The what, why and how of Hepatitis A

With Kerala reporting 1,977 Hepatitis A cases so far this year, TNIE speaks to authorities and health professionals about the reasons behind the outbreak and preventive steps being taken
According to available data, the state has recorded 5,536 suspected cases of Hepatitis A, and 15 suspected deaths.
According to available data, the state has recorded 5,536 suspected cases of Hepatitis A, and 15 suspected deaths.Express Illustrations

KOCHI: Since 2011, Kerala has seen several Hepatitis A outbreaks. This year, the caseload until May is 1,977 and 12 deaths with outbreaks being reported from several parts of the state, indicating that the total count this year could very well top the decade chart.

According to available data, the state has recorded 5,536 suspected cases of Hepatitis A, and 15 suspected deaths.

Hepatitis A, commonly referred to as jaundice, is a viral disease transmitted mainly through contaminated water sources. Symptoms include fatigue, loss of appetite, nausea, vomiting, and, in severe cases, liver damage and even death. The symptoms generally manifest in the body within 15 to 40 days of being infected.

Barring the pandemic years, Hepatitis A cases have been reported frequently as small and large outbreaks over past one and a half decades, and seen a steady rise. The number of deaths too has been constant if not higher. A matter of concern is that the disease’s occurrence is not restricted to summer months, as is commonly believed.

According to the data from the Directorate of Health Services (DHS), in recent times, the disease has been reported round the year. Though districts such as Thiruvananthapuram are also showing a steady increase, district medical authorities are not yet terming it an outbreak as the cases are scattered and hence not that concerning.

“There are no outbreaks in Thiruvananthapuram, just a minimal rise, so far,” says a senior district medical authority, not wishing to be named.

“Last year’s count was 33. This year, 32 cases have been reported so far. As countermeasures, we have convened meetings with related sectors in 72 local bodies and called for repairing broken taps to plug leaks and contamination of utility water supply sources along with chlorination and super chlorination of wells and other water sources. We are observing the situation closely and insisting on measures to nip any outbreak in the bud,” the officer adds.

Across other districts, especially northern ones, there is a scurry in the government machinery as corporations and panchayats are embarking on a host of measures to contain the outbreaks. Kozhikode has launched several clean-up and waste disposal campaigns. In Kannur, a study has been initiated by the district medical authorities on the outbreak.

In Ernakulam, where crisis loomed large at Vengoor with over 220 people admitted to hospitals following contamination of drinking water supplied from KWA’s Choorathodu pumping station, the public health officials launched a series of measures, including water quality checks, plugging holes in the supply system with KWA authorities, ensuring hygiene, and also insisting on chlorination.

“The count in the district may be higher than before but it is mainly due to cases such as in Vengoor, where 241 of the 600 cases in the district were reported. Other than that, there are sporadic cases. We have taken action to contain these,” says Dr Sakeena K, District Medical Officer, Ernakulam.

The culprit this time too, according to most district officials, is unsafe water distribution. During the rainy season, contamination happens when supply water mixes with unclean groundwater due to faults in the pipelines. During summer, water scarcity puts pressure on the supply system to tap local sources.

“Chlorination is insisted but in summer, the pressure is to supply more water faster. Hence, there may not be enough time for proper chlorination. Thus, the water supplied remains untreated,” says Dr Aneesh T S of the Department of Community Medicine from Government Medical College, Thiruvananthapuram. Though technological advances such as pipeline chlorination can be adapted during such situations, they are yet to be taken up in most places.

Authorities of each district claim they have launched campaigns to curb the rising cases, by asking people to ensure the water they use is chlorinated and boiled. Those in hostels and such facilities have been asked to take added care. Action has also been taken against eateries where such contamination was reported.

“In our district, we have convened panchayat-level meetings. We discussed with authorities concerned about damage to pipelines, some of which are half a century old, about ways to better the water supply. Proposals have been submitted to the state authorities based on these deliberations,” says Dr Sakeena.

Surveillance of water quality, norms to ensure food safety and a proper vaccination strategy are key to tackling Hepatitis A, say medical practitioners. A recent health department statement also asks adults contracting Hepatitis A to take extra care, as the virus affects the liver.

In some fatal cases, hepatic failure was the cause of sudden deaths. According to Dr Aneesh, the poor liver health of Keralites nowadays could be a major factor for the rising fatal cases, especially among the adult population.

“Reports from the National Institute of Virology say the virus has not mutated to be virulent. Then the obvious reason could be the poor liver health, which could be due to lifestyle diseases as well,” he says.

‘No proper plans’

Whatever is being done now to curb and contain Hepatitis A outbreaks or even other communicable diseases are mere responses rather than proper plans to address the issue, says Rajeev Sadanandan, former additional chief secretary of the Department of Health and Family Welfare. He says the root cause of such preventable diseases, not just Hepatitis A, is yet to be addressed head-on in Kerala.

“The public health system here mostly responds to an outbreak rather than analyse it and try to find the reasons behind it. Hepatitis A can be addressed promptly because it is water-borne and by ensuring health and hygiene, it can be contained efficiently,” he adds. But the fact that a rising occurrence of Hepatitis A since 2011 has not paved the way for a proper plan in place to address the issue shows the system needs to be more serious about handling public health, he says. “With climate change showing its effects more and more, the situation would worsen in the years to come if the authorities do not pull up their socks and devise a proper plan,” he warns.

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