A village in Kerala in the throes of a health crisisPremium

Heartbreaking tale of a hepatitis A outbreak in Kerala, leading to multiple casualties and a community in crisis.

Krishnankutty, 62, lifted the tip of his thorthu (towel) on his shoulders to wipe the tears welling up in his distraught eyes. He pointed to the bed in the drawing room where his ailing wife Ammini lay. “She was in hospital for nearly 21 days after being diagnosed with hepatitis A. For six days, she was on ventilator support,” his voice choked with emotions.

It was only last week that they returned to their modest one-storey home in Choorathodu ward in Vengoor panchayat, in Kerala’s Ernakulam district after she was discharged from a private hospital in Aluva. “She is so fatigued, she is still not able to get out of bed on her own,” said the daily-wage worker, as his wife raised her hand for assistance to turn over. Vengoor, with its tiled-roof houses and lush green surroundings, is located about 45 kilometres east of the district headquarters in Kakkanad. 

The 58-year-old homemaker was among nearly 35 diagnosed with hepatitis A in a span of four weeks. While trying to console Krishnankutty, 52-year-old Peter P.V., ward member, said he had never witnessed a health crisis of this magnitude in the area. Neither had the rest of the residents in four other wards of the panchayat (Edathuruth, Vengoor, Vakkuvally and Kaippilly). Officials of the Government Community Health Centre in Vengoor alerted the authorities to a possible hepatitis A outbreak on the evening of April 18.

The viral infection was first confirmed in a 23-year-old man and a resident of Kaippilly ward. He had sought treatment in a private clinic and was later referred to the Government Taluk Hospital in Perumbavoor town some 11 km away. Three more people from Kaippilly ward with fever sought treatment at the outpatient wing of the community health centre in Vengoor on April 18.

From a single case on April 18, the number of confirmed hepatitis A cases went up to 54 in just 12 days before climbing to nearly 190 cases as on May 10. Over 220 cases have been reported as of the third week of May. People from around 120 families in the five wards were hit by the outbreak.

Jolly Raju, 51, of Kaniyattupeedika in Vakkuvally, became the first casualty as she succumbed to the infection at the Government Medical College, Ernakulam, on May 7. Karthiyani M.C., 51, of Kariyampurathu, Choorathodu died while under treatment at the Government Medical College, Kottayam on May 19. K.K. Sajeev, 48, of the nearby Mudakuzha panchayat, succumbed to the infection on May 1. Nearly 30 people currently remain under treatment in various government and private hospitals in Ernakulam and Kottayam, according to the Department of Health.

On the day the outbreak was detected, officials of the community health centre received reports of people with fever and vomiting from Vakkuvally ward. A report prepared by the centre on April 18 indicated that a common source of infection may have triggered the spike in cases. An email sent by the health authorities to the Kerala Water Authority (KWA) on the evening of April 18 indicated that supply of contaminated water from the pumping station of the authority in Choorathodu may have triggered the outbreak.