Kerala reported as many as 104 Hepatitis A outbreaks across various districts in 2024, an alarming reflection of the state's deteriorating water quality. The figures were quoted by Health Minister Veena George in the assembly from the integrated disease surveillance project (IDSP) data while replying to a question on the spread of jaundice.

These outbreaks, which the Minister recounted, came with even more distressing results, as per data. Jaundice claimed 81 lives last year, the highest in a decade. If suspected deaths are also taken into account, the fatality would be 95. The caseload was 7943. The high mortality rate could be attributed to Kerala's proportionate increase in cases, however figures of previous years show that Kerala's cumulative case load and mortality due to jaundice has never crossed 2000 and 30 respectively in the last 10 years.

World Health Organization's note shows that the Hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person. The weekly outbreak report of IDSP issued by the National Centre for Disease Control for 2024 shows that the majority of jaundice outbreaks in Kerala happened due to a contaminated source of water, which was used in festivals, marriage functions and schools.

The source of infection was well water, welcome drink served at weddings and water used for cooking in gatherings. Kerala reported severe jaundice outbreaks in Malappuram, Kozhikode and Ernakulam in 2024.

The quality of drinking water was closely linked to the cause of infection in many of these places. At Eravathukunnu in Kozhikode, where the outbreak was confirmed, the officials reported that most residents depended on public irrigation projects for drinking purposes. The distribution had to be stopped after two wells were found contaminated.

In Vengara, Ernakulam, test results of water samples collected from taps showed that the drinking water supply was contaminated, according to the health department. In February 2024, cases were reported in Cheruvannur in Kozhikode, where 15 infected people had a history of consuming food at a family function. In the same month, 41 cases were reported in Kasaragod, where the patients had a history of having welcome drinks at a marriage function.

In Malappuram, an outbreak of 47 cases was reported, and the source was traced to canteen food. Fifty-seven cases and one death were reported at Kizhakoth village in Kozhikode in March, and the infected people had attended a wedding.

Fatality due to jaundice rose so much that it even replaced flu as the third leading cause of death due to communicable diseases in Kerala. The disease has claimed the lives of youngsters and people in the age group 30-45 in 2024.

Health experts point out that earlier, previous generations would get infected with jaundice and gain immunity during childhood. "Hepatitis A is milder and asymptomatic when infected in children. Earlier generations would acquire immunity, and infection at a later stage in their life wouldn't be severe. However, the present generation is not exposed to disease as children. When they get infected in adulthood, the infection is severe, sometimes leading to death. This also affects herd immunity; the chain gets broken, and transmission happens faster," according to health experts.

"The soaring number of cases is an indicator of Kerala's poor standards in water quality. Studies on Hepatitis A antibodies seroprevalence have shown that there has been a dip in the percentage of the population in Kerala with immunity to Hepatitis A," an epidemiologist said.