The health team probing the deaths of two sisters due to Hepatitis A in Kollam is dealing with a colony stricken by a virulent strain due to highly contaminated circumstances worsened by the dangerous trend of injection drug use. Disease investigation experts were initially puzzled by the nature of the mortality of the two girls. Meenakshi, who hailed from Cherikkonam in Kannanallor, 19, died of Hepatitis A on May 16, while her sister Neethu, 17, died on May 18.

While Hepatitis A mortality is relatively low, the deaths of two girls because of the same disease within a short span of time were considered unusual. The sudden progression of the disease soon after the onset of symptoms remains another mystery. Health officials said that in the absence of any underlying health condition, Hepatitis A generally doesn’t progress to a serious condition.

However, both the girls’ conditions worsened quickly, and death occurred within 3-4 days of the onset of symptoms. The officials are awaiting autopsy report and toxicology results to find out if any other factor may have led to sudden death, however body of Neethu was released to relatives without conducting autopsy.  

“They were not known to have contracted any co-infection. We also probed whether they were administered with any herbs by traditional healers. Initial investigation showed they didn’t consume any such traditional medicine. They also did not test positive for any other disease,” a health official said.

 What makes it even more complex is that the team has discovered the prevalence of Hepatitis B and C in the colony. Hepatitis B spreads via bodily fluids, while a person contracts Hepatitis C from blood-to-blood contact. Hepatitis A is associated with contaminated food and water. “There are live cases of Hepatitis C in this colony. If any person who has either of these diseases gets infected with Hepatitis A, it is like a double hit, and the chances of fatality increase,” an official said. The police have also communicated details of youths suspected of injection drug abuse to the disease investigation team. “We have collected the medical history of such youths and they are under surveillance,” the official said.

Water samples collected from the residential area have confirmed the presence of E. Coli bacteria, which can lead to infection. A medical camp was organised in the colony on Tuesday, and over 200 residents' samples were collected for testing.

Samples of girls who died of Hepatitis A are likely to be sent for genomic sequencing to determine variants and virus evolution. The team is also looking at the possibility of congenital defects in girls, which may have caused liver damage.

The index patient in this case is the girls’ youngest brother, Ambadi. In April, he was diagnosed with Hepatitis A and was hospitalised for almost a month. During this period, he was also confirmed with Hepatic encephalopathy, a condition which results in the accumulation of toxins in the blood and later affects the brain, causing disorientation. The boy was also diagnosed with Dengue. He recovered after prolonged hospitalisation but had to be shifted to a private hospital last week. The parents have not shown any symptoms so far, and their samples have been collected for testing.

In 2025, Kerala has recorded 4267 confirmed Hepatitis A cases and 30 deaths so far. The Kollam episode reflects Kerala's worrying rise in Hepatitis A cases. In 2024, as many as 104 Hepatitis A outbreaks were confirmed across various districts. The disease 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. Previous years' figures show that Kerala's cumulative case load and mortality due to Hepatitis A have never crossed 2000 and 30, respectively, in the last 10 years.