Written by: Dr Piyush Ranjan
4 min readMay 15, 2024 10:48 PM IST
First published on: May 15, 2024 at 07:13 PM IST
Over the last few days, there have been reports of a massive outbreak of Hepatitis A in Kerala’s Malappuram district, with about 8,000 cases and 12 deaths. Hepatitis A is caused by a virus and is highly contagious; you would definitely see at least two cases in the family of the infected. The latest outbreak could be because of communities using contaminated food and water resources. However, the infection is largely self-limiting with short-term liver inflammation and doesn’t damage the liver in 99 per cent cases. It is the least threatening of all the viruses and complicates matters only in those with serious co-morbidities.
It is because of its high recovery rate that people ignore taking a vaccine for it. But a shot can protect you, particularly the vulnerable population. The recent outbreak is a bit different because Hepatitis A, which usually affects children under 15, is affecting the older population, who have a lower immunity and may develop severe symptoms.
How serious is Hepatitis A?
People who get Hepatitis A have jaundice between two and six weeks with a gradual recovery. It does not cause permanent liver damage. In rare cases, Hepatitis A can cause liver failure and even death; this is more common in older people and in people with other comorbidities or chronic liver conditions. Only 0.5 per cent may develop acute liver failure. The liver function deteriorates to such a level that the patient might need a liver transplant. This stage is called fulminant hepatic failure (FHF), which occurs when liver cells are severely damaged.
How does the virus spread?
The virus can be present in the patient’s stool up to two weeks before jaundice symptoms manifest themselves and may persist two weeks after symptoms disappear. So the faecal discharge in sewers contains the virus. And whenever damaged sewer lines run close to water supply, the infected water leaches into fresh water triggering an outbreak. Epidemiologists saw this in Delhi in 1954 and in Kanpur in 1988-90.
What are signs and symptoms?
Patients report nausea, fever, diarrhoea, yellowness of urine and stomach ache. Worrisome symptoms are extreme lethargy, losing consciousness and bleeding. To avoid criticality, report these extreme symptoms to your doctor as soon as they manifest. Your doctor may then advise a prothrombin time (PT) test, which measures the time it takes for a clot to form in a blood sample and levels of prothrombin, the protein needed to do so, which is made by the liver. High levels indicate the liver isn’t functioning properly. In extreme cases of liver failure, a transplant may be recommended or a plasma exchange recommended as an intermediary measure to get rid of toxins generated by inflammation.
How is Hepatitis A treated?
Since the infection is self-limiting, treatment is symptomatic with plenty of rest, adequate nutrition and fluids. Some people with severe symptoms will need monitoring in a hospital.
How can I prevent Hepatitis A?
The best way to prevent hepatitis A is through vaccination. You can take the independent Hepatitis A vaccine or the combined vaccine with Hepatitis B. The hepatitis A vaccine is typically given as a series of two shots — the second administered at least six months after the first.
The combination vaccine can be given to anyone 18 years of age and older in a series of three shots over six months. Protection is good.
Practise good hand hygiene, wash and scrub your hands particularly after using the washroom, before preparing or eating food. Avoid street food or ice cubes in drinks in a restaurant because you do not know the source of the water frozen to form ice. Most importantly, boil your water if you are not sure of contaminants. The RO machine doesn’t filter viruses. Remember that the virus shed from an infected person can survive outside the human body for over a month if conditions are unhygienic. Keep your surroundings clean.
The virus can be present in the patient’s stool up to two weeks before jaundice symptoms manifest themselves and may persist two weeks after symptoms disappear. (Canva Image/Representational) 
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