Kerala AME spike linked to well water, natural water exposure
A Kerala-ICMR study links AME cases to well water use and natural water exposure, urging chlorination and targeted public health messaging.
A collaborative study between the Kerala Health Department and ICMR's National Institute of Epidemiology has identified key risk factors for amoebic meningoencephalitis (AME) in the state. The research, published in the journal Emerging Infectious Diseases, provides the first epidemiological evidence linking the disease to specific, modifiable exposures.
The case-control study found that using non-chlorinated well water for bathing or washing the face was independently associated with a 2.95 times higher odds of contracting AME caused by Acanthamoeba. The population attributable fraction was 34.2%, suggesting that over a third of such cases could be prevented if this risk factor were removed.
Exposure to natural water bodies, such as swimming or diving in ponds and canals, was also a significant risk factor, especially for individuals with a history of facial or nasal injury. The study found that exposing skin wounds or ulcers to natural water carried the strongest association, with 25.4 times higher odds of disease.
The research analysed 159 AME cases reported in Kerala between January and November 2025. Of these, 76 were confirmed by PCR, with 88.2% caused by Acanthamoeba species and 11.8% by Naegleria fowleri. The overall case fatality rate was 25.8%.
Researchers noted that Kerala reported only 45 AME cases between 2016 and 2024, suggesting that increased clinical awareness and improved diagnostics may have contributed to the higher number of cases identified in 2025. The study's authors emphasise the need for year-round water quality surveillance and periodic chlorination of wells through local self-governments.
Public health messaging should specifically advise against entering natural water bodies for those with wounds or recent injuries, particularly during the monsoon and post-monsoon periods. The study also highlights that lower socioeconomic status was associated with AME, likely due to greater reliance on non-chlorinated wells, and recommends prioritising risk communication for vulnerable communities.