Kerala is currently battling a severe Hepatitis A outbreak, with over 31,500 cases and 82 deaths reported by late December 2025. This alarming surge marks the highest numbers recorded for the state to date, driven largely by contaminated groundwater and poor sanitation^[1][2][3]. The highly contagious liver infection poses a significant public health challenge, particularly as outbreaks have become more frequent in recent years. ### Rising Cases and Key Affected Areas The latest figures from Kerala's health department show a dramatic increase in Hepatitis A infections. As of December 30, 2025, the state confirmed 31,536 probable and confirmed cases, along with 82 fatalities^[2]. This represents a substantial jump from the 28,412 cases and 96 deaths reported in 2024^[2][3]. In 2023, Kerala recorded 4,581 cases and 15 deaths, highlighting a multiplying trend in morbidity and mortality over the last two years^[2][3]. Several districts in Kerala are particularly hard-hit by the recurring outbreaks. Malappuram, Kozhikode, and Ernakulam consistently report high numbers of cases^[4][5][6][7]. Thrissur and Kollam have also seen a significant burden of the disease^[5][8]. The onset of the monsoon season often correlates with an increase in cases, as heavy rains and flooding can exacerbate water contamination risks^[4][5][7]. Public health experts note that many outbreaks occur in rural areas. These regions often lack safe, piped drinking water supplies. Instead, residents rely on local water schemes that may not be scientifically designed or properly monitored for water quality^[2]. ### How Hepatitis A Spreads Hepatitis A is a contagious liver infection caused by the Hepatitis A virus (HAV). The virus primarily spreads through the fecal-oral route^{[9][10][11][4][2][3]}. This means an uninfected person ingests food or water contaminated with the feces of someone already infected^{[9][10][11][3]}. The virus can be present in an infected person's stool and blood^[12][11][13]. People can also spread the virus even before they start feeling sick^[13]. Contaminated food and water sources are the main drivers of transmission. This includes drinking unsafe water or eating food prepared by an infected person who did not wash their hands thoroughly after using the bathroom^{[12][10][11][14][3]}. Specific high-risk items include raw or undercooked shellfish harvested from polluted waters, as well as commercially bought ice, cut fruits, and salads^{[10][11][15][14][16][2][3]}. In 2016, an outbreak in Ernakulam affecting nearly 400 people was traced to a hotel food handler preparing lime juice^[2][17]. Close personal contact also facilitates the spread of Hepatitis A. This can happen through sexual contact, particularly oral-anal contact^{[9][11][13][14]}. Living in the same household or caring for an infected person also increases the risk of transmission^{[9][12][10][11][13][3]}. Sharing injectable drugs is another, though less common, mode of spread^[11][13]. ### Shifting Demographics and Health Impact Historically, Hepatitis A infections were more common in early childhood. However, Kerala has seen a significant shift in the age group most susceptible to the virus. Adolescents and young adults, typically between 20 and 40 years old, are now the most vulnerable^[2][17][8]. This change means that more adults now lack immunity, making them more susceptible to infection^[8]. While Hepatitis A is often a self-limiting disease, meaning most people recover fully, it can cause severe illness^[9][12][3]. Adults, older people, pregnant women, and individuals with pre-existing liver conditions, diabetes, or alcoholism face a higher risk of complications and even death^{[9][11][2][8][3][18]}. In rare cases, it can lead to acute liver failure, which is often fatal^[9][3][18]. Recovery from symptoms can be slow, sometimes taking several weeks or months^[9][12][13]. Studies in Kerala show that a family can incur an average out-of-pocket expenditure of nearly ₹25,000 when an adult member is infected. ^[2] The rise in cases is also linked to changing food consumption habits in Kerala. Following the COVID-19 pandemic, there has been a notable increase in dining at restaurants and street food stalls. The rapid growth of these establishments, especially street food vendors, has contributed to the spread of the virus. ^[5] ### Staying Safe and Preventing Infection Preventing Hepatitis A largely relies on a combination of vaccination and strict hygiene practices. The most effective way to protect against the virus is through vaccination. ^{[9][15][14][16][19][3]}Safe and effective vaccines are available and recommended for all children as a routine immunization. ^[9][14][19]Certain high-risk adults, such as those traveling to endemic areas, individuals with chronic liver disease, or men who have sex with men, should also get vaccinated. ^{[9][14][16][19]}A single dose of the Hepatitis A vaccine can help prevent infection if administered within two weeks of exposure. ^[13][19] Practicing good personal hygiene is crucial to curb the spread of the virus. This includes thoroughly washing hands with soap and warm water after using the bathroom, changing diapers, and before preparing or eating food. ^{[9][13][15][14][16][19][2][3]}Keeping nails clean and trimmed also helps. ^[14] Ensuring food and water safety is paramount. Communities need adequate supplies of safe drinking water and proper sewage disposal systems. ^[9]When in areas with potential contamination risks, it is advisable to boil water or drink bottled water. ^[15][16]Only consume foods that are well-cooked, and peel raw fruits and vegetables yourself. ^[15][16]Avoiding raw or steamed shellfish is also recommended. ^[15][14][16]If someone is infected with Hepatitis A, they should avoid preparing food or beverages for others. ^[12][14][16] Health officials in Kerala are intensifying efforts to contain the outbreak, including super-chlorinating water sources in affected areas. ^[6][20]However, experts like Dr. Rajeev Jayadevan, convenor of the Indian Medical Association Research Cell, emphasize that these measures alone are not enough. He stresses the need for consistent efforts to clean and purify water sources, curb illegal waste dumping, and implement scientifically proven methods for septic waste disposal. ^[6] The challenges in Kerala also include public resistance to drinking boiled water, with some believing it makes the water “dead,” a senior Health official says. Addr^[2]essing these behavioral aspects and ensuring widespread access to safe water and sanitation infrastructure are vital steps in controlling Hepatitis A and safeguarding public health. As Kerala navigates this ongoing Hepatitis A crisis, a concerted effort from health authorities and the public is essential to break the chain of transmission and prevent further loss of life.

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