India's Water-Borne Disease Burden: 17 Million Cases Of Severe Diarrhoea, Typhoid, Hepatitis, Cholera In 5 Years

India recorded more than 17 million cases of water-borne disease over the past five years. These cases were reported between 2021 and 2025 through the IDSP (Integrated Disease Surveillance Programme) and IDSP-IHIP (Integrated Health Information Platform) surveillance platforms. This covers six major diseases: Acute Diarrhoeal Disease (ADD), Cholera, Leptospirosis, Hepatitis A & E and Typhoid. Together, they form one of the most comprehensive snapshots of India's water quality and sanitation-linked health challenges.

Diarrhoea

Diarrhoea has the highest number of cases every year. In 2021 alone, India recorded 6,015,506 cases, the largest annual figure across the entire five-year span. By 2025, reported diarrhoea cases had declined to 2,351,962. West Bengal reported 2,059,927 cases in 2021, which is the highest for any state. Odisha, Gujarat, Maharashtra and Kerala also form large diarrhoea clusters.

Symptoms Of Diarrhoea

Loose or watery stool is the most common sign of diarrhoea. Some of the other symptoms includes:

• Bloating or cramps in your belly
• Strong and urgent need to poop
• Nausea

While these symptoms don't require you to visit a doctor, however, if they persist for a few days, a medical evaluation is necessary. In some cases, the condition might become severe. Some signs of severe diarrhoea include:

• Fever
• Severe pain
• Vomiting
• Blood or mucous in your stool
• Weight loss
• Headache
• Flushed, dry skin
• Irritability and confusion
• Light-headedness and dizziness
• Fatigue (tiredness that doesn't improve with rest)
• Dark pee, small amounts of pee or no peeing at all

Typhoid

Typhoid is the second-highest contributor among the six diseases. In 2024, cases rose to 6 lakhs, compared with 1.9 lakh in 2021. States such as Madhya Pradesh (56,007 cases in 2025), Chhattisgarh (38,692 in 2025), and Karnataka (39,348 in 2025) were major contributors. States like Bihar, Delhi, Tamil Nadu and Uttar Pradesh show moderate but persistent clusters.

Symptoms Of Typhoid

High fever is the most common sign and it can last for weeks if left untreated. The condition can get progressively worse over a few days, says Cleveland Clinic. Some other signs of typhoid include:

• Headache
• Chills
• Loss of appetite
• Stomach (abdominal) pain
• Rash, or faint pink spots, on your chest or stomach
• Cough
• Muscle aches
• Nausea and vomiting
• Diarrhoea or constipation

Hepatitis A and E

Hepatitis A and Hepatitis E reveal another cluster, driven by southern and western states. Kerala tops the list, reporting 23,000 cases, followed by Gujarat (16,800), Delhi (13,800) and Tamil Nadu (11,000). The rise in hepatitis cases corresponds with the national spike seen in 2024 and 2025, when Hepatitis A alone touched 44,400 cases, up nearly ten-fold from 2021 levels.

Symptoms Of Hepatitis A and E

Both of these conditions have similar symptoms. Johns Hopkins Medicine says that the "diseases may develop without any signs or symptoms, or symptoms may be nonspecific." Some of the common signs of hepatitis A and E are:

• Fever
• Joint pain or arthritis
• Rash
• Oedema (swelling)
• Fatigue
• Muscle pain
• Anorexia
• Nausea and/or vomiting
• Cough
• Abdominal pain and/or diarrhoea
• Dark urine and light stool color
• Signs and symptoms when the condition reaches the icteric phase:
• Jaundice (yellowing of the skin and whites of the eyes) develops
• Anorexia, nausea and vomiting may worsen
• Irritated skin lesions may develop

Cholera and Leptospirosis

Cholera remains relatively contained nationally, with annual cases ranging from 217 cases in 2021 to 2,273 in 2024. But the burden is highly concentrated as Gujarat alone reported 594 cholera cases in 2024.

Leptospirosis exhibits a more coastal and monsoon-linked pattern. National cases climbed to 24,109 in 2024, with Kerala (4,523 cases) and Tamil Nadu (4,190 cases) emerging as consistent hotspots.

Symptoms Of Cholera

Watery diarrhoea is the most common sign. Diarrhoea can get severe and cause dehydration. Most people with cholera don't have symptoms. Other signs of the condition includes:

• Vomiting
• Extreme thirst
• Fatigue
• Muscle cramps or weakness
• Dizziness
• Peeing very little
• Fast heart rate

Symptoms Of Leptospirosis

In some people, the condition might show up with flu-like symptoms or no symptoms at all. In severe cases, there might be signs of internal bleeding and organ damage. Signs of cases acute leptospirosis include:

• High fever
• Red eyes (conjunctival injection)
• Headache
• Chills
• Muscle aches
• Abdominal pain
• Nausea and vomiting
• Diarrhoea
• Yellow skin or eyes (jaundice)
• Rash

Signs of severe leptospirosis, also known as Weil's syndrome, include:

• Coughing up blood
• Chest pain
• Trouble breathing
• Severe yellowing of your skin or eyes
• Black, tarry stool
• Blood in your pee
• Decrease in the amount you urinate
• Flat, red spots on your skin that look like a rash

When To Seek Medical Help If You Experience Symptoms Of These Water-Borne Diseases?

Seek medical help immediately if symptoms of these water-borne diseases persist beyond 2-3 days, worsen rapidly, or show severe signs like high fever, persistent vomiting, blood or mucous in stool, dehydration (dry mouth, dark urine, dizziness, reduced urination), jaundice (yellow skin/eyes), severe abdominal pain, confusion, rapid heartbeat, chest pain, bloody urine/stool, or breathing difficulties. Early intervention with antibiotics, antivirals, or supportive care, can help prevent complications like kidney failure or sepsis.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.