The story so far: Days after a paper in The Lancet journal raised concerns over the rise in cases of the “new virus known as tomato flu” among children in India, the Union Health Ministry on Tuesday issued an advisory, asking the States to take measures to prevent its spread.
In a set of guidelines, the Centre referred to the disease as a probable variant of the hand, foot and mouth Disease, or HFMD, which commonly occurs in children under 10 years of age and can also infect adults. As per theLancet paper, India recorded around 100 cases of ‘tomato flu’ in children below nine years of age in less than three months. The transmission of the “highly contagious” yet “non-life threatening virus” could lead to serious consequences by spreading to adults as well, it adds.
What does The Lancet report say?
In the article ‘Tomato flu outbreak in India’, published in The Lancet Respiratory Medicine journal on August 17, the authors define the infection as a “new virus” that has emerged in Kerala in children younger than five years. The report, however, also claims it to be in an endemic state. Epidemiologists use the term endemic to refer to a disease which has spread in a limited area but has been around for some time.
The report attempts to trace the history of the infection and claims that ‘tomato flu’ was first identified in the Kollam district of Kerala on May 6 this year. However, a study published by the U.S. National Library of Medicine in its Immunity, Inflammation and Disease journal in July says that cases of ‘tomato fever’ have been reported in the past in 2007.
The authors do not mention a specific origin, type or cause of the infection. . They suggest that it may be an after-effect of chikungunya or dengue fever in children rather than a viral infection, or that the virus could also be a new variant of the HFMD — a common viral infection affecting young children that appears with fever, rashes or blisters on the skin and mouth sores.
In response to The Lancet report, a group of doctors and medical experts wrote in The Pediatric Disease Infectious Journal about case studies of two children showing ‘tomato flu’ symptoms after their return to the U.Kafter a family holiday in Kerala in May. The two children developed rashes within a week after their return. They were tested and results showed that they had an enterovirus (EV) infection caused by Coxsackie A16, which is one of the most common EV causes of HFMD in India along with CA6, as per experts.
Lesions (3-5mm diametre) on the arms and legs, including the palms and soles, of the 13-month old girl (Day 4 of lesions) (A,B). Healing lesions (Day 16 of rash), with little or no scarring (C,D). | Photo Credit: The Pediatric Infectious Disease Journal
What are experts saying?
As far as its etymology is concerned, the Lancet report claims ‘tomato flu’ is so named because of the “eruption of red and painful blisters throughout the body that gradually enlarge to the size of a tomato.” Medical experts have taken strong exception to this, saying using such terms is unscientific and misleading. They also clarify that the infection is not related to the consumption of tomatoes in any way.
“Tomato fever is a misleading colloquial name for hand, foot, and mouth disease. This is a mild viral illness commonly affecting young children typically below age 10. It is usually caused by a Coxsackie virus… It produces red spots on the skin, and hence someone called it ‘tomato fever’, and the name became popular. But using such terms is misleading because many people mistakenly believe it comes from tomatoes,” Indian Medical Association (IMA) member Dr. Rajeev Jayadevan was quoted as saying by news agency ANI.
Hyderabad-based paediatrician Dr. Suresh Kumar Panuganti shared a similar view with The Hindu. “‘Tomato flu’ is caused by Coxsackievirus A16. It belongs to the Enterovirus family. HFMD is a frequent febrile rash illness of childhood caused by enteroviruses (EV): Coxsackie A16 (CA16), EV A71, Coxsackie A6, Coxsackie B and Echo viruses.”
Another doctor said such reports cause panic. “The community is just recovering from serious Covid therefore very sensitive and receptive to new endemics. Additionally, this type of news creates panic,” Dr Dhiren Gupta of Sir Ganga Ram Hospital told ANI.
Virologist Dr. Angela Rasmussen has also highlighted the lack of evidence in the report published by The Lancet. In a series of tweets, she said the paper had failed to establish some crucial points related to ‘tomato flu’. She also pointed out that the paper was published in the ‘correspondence’ section of The Lancet. ‘Correspondence’ news or discussions are not normally externally peer-reviewed, according to the medical journal’s website.
What did the Central government advisory state?
In its communication on Tuesday, the Ministry of Health and Family Welfare stated that the illness is a clinical variant of the hand, foot and mouth disease. The ministry, however, also used the term ‘tomato flu’ in the advisory.
The ministry clarified that the virus causing ‘tomato flu’ is not related to SARS-CoV-2, monkeypox, dengue, or chikungunya despite symptoms similar to those in viral infections. “It seems the disease is a clinical variant of the so-called hand, foot and mouth disease (HFMD) that is common in school-going children. Infants and young children are also prone to this infection through the use of nappies, touching unclean surfaces as well as putting things directly into the mouth,” the Centre said. It is a self-limiting illness and no specific medication exists for its treatment yet, it said.
It also advised isolation for five to seven days from the onset of any symptom to prevent the spread of infection.
On symptoms, the Centre said a child infected with ‘tomato flu’ will have fever, rashes and pain in joints. The illness usually begins with mild fever, poor appetite, malaise, and occasionally, a sore throat. Small red blisters appear one or two days after the fever and these sores are usually located on the tongue, gums, inside of the cheeks, palms and soles, the advisory reads. In some cases, fatigue, nausea, vomiting, diarrhoea, dehydration, swelling of joints, body ache, and common influenza-like symptoms have also been noted.
Other guidelines include:
- States to spread awareness among children about symptoms and side-effects of ‘tomato flu’
- Maintain proper hygiene and restrict sharing of toys, clothes, food, with other non-infected children
- Avoid immediate contact with an infected person
- Ensure kids are hydrated
- A nutrition-rich, balanced diet to boost immunity
- Don’t scratch or rub the blister
- Testing is to be done for the investigation of an outbreak. It will take two to four weeks to get the test results of the samples
- Use warm water to clean skin or for bathing the child.
- Rest, plenty of fluids and a hot water sponge will provide relief from irritation and rashes.
- Supportive therapy of paracetamol for fever and body ache and other symptomatic treatments may be required.
