Hepatitis A Kerala Outbreak: What's Causing It and How to Stay Safe

For the past few years, Kerala has continuously seen isolated cases of Hepatitis A outbreaks, especially in rural areas. However, by the end of December 2025, the state reported a record of more than 31,000 confirmed cases and 82 deaths, the highest to date. The outbreak is not a sudden event but a reflection of how a state taking pride in its public health infrastructure still lacks basic medical facilities in rural areas, especially in northern districts, including safe drinking water and proper sanitation systems.

Kerala has hit its highest number of Hepatitis A cases, particularly coming from districts like Ernakulam, Malappuram, Kozhikode, and Kollam, and the infection has spread from children to teenagers. To understand p the cause of this spread, the symptoms, and what people can do to safeguard themselves and their families during this outbreak, we reached out to Dr Pooja Pillai, Consultant - Internal Medicine at Aster CMI Hospital, Bangalore. Continue reading to know what she shared with us.

Hepatitis A Outbreak In Kerala

Kerala’s recent outbreak of this preventable infection is not a random occurrence but has become an easily noticeable pattern over the past few years. According to reports, the state has seen mortality and morbidity rates shooting up in the past two years. In 2023, Kerala recorded more than 4,500 cases (including probable cases) and 15 deaths. In 2024, the state reported over 28,000 cases and 96 deaths due to this infection. Breaking the record in 2025, the state has recorded more than 31,000 cases (including probable cases) and 82 deaths.

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Reports indicate that contaminated groundwater, poor sanitation, and a lack of hygiene in local areas are the major causes behind this deadly outbreak.

Explaining what could be the major cause behind this outbreak, Dr Pillai shared, “In this current outbreak, the major contributor is believed to be contaminated water sources, as a result of improper sanitation, especially in schools.”

What Is Hepatitis A Virus?

Hepatitis A is a viral infection that mainly targets the liver and is transmitted through a faeco-oral route, most probably through eating infected food and water or through improper washing of hands. According to the World Health Organization (WHO), this contagious infection has a close link with inadequate sanitation, poor personal hygiene, and oral-anal sex.

As mentioned in the WHO report, Hepatitis A does not cause chronic liver disease, but it can cause mild to severe symptoms and, rarely, fulminant hepatitis (acute liver failure), which is often fatal.

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Explaining how this virus affects the body, Dr Pillai mentioned, “After being ingested, this virus migrates to the liver and results in liver inflammation and impairment of the liver functions of detoxifying blood, processing nutrients, and producing vital proteins.”

However, she also noted that Hepatitis A does not produce a chronic form of liver disease or a carrier state, unlike Hepatitis B and Hepatitis C. In the majority of cases, a complete recovery takes place, but it can be serious in young children and older people.

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What Is Causing The Spike?

According to Dr Pillai, "Hepatitis A outbreaks are usually caused by eating or drinking food or water contaminated with the hepatitis A virus. This virus is essentially a result of poor hygiene and improper sanitation. Cases spike, especially during the monsoon, if water sources are not properly treated or protected.”

The virus spreads through the faecal-oral route, meaning it can pass from an infected person to others through contaminated surfaces, food, or drinks.

Dr Pillai further mentioned that these outbreaks are more likely in rural and crowded places where water treatment is poor, and where sanitation, safe drinking water, clean toilets, basic hygiene habits, and vaccination are not readily available.

Silent Symptoms Of Hepatitis A

In general, Hepatitis A is considered a silent virus that does not show any visible signs or may be misunderstood with other illnesses like food poisoning or regular fever, making it undetected for long periods. According to the WHO, its incubation period lies between 14 to 28 days, and its symptoms range from mild to severe. Here are a few initial symptoms of Hepatitis A shared by Dr Pillai:

• Fever and body ache
• Fatigue and weakness
• Malaise
• Loss of appetite
• Gastrointestinal upset
• Diarrhoea
• Nausea
• Abdominal discomfort
• Dark-coloured urine
• Jaundice (a yellowing of the eyes and skin)

However, as Dr Pillai shared, by the time jaundice or brown urine appears, the inflammation of the liver is already quite advanced. “Children usually do not suffer from extreme symptoms, which is concerning, as this contributes to Hepatitis spreading undetected in schools or neighbourhoods,” she stated.

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Who Is Most At Risk

• People above the age of 50 are more at risk of developing severe symptoms.
• Individuals living with pre-existing conditions, chronic health problems, or Hepatitis B and C.
• Individuals with a weak immune system or those living with HIV and AIDS are considered among the most vulnerable to this disease.

Why is prevention a greater priority than treatment in Hepatitis A?

Explaining why doctors always emphasise preventive measures more than treatment when it comes to Hepatitis A, Dr Pillai said, “There is no specific treatment to counter Hepatitis A once it is contracted. Treatment focuses mostly on rest, hydration, and monitoring the patient’s liver function. Severe infections may warrant hospitalisation, while in certain circumstances, acute liver failure may occur.”

Clean water, alongside personal and environmental cleanliness, is far more effective in combating the Hepatitis A virus than any other treatment mechanism.

How to Protect Yourself

Dr Pillai shared how one can protect oneself and one's family during such outbreaks:

• Ensure drinking water is boiled or filtered.
• Avoid street food as well as raw or undercooked foods.
• Wash your hands thoroughly before and after meals and after using the toilet.
• Ensure children receive the vaccination if they are eligible.

“A lapse in any of these measures during an outbreak can cause further spread,” she mentioned.

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Regarding community-level action, Dr Pillai suggested:

• Authorities should ensure adequate supplies of safe drinking water.
• Proper disposal of sewage within communities is a vital step.
• Awareness regarding safe sex practices, including the use of condoms and dental dams, as well as good hygiene, should be promoted.
• Vaccination campaigns against the Hepatitis A virus are considered highly effective.
• During outbreaks, physical contact with infected individuals should be avoided.

Conclusion

The Hepatitis A outbreak in Kerala has raised concerns not only for the state but across the nation. While urban parts of the country possess super-speciality hospitals, indicating advanced medical infrastructure, such outbreaks in states like Kerala highlight the stark reality that many still lack access to basic hygiene, sanitation, proper tracing, and essential medical facilities. However, Dr Pillai emphasised that Hepatitis A is completely preventable and manageable if the correct measures are taken on time.