What is tomato flu: All you need to know

After COVID-19 and Monkeypox, a new disease called Tomato Flu was reported from at least four states, Kerala, Tamil Nadu, Haryana, and Odisha. The Union Health Ministry issued guidelines on prevention, testing, and treatment of the disease on August 23.

The flu was intermittently reported from Kerala earlier. It drew attention after a correspondence was published in the journal The Lancet Respiratory Medicine recently. Some researchers believe that it is a different clinical presentation of hand-foot-and-mouth disease (HFMD) which is caused by a group of enteroviruses (viruses transmitted through the intestine).

What is Tomato Flu?

Tomato flu or tomato fever is characterised by fever, joint pain, and red, tomato-like rashes usually seen in children below the age of five years. This is accompanied by other symptoms of viral fevers such as diarrhoea, dehydration, nausea and vomiting, and fatigue.

Researchers believe that it is HFMD caused by enteroviruses like Coxsackievirus A-6 and A-16.

“Tomato Flu could be an after-effect of chikungunya or dengue fever in children rather than a viral infection. It could also be a new variant of the viral hand, foot, and mouth disease, a common infectious disease targeting mostly children aged 1–5 years and immunocompromised adults,” the recent correspondence in The Lancet read.

“HFMD is not a new infection, we have read about it in our textbooks. It is reported from time to time across the country, but it is not very common,” said Dr Ekta Gupta, professor of virology at the Institute of Liver and Biliary Sciences as reported by Indian Express

Why is Tomato Flu infection spreading now?

Dr Gupta said, “Perhaps there is more attention on the infection because more cases are being reported this year. This could either be because there actually are more cases or because we are more vigilant about viral infections and testing after Covid-19.”

She explained that since the disease is self-limiting, doctors do not usually test for it. “There are so many viral infections in children, but we cannot — and there is no need to — test for each and every one of it. However, we are now seeing more and more viral infections because testing for viral infections has increased over the last five years with virology labs being set up across the country. And the pandemic has given a further push to such surveillance,” Dr Gupta said.

Which pathogen is causing it now? And how is the clinical presentation different?

According to Dr Asawathyraj, who characterised the virus from Kerala and has been studying the infection, the current HFMD cases are mainly caused by Coxsackievirus A-6 and A-16. Another pathogen — Enterovirus71 — that also causes the disease is not very prevalent now, according to her, reported Indian Express

This is good because the pathogen was known to lead to severe neurologic symptoms, including fatal encephalitis (brain inflammation).

“In almost all cases, say 99.9% cases, the disease is self-limiting. But, in a small number of cases it can lead to CNS (central nervous system) complications,” said Dr Asawathyraj.

“The monkeypox rashes are more deep rooted and the distribution is also different,” she said.

Is there a treatment for Tomato Flu?

There is no specific treatment or vaccine available for the disease. Those with the infection are treated symptomatically, such as prescription of paracetamol for fever, reported Indian Express

How can Tomato Flu be prevented?

As it happens mainly in children, the Centre’s advisory to states that was issued on Tuesday focuses on preventions in these age groups, reported Indian Express

As per the advisory, anyone suspected to have the infection should remain in isolation for five to seven days after the onset of the symptoms.

It states that children must be educated about the infection and asked not to hug or touch other children with fever or rashes. The children should be encouraged to maintain hygiene, stop thumb or finger sucking, and use a handkerchief for a running nose, the advisory states.

If a child develops symptoms, they should be isolated, their utensils, clothing, and bedding must be regularly sanitised, they must be kept hydrated, and the blisters must be cleaned using warm water, according to the advisory.

It also states that testing should be conducted to take measures if there is an outbreak. Any respiratory, faecal, or cerebrospinal fluid samples (in cases with encephalitis or inflammation of the brain) have to be collected within 48 hours of illness. The biopsy of the lesions or skin scraping samples does not have such time limits.