbreaks are not random, isolated events but these seem to be part of a pattern, especially in northern districts which have been experiencing repeated outbreaks. Almost all Hep A outbreaks in the State over the decade have been in rural areas wherein provision of safe, piped drinking water is nil and people are serviced by local water supply schemes which may not be designed scientifically and regular water quality surveillance would be poor.

For a State which takes much pride in its achievements in public health, general health infrastructure and provision of advanced medical care, it is indeed a disgrace that it is still not able to provide people the most basic of public health requirements, which is safe drinking water, public health experts point out.

The last two years have seen the mortality and morbidity due to Hep A multiply by several fold in the State. In 2023, Kerala reported a total of 4,581 cases of Hep A (including probable cases) and 15 deaths.

As on December 30, 2025, Kerala has reported a total of 31,536 confirmed and probable cases of Hep A and 82 deaths, the highest numbers till date.

The year 2024 also had the State reporting a total of 28,412 cases of Hep A and 96 deaths due to the infection.

“ There are huge areas in the State which do not receive treated, piped water supply and in many rural water supply schemes, chlorination might not be proper, the process might not be properly monitored and often we find water lines running too close to sewage lines. In some areas people refuse to drink water that has been boiled, saying it makes the water “dead”,” a senior Health official says.

The widespread use of commercially bought ice to serve cold drinks in juice parlours or during functions, contamination through cut fruits and salads are also other ways in which the virus spreads.

Once Hep A outbreak occurs in an area, it usually takes months months before the outbreak can be controlled because person-to-person transmission occurs rapidly, with the virus spreading amongst close contacts. The transmission is through the faeco-oral route and hand hygiene becomes paramount.

In a 2016 outbreak in Ernakulam, which affected close to 400 persons, Health department had traced the infection to a hotel in the locality and specifically a food handler, who had been engaged to make lime juice

While Hep A is usually a self limiting disease, the disease can have significant morbidity and occasional fatalities when it affects the adult population. Studies done in Kerala have reported that the average out-of-pocket expenditure incurred by a family, when one adult member is infected by Hep A is nearly ₹25,000.

Because of the age shift, in all outbreaks in the recent decade, the most vulnerable have been adolescents and those in the 20-40 year age group.

While vaccination with the two-dose inactivated hepatitis A vaccine or one dose of live attenuated hepatitis A vaccine is the effective method to prevent Hep A infection, cost considerations may have been preventing the inclusion of these vaccines in the health budgets of States.

A June 2024 study in Kerala (Cost-effective analysis of hepatitis A vaccination in Kerala by Gurav Y.K. et.al), reported that among individuals aged 15 years, vaccination program with live attenuated hepatitis A vaccination or inactivated hepatitis A vaccination would be a cost-saving intervention.

However, nothing can replace the importance of the State investing in the provision of safe drinking water supply, proper sewerage systems and consistent water quality surveillance. Super chlorination of water sources during an outbreak is just a stop gap measure, experts say.

Published – January 03, 2026 07:59 pm IST