Kerala has been experiencing explosive outbreaks of Hepatitis A , with increased mortality and morbidity, over the last four years
Why It Matters
Because of the age shift in the susceptible population, from children to young adults, 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.
Why vaccination is needed
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. A multi-centre study done across six tertiary care hospitals in Kerala in 2024-25, ‘Clinicopathological Profile and Outcomes of Severe Hepatitis A Outbreak in India: A Multicenter Cross-sectional Study’, which studied 324 adults (mean age 32 years) with confirmed Hep A, reported that Kerala was witnessing a paradigm shift in Hep A — from a benign childhood illness to a multisystem disease in adults characterised by immune dysregulation, extra-hepatic organ involvement and higher mortality. The researchers reported atypical features such as pulmonary complications (16.8%), acute kidney injury (13.4%), hemophagocytic lymphohistiocytosis (HLH) in 12.8%. Therapeutic interventions included high steroid use (30%), plasmapheresis (21%), continuous renal replacement therapy (7.8%) and mechanical ventilation (10%) The study reported that adults infected later in life had 8.4 times higher odds of moderate-to-severe disease. The immunological profile done in Hep A patients showed that adults have a larger reservoir of CD 8 and primed memory T cells, which mount a higher inflammatory cytokine response, resulting in 18% of adults getting hospitalised against zero hospitalisation in those less than 18 years.
Because the economic fallout of huge Hep A outbreaks — apart from high morbidity and loss of lives — is immense,” a senior public health expert says, this is important.
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. “The Malappuram-Kozhikode belt continues to be the hub of water-borne infectious diseases, especially Hep A and Shigellosis, in the State. Aravind, head of infectious diseases, Thiruvananthapuram Government Medical College. 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. Shameer, associate professor of general medicine, Kozhikode Government Medical College. The study was published in the Journal of Clinical and Experimental Hepatology this year. “It is indeed a shame that on one side we are extolling the State’s public health successes and on the other side we are unable to provide safe drinking water to the public. Improving water safety cannot be achieved overnight whereas there are studies proving the cost effectiveness of universal Hep A vaccination in Kerala.
