Hepatitis A And E: How Contaminated Water Increases Liver Infection Risk

During the rainy season, the risk of exposure to contaminated water increases significantly, which is the primary driver of the spread of Hepatitis A and E. Hepatitis A and E are viral infections that cause inflammation of the liver. They are primarily spread through contaminated food and water or poor hygiene. Unlike Hepatitis B and C, these infections usually do not become chronic, and most people recover completely.

Why is Hepatitis A becoming more common in adults?

In the past, most people in India were exposed to Hepatitis A during childhood because of poor sanitation, often developing lifelong immunity. With better hygiene and improved living conditions, fewer children are getting infected. As a result, many adolescents and adults remain unprotected and are now more likely to develop symptomatic infections when exposed.

Who is at higher risk?

You may be at increased risk if you:

• Drink contaminated water or eat unhygienic food
• Live in or travel to areas with poor sanitation
• Have not been vaccinated against Hepatitis A
• Have a weakened immune system or an existing liver disease

Symptoms to watch out for

Early symptoms may include:

• Fever
• Fatigue and weakness
• Loss of appetite
• Nausea or vomiting
• Abdominal pain
• Muscle aches

As the illness progresses, patients may develop:

• Yellowing of the eyes and skin (jaundice)
• Dark-coloured urine
• Pale stools
• Itching

Anyone who develops jaundice should seek medical attention promptly.

Can Hepatitis A or E become serious?

Most children experience a mild illness or have no symptoms. However, adolescents and adults are more likely to develop severe disease. In rare cases, especially in older adults or people with pre-existing liver disease, the infection can lead to acute liver failure, which may require a liver transplant. However, unlike Hepatitis B and C, Hepatitis A and E do not usually cause chronic liver disease or liver cirrhosis.

How can you prevent Hepatitis A and E?

Protecting yourself against waterborne liver infections relies on simple hygiene and water treatment tactics:

• Boil your water: Bringing water to a rolling boil for at least one minute neutralises HAV and HEV, making it safe for consumption.
• Get vaccinated: Ensure you receive the Hepatitis A vaccine, especially if travelling to regions with suboptimal water purification infrastructure.
• Sanitise raw foods: Wash fruits and vegetables exclusively with filtered or boiled water before consuming them raw.
• Separate well and waste: Maintain strict structural separation between septic tanks and water wells to avoid underground leaching.
• Practice hand hygiene: Wash your hands thoroughly before eating and after using the toilet.

The way forward

As India's sanitation and living conditions improve, the pattern of Hepatitis A infection is changing. While fewer children are getting infected, more adolescents and adults remain vulnerable to severe disease. Increasing public awareness, ensuring access to safe water, strengthening disease surveillance, and promoting vaccination among high-risk groups are essential to prevent future outbreaks and protect liver health.

(Dr. Vikas Singla, Vice Chairman & Head - Gastroenterology, Max Super Speciality Hospital, Saket)

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