As India grapples with a “probable emergence of fourth wave” of Covid-19, a new virus has entered the scene among young children between 1 and 5. An article in the Lancet Respiratory Medicine in August 2022 explored the rise of “tomato flu” or “tomato fever”. It was first observed in the Kollam district of Kerala in May 2022. So-called tomato fever is characterised by the “eruption of red and painful blisters” across the body, each gradually building up to the size of a tomato. These are reported to resemble those seen in young individuals with monkeypox virus.  

The article suggests that the virus shows symptoms similar to those associated with Covid-19, although it is not related to SARS-CoV-2. The origin of this virus is unknown. However, one thought is that it is an “after-effect of chikungunya or dengue fever” in children. Alternatively, it could be a new variant of the viral hand, foot, and mouth disease. This is a “common infectious disease” that largely affects children aged 1-5 years and immunocompromised adults.  

What is tomato flu? 

Tomato flu is a “self-limiting illness” with no specific treatment. The primary symptoms reported in children with tomato flu are likened to those of chikungunya, including high fever, rashes, and joint pains. Further symptoms include “fatigue, nausea, vomiting, diarrhoea, fever, dehydration” and “common influenza-like symptoms”. When children begin to present symptoms, “molecular and serological tests” are carried out to diagnose “dengue, chikungunya, zika virus, varicella-zoster virus, and herpes”. Once each of these has been ruled out, tomato virus is confirmed. Treatment is similar to that of these other diseases: “isolation, rest, plenty of fluids, and hot water sponge for the relief of irritation and rashes”.  

The viral infection is “in an endemic state” and is “considered non-life-threatening”. However, after traumatic Covid-19 experiences, the community is responding with vigilance to prevent further infection. Children are at “increased risk of exposure” as viral infections are “common in this age group” and the spread is “likely to be through close contact”.  

The authors state that in July 2022 more than 82 children under the age of 5 with the infection had been reported by local government hospitals. Within Kerala, apart from the Kollam district, Anchal, Aryankavu, and Neduvathur are affected. This has triggered an “alert to the neighbouring states” Tamil Nadu and Karnataka. Furthermore, 26 children between the ages of 1 and 9 have been reported to have the disease in Odisha. Precautionary measures to “monitor” and “prevent” the spread have been taken by the Kerala Health Department.  

Where next? 

The authors report that “no antiviral drugs or vaccines are available for the treatment or prevention” of this disease. Thus, further research into “outcomes and sequalae” is required.  

To hear more about how the industry is preparing to meet diseases head on come to the World Vaccine Congress in Europe, 2022.