Malappuram: The southern state of Kerala is experiencing a severe outbreak of the viral waterborne disease Hepatitis A. The crisis coincides with a heatwave in Kerala with temperatures exceeding 40 degrees Celsius in some places. “The heatwave in Kerala has led to a scarcity of clean water in many districts, this leads local vendors and the public to use water from contaminated sources. This problem gets further aggravated by a lack of sanitation and cleanliness in several areas, which in turn is related to a lack of water resources,” said Renuka R, Malappuram’s District Medical Officer.

Roadside food stall owners, hotels, and restaurants are under scrutiny in terms of food hygiene as food can get contaminated at any point during the production process when it comes in contact with contaminated water.  “Our local health staff visits food establishments and conducts inspections, regarding hygiene, sanitation, food licenses, mandatory staff health check-ups. Furthermore, we have also temporarily shut down several places as they did not meet the safety requirements,” says Renuka.

Experts say the virus can survive in temperatures as high as 85 degrees Celsius, making boiling of water the only feasible solution to control the spread of the disease.  “Boiled water can kill the virus, however, it has to be brought to a complete boil (100 degrees Celsius) to kill the virus,” says Nithin S Babu, a Kottayam-based epidemiologist. Apart from this, “maintaining proper sanitary hygiene in homes and restaurants, and effective and regular public health inspections can also curb the spread of this disease”, he adds.

Hepatitis A outbreaks are a recurring phenomenon in Kerala, happening annually, but there has been a gradual increase in case numbers over the years. The outbreak in 2024 has been one of the most severe in recent memory, with the district of Malappuram bearing the brunt of the impact.

The Kerala Health Department’s Integrated Disease Surveillance Programme (IDSF) reports that this year as of 31 March, there have been 3,270 probable cases of hepatitis A and 1,055 confirmed cases. There have been 11 suspected/probable hepatitis A deaths and five confirmed deaths. However, the count of deaths due to the disease is higher than reported figures, according to local sources in Malappuram. It is also noteworthy that cases have almost doubled in March as Kerala braces for another record-breaking summer season.

Hepatitis A is caused by a viral infection that affects the liver. It causes mild to severe illness with the infection lasting for up to two months. Food poisoning is a typical way for Hepatitis A to spread. It can also happen if you have close intimate contact with an infected person. The virus is present in the blood and faeces of infected individuals. It spreads when it enters an uninfected person’s body, usually through the mouth.

Kerala:What citizens can do to rein in the Hepatitis A outbreak

The problem with vaccination

The health department may have been doing its due diligence but it can often seem short-staffed compared to the number of establishments they need to monitor. Ankit Singh, Head of Partnerships at VaccineOnWheels, took to LinkedIn and informed in a post that eateries were negligent in enforcing healthy sanitary and hygiene practices in the state of Kerala in their sample study. “We discovered a distressing reality. Out of every ten places we visited, a staggering nine failed to adhere to FSSAI mandatory compliances regarding vaccination against all four enteric group diseases and routine health check-ups. This not only poses a significant public health risk but also raises questions about the efficacy of compliance checks conducted by regulatory officers.”

Vaccinations not being under the Central Government’s schedule also restrict the local health authorities. “We can only advise for the administration of a vaccine; however, since vaccination for Hepatitis A is not made mandatory by the Government of India, we cannot administer vaccines on our own. If a person wants to get vaccinated, they will need to buy it on their own, at a cost of about 600 rupees.”

What can you do to protect yourself?

Kerala State Health Department advises the following to avoid a possible infection from the virus:
* Use only boiled water for drinking. Even if it is from an RO plant/filter, boil it before drinking.
* Wash vegetables and fruits thoroughly in clean water.
* Cook food thoroughly before consumption.
* Do not eat exposed or cold food items.
* Ensure that cold drinks, pickles, ice cream, etc., are prepared with clean water.
* Use chlorine tablets to disinfect water used for washing dishes etc.
* Wash hands thoroughly with soap after using the toilets.
* Wash hands with soap before starting to cook food and before serving food.
* Keep nails clean and trimmed.
* To prevent germs from entering the water from the stool of infected persons, open defecation should not be practised under any circumstances.

(With inputs from Father Bijo from Radio Mattoli 90.4 FM )