With repeated outbreaks of Hepatitis A cases in Kerala — as of December 30, 2025, the State reported a total of 31,536 confirmed and probable cases of Hepatitis A and 82 deaths, the highest numbers to date — this may be a good time to learn a little more about the condition.
What is Hepatitis A?
Hepatitis A is a liver disease caused by the Hepatitis A virus (HAV). It is a contagious infection, and spreads through contaminated food and water, and through close personal contact with an infected person. In general, it is not a serious illness, and most people recover without specific treatment, but with supportive care. There is a vaccine available against Hepatitis A.
Understanding viral hepatitis
Viral hepatitis refers to hepatitis, or inflammation of the liver, caused by viruses. There are five different viruses causing five separate diseases of the liver. They are: Hepatitis A, B, C, D and E. While Hepatitis B and C can cause chronic liver disease, Hepatitis A, in general, does not, but its symptoms can range from mild to severe.
According to the World Health Organization, Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. Epidemics related to contaminated food or water can erupt explosively. They can also be prolonged, affecting communities for months through person-to-person transmission. Hepatitis A viruses persist in the environment and can withstand food production processes routinely used to inactivate or control bacterial pathogens, it states.
How does it spread?
Hepatitis A is highly contagious. It is transmitted primarily through the faecal-oral route. The virus lives in the faeces and blood of people who have the infection. When an uninfected person consumes food or water that has been contaminated with the faeces of an infected person (through dirty hands when preparing food for instance), or ingests water/food (raw produce) that is contaminated by sewage (due to poor sewage systems) or has close, personal contact with an infected person, the virus can be transmitted.
In Kerala, gaps in sanitation and poor environmental health are believed to be major drivers behind the outbreaks. Experts have pointed to the non-availability of safe drinking water, water lines running close to sewage lines, the widespread use of commercially-bought ice and contamination through cut fruit as some of the methods of transmission.
Signs and symptoms
Hepatitis A has an incubation period of about two to six weeks, which means that signs and symptoms may develop a few weeks after the infection is contracted.
Not everyone with Hepatitis A will have symptoms. Those who do, may experience: fever, tiredness, joint pain, nausea, vomiting, diarrhoea, abdominal pain on the upper right side, itchiness, dark urine, clay-coloured stools, loss of appetite and yellowing of the eyes and skin (jaundice).
Adults are more likely to show symptoms than children.
Treatment and prognosis
A blood test is usually taken to diagnose Hepatitis A. There is no specific treatment for it. Rest, eating a nutritious diet, staying hydrated and supportive care, can all help. Avoiding alcohol and making sure medication is only taken on the advice of a medical professional (as medications can affect the liver) are also important. Recovery can be slow, lasting for weeks or months; however, most people recover completely, with the liver healing within six months, with no lasting damage.
In rare cases however, Hepatitis A can cause fulminant hepatitis (acute liver failure), which can be fatal. This is more likely to occur in people with weakened immune systems.
Vaccination
There are vaccines available for Hepatitis A that offer long-lasting protection. Both live-attenuated and inactivated vaccines are available.
The vaccine is recommended for children above the age of one: the Centers for Disease Control and Prevention, U.S., recommended it for all children aged 12 to 23 months and all all children and adolescents between ages 2–18 years who have not been vaccinated and all people, including pregnant women, with increased risk factors for hepatitis A. However, the United States, on January 5, 2025 ended this longstanding guidance, and Hepatitis A vaccine recommendation has now been removed.
The WHO recommends that vaccination against Hepatitis A virus be introduced into national immunisation schedules for individuals aged ≥12 months, if indicated on the basis of: i) an increasing trend over time of acute hepatitis A disease, including severe disease, among older children, adolescents or adults; ii) changes in the endemicity from high to intermediate; and iii) considerations of cost–effectiveness.
However, the Hepatitis A vaccine is not part of the Indian government’s universal immunisation programme (UIP).
The Indian scenario
The Ministry of Health’s National Action Plan Combating Viral Hepatitis in India’s 2019 document notes that viral hepatitis is increasingly being recognised as a public health problem in India. HAV and HEV (Hepatitis E virus) are important causes of acute viral hepatitis and acute liver failure (ALF), it states. “Due to paucity of data, the exact burden of disease for the country is not established. However, available literature indicates a wide range and suggests that HAV is responsible for 10-30% of acute hepatitis and 5-15% of acute liver failure cases in India,” the documents notes.
A research paper, ‘Rising trend of symptomatic infections due to Hepatitis A virus infection in adolescent and adult age group: An observational study from a tertiary care liver institute in India’, published in the Indian Journal of Medical Microbiology in 2024, notes that “the number of adults experiencing symptomatic HAV infection was seen to increase over the years in the present study. Infection in adolescents was associated with higher mortality and ALF as the clinical presentation.”
Calls are now being made to include the Hepatitis A vaccine in India’s UIP: Vipin M. Vashishtha, former national convener, Indian Academy of Paediatrics’ Committee on Immunisation, writing for The Hindu, pointed to improved sanitation and hygiene leading to fewer children being exposed, leaving adolescents and adults unprotected from the immunity the infection can provide, multiple States experiencing outbreaks and seroprevalence studies revealing a steady decline in protective antibodies, to recommend that the vaccine be incorporated into the programme.
