Why Hepatitis A is no longer a simple disease in Kerala
Kerala has been experiencing explosive outbreaks of Hepatitis A, with increased mortality and morbidity, over the last four years Clinicians and public health experts in
Kerala has been experiencing explosive outbreaks of Hepatitis A, with increased mortality and morbidity, over the last four years Clinicians and public health experts in the State have now issued a warning that Hep A is no longer a simple disease in the State because of the age shift in the susceptible population, from children to young adults. Doctors are reporting severe and atypical symptoms in those affected, including a prolonged phase of high liver enzyme levels, extra-hepatic complications such as bone marrow suppression and many young adults going into fulminant hepatitis requiring liver transplantation. If the government cannot ensure safe drinking water for the people, then the least it can do is protect people through universal Hep A vaccination, they point out. What’s happening Last year, (as on December 30), Kerala had reported a total of 31,536 confirmed and probable cases of Hep A and 82 deaths. In 2024, the State had reported 28,412 cases and 96 deaths. The situation is no better this year, with 12,437 (confirmed and probable) cases and 125 deaths, of which 69 are confirmed Hep A deaths. “The Malappuram-Kozhikode belt continues to be the hub of water-borne infectious diseases, especially Hep A and Shigellosis, in the State. Clinicians have been seeing severe Hep A with dysregulated or inflammatory response, requiring treatment with steroids.This cytokine storm is something we have been seeing in many infectious diseases now, especially post-Covid,” says R.
Aravind, head of infectious diseases, Thiruvananthapuram Government Medical College. What’s changing Across India, Hep A has traditionally been a universal childhood disease, which is mild and self-resolving, leaving those affected with life-long immunity against the disease. But in Kerala, better socio economic status and improved sanitation meant that children grew up without exposure to Hep A, becoming immunologically naive adults, vulnerable to all complications of adult hepatitis The epidemiological shift in the age group of Hep A patients is very evident, with 90% of the patients in the 18-40 years age group, for whom eating out, especially from wayside shops and so-called exotic juice shops, is a way of life, says V.K. Shameer, assistant professor of general medicine, Kozhikode Government Medical College. “Over the last two years, the Hep A case load has been huge and we see a lot of complications. In about 1% of the cases, patients went into acute liver failure and death, and some others ended up requiring a liver transplant,” Dr. Shameer says. Many patients who went into acute liver failure were saved using the plasmapheresis procedure, which has been incorporated into the State’s Hep A management protocols since the last two years. “We also had a youngster who developed the rare complication of bone marrow suppression following Hep A, which progressed to hepatitis-associated aplastic anaemia, requiring a bone marrow transplant,” he notes. In several others who apparently recovered, the bilirubin levels remained high for three to six months, also known as relapsing or cholestatic hepatitis.
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