Kerala has been experiencing explosive outbreaks of Hepatitis A , with increased mortality and morbidity, over the last four years
What Happened
Shameer, associate 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. 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.
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. 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. 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. In about 1% of the cases, patients went into acute liver failure and death, and some others ended up requiring a liver transplant,” Dr. 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%) In yet another study published in April 2026 in BMC Infectious Diseases , based on Kerala surveillance data, researchers examined more than 34,000 confirmed and probable HAV cases between 2020 and 2024, alongside detailed immune profiling of infected patients. 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.
Shameer says.
