Experts warn of ‘serious consequences’ if ‘highly contagious’ virus spreads

Noting an alarming increase in cases of tomato fever or tomato flu in India, experts have warned of new outbreaks which started in Kollam in Kerala and have so far infected 82 children. According to a study published in the Lancet Respiratory Journal, the common infectious disease mainly targeting children aged 1 to 5 and immunocompromised adults could also be a new variant of hand-foot-mouth disease (HFMD).

The study said the rare viral infection is in an endemic state and is considered non-life threatening and is being reported amid concerns of a likely fourth wave of the Covid-19 pandemic. “Just as we are dealing with the probable emergence of the fourth wave of Covid-19, a new virus known as tomato flu, or tomato fever, has emerged in India in the Kerala state in children under 5. The rare virus infection is in endemic condition and is considered not life threatening however due to terrible experience of Covid-19 pandemic , vigilant management is desirable to prevent further outbreaks,” the study found.

Commonly known as the “tomato flu”, this infectious disease is caused by intestinal viruses and occurs mainly in children. The disease is rare in adults because they usually have a strong enough immune system to defend them against the virus.

The study noted that although the tomato flu virus has symptoms similar to those of Covid-19, including the initial onset of fever, fatigue, body aches and rashes, the virus does not is not related to SARS-CoV-2.

Tomato fever could be a sequela of chikungunya or dengue fever in children rather than a viral infection, the Lancet study noted, adding that influenza is a self-limiting disease and no specific medication is needed. exist to deal with it.

First cases in Kerala

Tomato flu was first reported from Kollam district, Kerala on May 6, 2022. More than 82 infected children under 5 years old were reported from local government hospitals as of July 26, 2022. other affected areas of Kerala are Anchal, Aryankavu and Neduvathur. Precautionary measures are being taken by the Health Department of Kerala to monitor the spread of the virus infection and prevent its spread to other parts of India.


Twenty-six children have been diagnosed with hand-foot-mouth disease (HFMD) in Odisha by the Bhubaneswar Regional Medical Research Centre.

This endemic viral disease has also triggered an alert to the neighboring states of Tamil Nadu and Karnataka to increase vigilance in the border districts. However, apart from Kerala, Tamil Nadu and Odisha, no other parts of India have been affected by the virus.


According to the World Health Organization (WHO), in most cases, the viral illness is manifested by symptoms like fever, painful sores in the mouth and rash with blisters on the hands, feet and buttocks.

The Lancet study notes that the main symptoms seen in children with tomato flu are similar to those of chikungunya, which include high fever, skin rash and severe pain in the joints. Named tomato fever because of red, painful blisters throughout the body that grow to the size of a tomato, they also resemble these blisters in cases of monkeypox virus in young individuals.

The rashes on the patient’s body lead to skin irritation, and like other viral infections, symptoms include fatigue, nausea, vomiting, diarrhea, fever, dehydration, joint swelling, body aches, and common flu, which are similar to dengue fever.


In children with these symptoms, molecular and serological tests are done for the diagnosis of dengue fever, chikungunya, zika virus, varicella zoster virus and herpes. Once these viral infections are ruled out, contraction of the tomato virus is confirmed, the study notes.


As tomato flu is similar to the symptoms of chikungunya, dengue, and hand-foot-mouth disease, treatment for the infection is also similar. Patients are advised to self-isolate, rest, drink plenty of fluids, and mop up with warm water to relieve irritation and rashes. “Supportive treatment with paracetamol for fever and body aches and other symptomatic treatment are needed,” he said.

Risk and epidemic

The study noted that children are at increased risk of exposure to tomato flu because viral infections are common and likely to be spread due to close contact. Infants are prone to infection from diapers, contact with dirty surfaces and unhygienic practices. Due to similarities with hand-foot-mouth disease, “if the tomato flu epidemic in children is not controlled and prevented, transmission could lead to serious consequences by spreading to adults as well”, notes the study.

“Very Contagious”

The study warned that tomato flu is “highly contagious” and similar to other types of flu and called for “careful isolation of confirmed or suspected cases and other precautionary measures to prevent the outbreak of tomato flu virus from Kerala to other parts of India.”

“Isolation should be followed for 5-7 days from the onset of symptoms to prevent the spread of infection to other children or adults,” the study says. The best prevention solution is maintaining proper hygiene and disinfection of the surrounding necessities and environment, as well as preventing the infected child from sharing toys, clothes, food or other articles with other uninfected children, he added.

However, he said no antiviral drugs or vaccines are available for the treatment or prevention of tomato flu. “Additional follow-up and monitoring of serious outcomes and sequelae is needed to better understand the need for potential treatments,” he said.

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