Return of the Water Devil: Kerala need to be cautious about Hepatitis A Outbreaks

Abstract

Hepatitis A, a self-limiting viral disease, is the most common form of acute viral hepatitis worldwide. Hepatitis A virus (HAV) infection occurs sporadically and epidemically and every year there are about 1.4 million cases of hepatitis A occurring worldwide. Even though a significant proportion remains asymptomatic and most of the infected persons recover completely, HAV infection causes significant morbidity. People affected with HAV may take a few months to return to work, school, or daily life and so itself HAV infections can lead to economic losses and social consequences in the community.

Kerala is one state where early and rapid socioeconomic development and urbanization happened. Ironically, these improved economic and sanitary conditions lead to a higher susceptibility in older age groups and higher disease rates and large outbreaks can occur. Improvement in hygienic and socio-economic conditions in the state might have resulted in a decrease in the number of natural childhood infections.

A substantial proportion of individuals in Kerala were not exposed to HAV until adulthood. A mild contamination of water with HAV in such scenario is sufficient to lead to explosive hepatitis A outbreaks. These findings reiterate the fact that huge outbreaks of hepatitis A have to be expected in the state in coming years.