Infections are common in a country where 1.3 billion people live in close proximity and safe water and sanitation challenges persist, with outbreaks of food-borne illnesses and diarrhoea peaking during the monsoons, when flood waters bring faecal contaminants and infecting agents such as bacteria, viruses, protozoa and parasitic worms (helminths) into homes and the food chain.

Unsafe food and water are the biggest cause of preventable infection in India. Acute diarrhoeal disease and food poisoning have together consistently accounted for a third of the laboratory-confirmed disease outbreaks since 2015, according to data reported by states and union territories to the Integrated Disease Surveillance Programme (IDSP). Though acute encephalitis syndrome, Nipah, and Zika grab headlines, acute diarrhoeal diseases, food poisoning, chickenpox, measles, and dengue are the leading recorded outbreaks of infectious diseases in 2019, according to IDSP, which maintains a decentralized database for epidemic-prone diseases across the country. These five diseases have accounted for roughly half the outbreaks this year.

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