Tomato flu -what it is and how it affects kids under five

An outbreak of a viral infection referred to as tomato flu, first detected in children in the southern Indian state of Kerala in May, has spread to two other states: Tamil Nadu and Odisha.

So far, there have been 82 cases of children under five years old, according to an article in the Lancet Respiratory Medicine, which also points out that the first case was reported on May 6.

The symptoms include a high temperature, intense joint pain, and painful red blisters.

The eruption of red, painful blisters can grow to the size of a tomato, hence the name tomato flu.

There have been no reports of serious illness or death so far. Tomato flu is usually mild and clears up by itself within a week or so.

Even though the flu only lasts for about a week without treatment, pain killers are recommended as it can be very painful.

Image: Brett Jordan/Unsplash

Like many common childhood infections, it is very contagious and can be spread through feces and the fluid in the spots, so parents are advised that children with tomato flu should be kept away from school or nursery for five days after the symptoms start.

Some patients get sores in the mouth, which makes it hard to swallow, so dehydration can be a problem in small children. In very rare cases, the person can develop viral meningitis, but so far, no cases following tomato flu have been reported from India.

Doctors treating the children were unsure what was causing this illness. The fever, aches and pains could be due to any number of infections. They speculated that it might be the result of viruses transmitted by mosquitoes, such as dengue and chikungunya.

Doctors thought that perhaps the unusual rash might occur because children were reacting differently to infections after they had Covid. Also, because of the large size of the spots, there was even a suggestion that it might be monkeypox.

Two children in the UK who developed suspected tomato flu symptoms after returning from a family holiday in Kerala were tested. The lab results revealed that they were infected with an enterovirus named coxsackie A16.

Coxsackie A16 causes hand, foot and mouth disease (HFMD). It is called that because the patient gets blisters on the palms of their hands, soles of their feet and in their mouth.

So it seems that tomato flu is actually HFMD (hand, foot and mouth disease), as it is the same virus. However, the large tomato-looking rashes aren’t typical of HFMD.

The fact that the spots look different enough for the disease to be given a new name, can be explained through examples of other changes in viruses since the Covid pandemic began.

“Viruses have been doing strange things since the Covid pandemic started”, writes a scientist in The Conversation.“For example, seasonal winter viruses spread in summer 2020, and until 2022, monkeypox outbreaks outside of Africa only involved small numbers of people”.

The tomato-like rash might be due to a range of different causes, which highlights the value of accurate laboratory testing for viruses.

However, it is worth noting that fewer than 100 cases of tomato flu have been reported since early May, meaning the outbreak is most likely under control.