How dangerous is the emerging flu epidemic in India?

India has reported cases of a strange virus known as tomato flu, which has been spreading silently since May. The infections are mostly children, spreading to several provinces such as Kerala, Tamil Nadu, Haryana and Odisha. On August 23, the Union Health Ministry of India issued guidance on the prevention, testing and treatment of tomato flu infections.

What is tomato flu?

Tomato flu is characterized by fever, joint pain, and a red, tomato-like rash, commonly seen in children under 5 years of age. These symptoms are accompanied by manifestations of viral fever such as diarrhea, dehydration, nausea, vomiting and fatigue.

Tomato flu is believed to be the result of dengue and chikungunya diseases commonly found in the Kerala region. However, researchers now believe it is a variant of hand, foot and mouth disease, caused by viruses such as Coxsackievirus A-6 and A-16.

 Tomato flu has some atypical manifestations.

"Tomato flu may be more a consequence of chikungunya or dengue in children than a viral infection. It could also be a new form of viral hand, foot and mouth disease, an infectious disease common in children aged one to two years old. 5 years old and immunocompromised adults," the Lancet report states.

"Hand-foot-and-mouth disease is not a new type of infectious disease," said Ekta Gupta, a professor of virology at the Institute of Liver and Bile Sciences.

Why does India record so many tomato flu cases?

According to Professor Gupta, people are paying attention to tomato flu because many new infectious diseases have been reported this year. She said that after Covid-19 raged, people and experts became wary of emerging viruses.

Usually, many diseases have a limited spread, so doctors don't test them, she explained.

"There are many types of viral infections in children, but we cannot, and do not need to test for each virus. However, we are now seeing many new cases as the number of virus tests increases. increased over the past five years in clinics spread across the country. The pandemic has also fueled this activity," explained Professor Gupta.

Differences between tomato flu and other childhood infectious diseases

According to Dr Asawathyraj, a scientist at the Advanced Virology Institute, tomato flu has some atypical manifestations. The red, tomato-like rash is limited to the mouth (tongue, gums, and inside of the cheeks), palms, and soles of the feet. Some children develop a rash on their buttocks and fall off their fingernails.

Dr Asawathyraj also said the rash was visually distinguishable from monkeypox. "The rash in monkeypox is deeper, the distribution is also different," she said.

However, the disease can be confused with hand, foot and mouth disease. The current cases of hand, foot and mouth disease are mainly caused by Coxsackievirus A-6 and A-16. Some cases originate from Enterovirus71, but are not common.

Prevention and treatment of tomato flu

There is currently no specific treatment or vaccine for this disease. However, pediatric patients will be treated symptomatically, such as prescribing paracetamol to reduce fever.

Because the virus is mainly spread among children, the Centers for Disease Control and Prevention recommends focusing on prevention measures in this age group. According to agency guidelines, suspected cases should be isolated for 5 to 7 days after the onset of symptoms.

Children should be educated about the condition and asked not to hug or touch other children with typhus. Children need to stay clean, stop sucking their thumbs and use a tissue to get rid of a runny nose.

According to the recommendation, children with symptoms of the disease must isolate, clean utensils, clothes, bedding regularly, gargle with salt water, and wash their acne with warm water.

Localities need to check and take countermeasures if the disease breaks out. All respiratory, fecal, or cerebrospinal fluid samples (in the case of pediatric encephalitis) should be collected within 48 hours of illness.