Mutation worries add to Hepatitis-A woes of Kerala

As Hepatitis-A cases spurt in the state, health officials are suspecting mutation of the virus. The department might seek the help of the Institute of Advanced Virology in Thiruvananthapuram to check the potential mutation through measures like viral sequencing.

ByDileep V Kumar

Published May 16, 2024 | 8:00 AMUpdatedMay 16, 2024 | 8:00 AM


A sudden surge in Hepatitis-A cases in Kerala has prompted the health authorities to consider the possibility of a mutated strain of the virus.

Health officials are closely monitoring the situation in the affected areas where reports suggest that the root cause of the outbreak may be linked to conventional modes of transmission like contaminated drinking water sources/food. However, they have not ruled out the mutation.

It is learnt that the Health Department will seek the help of the Institute of Advanced Virology (IAV) in Thiruvananthapuram, to check the potential mutation through measures like viral sequencing.

The institute focuses on research, diagnosis, and management of emerging and re-emerging infectious viral diseases.

Also Read: WHO warns of viral hepatitis infections claiming 3,500 lives every day

‘A possibility is there’

An epidemiologist with the Kerala Health Department told South First, “Viruses, like all living things, are prone to mutations — changes in their genetic code. ”

He noted: “Hepatitis A is an RNA virus, known for a higher mutation rate comparable to DNA viruses.”

The epidemiologist added, “These mutations can be harmless, but some can alter the virus’ behaviour. In this instance, the concern is that the mutation might make the virus more transmissible or lead to a more severe form of the disease.”

As per data compiled by the Health Department, in this month alone (till 13 May), 265 confirmed cases, 591 suspected cases, and two deaths due to Hepatitis-A were reported.

On 13 May alone, 29 confirmed cases and 70 suspected cases were reported. As for this year alone, 1,977 confirmed cases and 12 deaths were recorded in the state.

It is learnt that viral sequencing might shed light on the mutation doubt and by comparing the viral sequences from the current outbreak with known Hepatitis A strains, the concerned can determine if a mutation has occurred.

“It’s a critical step in understanding the cause of this outbreak and implementing appropriate control measures,” said the epidemiologist.

“While contaminated water remains a major concern, identifying a potential mutation would raise the stakes significantly, requiring a more aggressive public health response,” he added.

However, when South First contacted Dr E Sreekumar, the director of IAV, he said that a proposal for sequencing of the Hepatitis A virus was yet to come from the Health Department.

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‘No need to worry’

At the same time, Dr Rajeev Jayadevan, a senior consultant gastroenterologist, told South First that the Hepatitis A virus was not known to be a rapidly changing virus, unlike the viruses that cause influenza or COVID-19.

“This virus has a stable genome, with only limited antigenic variation. Although it exhibits genetic diversity as expected of a virus, it is worth noting that there is only one single worldwide serotype for this virus,” he said.

“This basically means that a person exposed to Hepatitis A either by natural infection or vaccination will enjoy lifelong immunity,” explained Jayadevan.

The medical expert also said, “Besides, the clinical and epidemiological characteristics of the current outbreak are identical to what has been described earlier.”

He cncluded: “Hence there is no need to worry about a new type of the Hepatitis A virus causing each outbreak.”

Also Read: Inconsistent vaccination against Hepatitis B in South India

Four districts on alert

On 14 May, Kerala Health Minister Veena George put four districts — Kozhikode, Malappuram, Thrissur, and Ernakulam — on alert, as it was from there that most cases were being reported.

At the same time, the outbreak raised alarm bells in particularly one village — Vengoor — where a significant portion of the reported cases has been concentrated.

Health officials are closely monitoring the situation in the affected village, where reports suggest that the root cause of the outbreak may be linked to contaminated drinking-water sources.

Investigations revealed that drainage water seeped into the community’s water supply, potentially exposing residents to harmful pathogens.

A senior health official from Ernakulam District Medical Office said, “The situation is concerning, to say the least.”

He noted: “Hepatitis A is a highly contagious viral infection that primarily spreads through the faecal-oral route.”

He added: “The suspected contamination of the drinking water source has likely facilitated the rapid transmission of the virus within the community.”

The district administration has ordered an inquiry as the local body representatives alleged that the laxity of the Kerala water authority caused the outbreak.

Also Read: More youngsters dying of alcohol-related hepatitis, cirrhosis

Inflammation of the liver

According to the World Health Organisation (WHO), hepatitis A is an inflammation of the liver caused by the hepatitis-A virus (HAV). The incubation period of hepatitis A is usually 14-28 days.

The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the faeces of an infected person.

The disease is closely associated with unsafe water or food, inadequate sanitation, poor personal hygiene, and oral-anal sex.

Symptoms range from mild to severe and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-coloured urine and jaundice (yellowing of the eyes and skin). Not everyone who is infected will have all the symptoms.

Anyone not vaccinated or previously infected can get infected with the hepatitis A virus. In areas where the virus is widespread (high endemicity), most hepatitis A infections occur during early childhood.

Risk factors include:

  • poor sanitation,
  • lack of safe water,
  • living in a household with an infected person,
  • being a sexual partner of someone with acute hepatitis-A infection,
  • use of recreational drugs,
  • sex between men, and
  • travelling to areas of high endemicity without being immunised.

However, there is no specific treatment for hepatitis A, and recovery from symptoms following infection may be slow and can take several weeks or months.

(Edited by Arkadev Ghoshal)