Waterborne hepatitis primarily refers to hepatitis A and hepatitis E, both of which are viral infections transmitted via the faecal-oral route, most commonly through the ingestion of contaminated water or food. These viruses cause acute hepatitis, an inflammation of the liver and are major public health concerns in areas with poor sanitation and hygiene practices.
The onset of water-borne hepatitis is often abrupt. The observable signs of water-borne hepatitis include malaise or unease, anorexia (an eating disorder with loss of appetite for food), low-grade fever, nausea, vomiting or discomfort on the right side of the abdomen, above the navel. This is followed by the icteric phase or jaundice phase, where dark urine and light-coloured stools are observed. Jaundice is a symptom, not a disease. It represents bilirubin accumulation due to liver dysfunction. In hepatitis, jaundice is part of the broader spectrum of liver inflammation caused by viral replication and immune-mediated liver injury.
Liver enzymes ALT (alanine transaminase) and AST (aspartate aminotransferase) are markedly elevated. Most cases of hepatitis A and E are self-limiting, with complete recovery occurring within a few weeks. However, hepatitis E, particularly in pregnant women (third trimester), can lead to fulminant hepatic failure, a severe condition where the liver rapidly loses its ability to function properly, which has a high maternal and foetal mortality rate. In rare situations, hepatitis A can cause acute liver failure in elderly or immunocompromised individuals. Supportive care and close monitoring are crucial in severe cases.
During the monsoon season, sewage overflow and flooding commonly lead to contamination of water sources, including wells, rivers and even piped supply systems. The resultant faecal contamination significantly increases the risk of outbreaks of enteric viruses that infect the gastrointestinal tract, including Hepatitis A and E, especially in coastal and semi-urban areas of Goa.
Roadside vendors often lack access to potable water and adequate hand hygiene, increasing the risk of faecal contamination of food. Uncooked or inadequately washed items such as chutneys, raw salads and fruit juices are particularly high risk. During outbreaks, these stalls frequently become epicentres of hepatitis transmission.
Wells or water tankers can carry the infection too, especially if sourced from or passing through contaminated areas, serving as vehicles for hepatitis A and E viruses. To mitigate this, water should be boiled for at least ten minutes before consumption or filtered through in-home water filters with UV or RO (reverse osmosis) purification. Ensure water storage vessels are covered and regularly cleaned. Tanker sources should be routinely tested for microbial contamination.
Some wrongly believe that waterborne hepatitis is more likely to occur among individuals from poor socioeconomic backgrounds and recovery from one type of hepatitis provides lifelong protection against all others. Having recovered from hepatitis A does not make you immune to hepatitis E. Some even think all forms of jaundice are infectious, but in reality, jaundice is a symptom of many conditions, not all of them are infectious or viral.
Individuals at risk
Children and adolescents in endemic areas
Pregnant women, particularly for hepatitis E
Residents of overcrowded or low-sanitised environments
Individuals consuming contaminated water or foods during monsoon seasons or flooding
Preventive measures
Use boiled, chlorinated or properly filtered drinking water
Avoid consumption of raw vegetables or fruits washed in unsafe water
Maintain hand hygiene, particularly before eating or preparing food
Ensure proper sanitation facilities
Vaccination against hepatitis A is recommended in endemic regions or for travellers
(The writer is a general physician at Healthway Hospitals, Old Goa)
