In the coastal district of Kozhikode, Kerala, a familiar pattern is beginning to reappear as the monsoon gathers strength. Classrooms that were full just weeks ago are now seeing a steady trickle of absences, with children staying home due to fever, diarrhea and other monsoon illnesses.

The situation is not unique to Kozhikode. Across Kerala, schools and health facilities are reporting a seasonal rise in illnesses that typically accompany the monsoon, including viral fevers, influenza-like infections, diarrhoeal diseases and, increasingly, Shigella infections.

“At least 5–6 students are absent daily due to some illness. Even though the school hasn’t reported cases of Shigella, there are cases of diarrhoea and viral fever,” said Jayasree, a school teacher from Kozhikode.

While such absenteeism is not unusual during the rainy season, doctors and public health officials say this year’s disease burden warrants closer attention. Kerala has reported 241 Shigella infections since the beginning of the year, and four of the first five deaths linked to the bacterial disease were children under the age of 10.

While Shigella has attracted particular attention, doctors say it is part of a broader seasonal pattern that includes viral fevers, influenza-like illnesses, diarrhoeal diseases and other infections that tend to surge during the rainy season. The wider disease burden is already visible across the state. In June, Kerala recorded more than 39,000 outpatient visits related to fever and seasonal illnesses over a three-day period, according to official figures, underscoring the pressure monsoon-related diseases continue to place on the healthcare system.

Why Children Face Greater Risks During Kerala’s Monsoon

Children are particularly vulnerable to infections during outbreaks because of both biological and behavioural factors.

“Young children are more likely to put their hands, toys, or other objects into their mouths, increasing exposure to germs. Maintaining good hand hygiene can also be challenging in this age group,” said Dr Sajana, paediatrician at Aster Medcity, Cochin.

She explained that Shigella spreads through the faeco-oral route. Even a very small number of bacteria can cause infection. Children also become dehydrated more quickly during diarrhoeal illnesses, making early detection and treatment critical.

The concern is not unique to Kerala. According to the Global Burden of Disease Study 1990–2016, published in The Lancet Infectious Diseases, Shigella was the second leading cause of diarrhoeal mortality globally in 2016 and was responsible for more than 63,000 deaths among children under five years of age. Public health experts note that young children are especially susceptible to complications because diarrhoeal illnesses can lead to rapid dehydration if not treated promptly.

Monsoon Illnesses Thrive When Water and Sanitation Systems Are Under Pressure

Public health researchers have repeatedly found that periods of intense rainfall can increase the risk of diarrhoeal disease outbreaks. Heavy rain can exposure to pathogens, particularly in densely populated communities and areas with inadequate sanitation.

Climate scientists and public health researchers have increasingly warned that changing rainfall patterns and more frequent extreme weather events can heighten the risk of waterborne diseases by contaminating drinking water sources and overwhelming sanitation infrastructure. For a state like Kerala, where the monsoon shapes both daily life and disease patterns, strengthening sanitation and surveillance has become as important as clinical care.

A recent incident in Malappuram district in northern Kerala, where a tender coconut stall was identified as the source of a Shigella outbreak, highlights how even commonly consumed foods can become transmission points when hygiene practices break down.

The concern has now prompted intervention at the highest levels of government. A high-level committee appointed by the Kerala government to review infectious disease control has warned that waterborne diseases such as Shigella are being reported more frequently this year. The committee recommended intensified sanitation campaigns, routine testing of drinking water sources, stronger food safety inspections and the deployment of field testing kits to health workers to identify contamination before outbreaks occur.

The committee also called for joint inspections of restaurants, street-food stalls and other food establishments, recommending that all food outlets be checked at least once every three months. Health officials believe such measures could help reduce the risk of food- and water-borne outbreaks that often emerge during the monsoon season.

The link between sanitation and disease is well established in Kerala itself. A study by researchers Chitra Grace A. and V. Mohanan Nair found that childhood diarrhoeal disease in rural Kerala remains closely associated with access to safe drinking water, sanitation facilities and household hygiene practices. The findings suggest that despite Kerala’s strong public health indicators, environmental and behavioural factors continue to shape disease risks among children.

These findings underline how even small lapses in sanitation, particularly during the monsoon when water sources become more vulnerable to contamination, can quickly translate into disease outbreaks.

Schools Become Kerala’s First Warning System

Schools often act as the first line of detection during seasonal outbreaks. Teachers are usually the first to notice patterns of illness among children, making early reporting critical.

“We are sending students back home even if they show mild symptoms such as a runny nose. Mask-wearing has also been made mandatory across the campus. Recently, a child was diagnosed with H1N1, but the situation has been well contained”, said Malini Arun Menon, Founder and Principal of Dolphinz Preschool, Kakkanad.

Health experts say that timely interventions such as sending symptomatic children home, temporary class suspensions and improved sanitation practices can significantly reduce transmission in school environments.

Regular cleaning of drinking water tanks, monitoring food preparation areas and ensuring that washrooms remain hygienic become especially important during the rainy season, when disease transmission risks tend to increase.

The First Line of Defence Begins at Home

Doctors say prevention often comes down to a handful of everyday practices. Ensuring children wash their hands regularly with soap, drink safe water and avoid unhygienic food can significantly reduce the risk of infection.

Families are also encouraged to keep children with symptoms at home and seek medical care promptly if warning signs such as persistent fever, bloody diarrhoea, repeated vomiting, dehydration or unusual drowsiness develop.

The state government’s expert committee has similarly emphasised the importance of community participation. It has recommended strengthening public awareness campaigns on sanitation, safe water practices and disease prevention while urging local bodies and health workers to intensify surveillance in identified disease hotspots.

The monsoon season can magnify risks, but experts say many infections remain preventable through simple hygiene measures and timely medical attention.

Can Kerala Predict Outbreaks Before They Happen?

Recognising the seasonal nature of disease outbreaks, Kerala is attempting to strengthen its predictive public health systems.

The state government recently highlighted plans for a seasonal disease calendar that would map when and where recurring outbreaks are most likely to occur. The initiative aims to help health authorities anticipate disease trends rather than merely respond to them after outbreaks have begun.

The high-level committee chaired by public health expert Dr S.S. Lal has reinforced that approach. In its preliminary report submitted this week, the committee recommended identifying disease hotspots using the Integrated Disease Surveillance Programme (IDSP), strengthening district-level surveillance and improving coordination between the health, education, local self-government, agriculture, forest and animal husbandry departments under a One Health framework.

The committee has also cautioned that mosquito-borne diseases such as dengue and chikungunya could become more widespread in the coming months due to the continuing effects of climate variability and changing weather patterns. Although dengue cases remain lower than during the same period last year, experts warn that sustained preventive measures will be necessary as the monsoon progresses.

The committee is expected to conduct further field visits and detailed studies, including investigations into recurring Nipah hotspots and the source of amoebic meningoencephalitis cases, before submitting its final report.

The idea reflects a broader shift in public health thinking, from reacting to outbreaks to predicting them. Kerala’s public health system has earned national recognition for responding quickly to health emergencies. The challenge now is whether it can stay ahead of them. As classrooms fill and the monsoon deepens across the state, health officials, schools and families face the same annual test: preventing familiar illnesses from becoming avoidable outbreaks.

India needs to place greater emphasis on early cancer detection to improve treatment outcomes, internationally renowned oncologist Keith Flaherty said during a visit to VPS Lakeshore Hospital in India’s southern state Kerala.

“Early detection is absolutely essential to better treatment outcomes. If cancers are identified at an earlier stage, therapies can be far more effective and, in many cases, curative,” Flaherty said after launching Lakeshore Yathra, an initiative focused on wellness and early cancer detection across Kerala.

Flaherty, Director of Clinical Research at the Massachusetts General Hospital Cancer Center and Professor at Harvard Medical School, spoke about the future of cancer care and the evolution of precision medicine since 2000. He said India has significant potential to contribute to precision oncology and targeted cancer therapies, but noted that important gaps remain in understanding the molecular profile of cancers among the Indian population.

Widely recognised for his contributions to precision medicine and targeted cancer therapy, Flaherty’s work has played a major role in shaping modern oncology globally.

Presiding over the event, S.K. Abdulla, Managing Director of VPS Lakeshore Hospital, said healthcare institutions must increasingly focus on wellness, prevention and early diagnosis alongside treatment.

“Through Lakeshore Yathra, we are trying to take healthcare closer to people and encourage regular screening and timely identification of disease. Detecting cancer early can make a significant difference in treatment outcomes and quality of life,” he said.

Abdulla also highlighted the hospital’s collaboration with the Indian Dental Association for a statewide initiative aimed at improving early oral cancer detection. The programme focuses on training dentists across Kerala to identify suspicious lesions and ensure timely referrals.

Moni Abraham Kuriakose, Head of the Institute of Head & Neck Sciences at VPS Lakeshore Hospital, said the hospital is adopting a three-pronged strategy for early cancer detection.

“Yathra includes screening programs for patients and family members visiting the hospital, population-level outreach initiatives for cancer and non-communicable disease screening in partnership with NGOs and workplaces, and the deployment of a mobile medical unit to facilitate diagnostic investigations closer to patients’ homes,” Moni said.

Flaherty also interacted with doctors and healthcare professionals during the event and shared insights on evolving approaches in oncology care, cancer research and precision medicine.

A new global commission led by The Lancet has been launched to examine the growing health and justice impacts of sea-level rise, as climate change accelerates risks for millions living in coastal and low-lying regions.

The Lancet Commission on Sea-Level Rise, Health and Justice, announced on April 8, brings together 26 international experts to assess how rising seas are reshaping public health, livelihoods, and global equity.

A Growing Crisis Beyond Climate

Sea-level rise, driven by anthropogenic climate change, is already contributing to displacement, food and water insecurity, and changing patterns of infectious diseases. The Commission marks the first major effort to analyse these intersecting risks through a health-focused lens.

“This commission comes at exactly the right time… sea-level rise is no longer a distant threat. It is already disrupting lives, health and wellbeing, especially for the most vulnerable,” said Christiana Figueres, Co-Chair of the Commission and a former UN climate chief.

Experts warn that the impacts extend far beyond environmental damage, affecting the social and economic fabric of vulnerable communities.

“Rising seas don’t just threaten coastlines, they threaten lives, livelihoods, and basic fairness. This is not only a climate problem. It is a health crisis, a justice crisis, and an urgent call for collective action,” said Jemilah Mahmood, Commissioner, Lancet Commission, and Executive Director of the Sunway Centre for Planetary Health, Malaysia.

An Urgent Global Health Challenge

The Commission is supported by the WHO Asia-Pacific Centre for Environment and Health and aims to generate evidence-based policy recommendations to strengthen adaptation, resilience, and equitable responses.

Dr Sandro Demaio, Director of WHO ACE, emphasised the immediacy of the crisis.

“Sea-level rise is no longer a distant threat — it is a public health emergency unfolding now. Through this WHO supported global Commission, we are clear: inaction is not neutral, it is a choice that puts lives and justice at risk.”

Human Impacts at the Core

The Commission also highlights the disproportionate burden on vulnerable populations, particularly in coastal and low-income regions.

“Rising sea levels are more than an environmental issue; they quietly contaminate water, displace communities, and increase health risks for those least able to cope. Every centimetre of sea level rise is not just a measure of water, but a measure of injustice,” said Kathryn Bowen, Co-Chair of the Commission.

A Defining Policy Moment

With projections suggesting that hundreds of millions of people could be displaced by the end of the century, the Commission aims to inform global policy and strengthen international cooperation.

“Sea-level rise is not just an environmental issue — it is a test of our commitment to people, equity, and future generations,” said Jiho Cha, Member of Parliament, Republic of Korea and Co-Chair of the Commission.

The Commission will contribute to global policy discussions, including international climate platforms, and aims to place human and planetary health at the centre of climate action.