What is Tomato Flu?

Tomato flu, also known as tomato fever, is a rare but contagious viral infection primarily affecting young children under the age of 5. It earned its name from the distinctive red, blister-like rashes that resemble small tomatoes in size and color, typically appearing on the hands, feet, mouth, and sometimes other parts of the body. Despite initial fears of a “new” virus during its 2022 outbreak in India, it is not a novel pathogen but a variant or atypical presentation of hand, foot, and mouth disease (HFMD), caused by enteroviruses such as Coxsackievirus A16 or A6.

This illness is self-limiting, meaning it usually resolves on its own within 5–7 days without specific antiviral treatment, and it is not life-threatening in most cases. However, it can cause discomfort and dehydration, especially in small children. As of October 2025, there are no reports of ongoing widespread outbreaks, and it remains a localized concern mainly in parts of India, though vigilance is advised during viral seasons.

Causes

Tomato flu is triggered by enteroviruses from the Picornaviridae family, most commonly:

• Coxsackievirus A16: The primary culprit behind many HFMD cases, including tomato flu.
• Coxsackievirus A6: Responsible for more severe or atypical rashes.

It is not related to COVID-19, monkeypox, dengue, chikungunya, or Zika, despite some overlapping symptoms like fever. Early speculation linked it to mosquito-borne transmission, but this has been debunked—it’s a human-to-human virus. The exact reason for the 2022 surge in India remains unclear, but it may have been amplified by post-pandemic immunity gaps or environmental factors.

Symptoms

Symptoms typically appear 3–6 days after exposure and progress in stages:

1. Prodromal phase (first 1–2 days): Flu-like signs including high fever (up to 102°F/39°C), fatigue, irritability, loss of appetite, sore throat, and body aches.
2. Rash phase (days 2–5): Red, painful spots or blisters (vesicles) that fill with fluid and turn yellowish before crusting over. These are most common on:

• Palms and soles of feet.
• Inside the mouth, tongue, or gums (causing painful ulcers that make eating/drinking difficult).
• Occasionally buttocks, knees, or elbows.

1. Other effects: Nausea, vomiting, diarrhea, joint swelling, and dehydration from reduced fluid intake.

Rare complications (in <1% of cases) include viral meningitis (stiff neck, headache) or encephalitis, but these are uncommon and mostly seen in immunocompromised children. No scarring usually occurs after healing.

Transmission

The virus spreads easily through:

• Direct contact: Touching blisters, saliva, or nasal secretions from an infected person.
• Fecal-oral route: Poor hand hygiene after diaper changes or using the bathroom.
• Contaminated surfaces: Sharing toys, utensils, or bedding.
• Respiratory droplets: Coughing or sneezing (less common than in flu).

Children in daycare or playgroups are at highest risk due to close contact. It’s highly contagious during the first week of symptoms but can linger in stools for weeks.

Treatment

There is no specific cure or vaccine, as it’s a viral illness. Management focuses on symptom relief and supportive care:

• Hydration: Encourage plenty of fluids (oral rehydration solutions if needed) to prevent dehydration.
• Pain and fever relief: Paracetamol (acetaminophen) for fever and discomfort; avoid ibuprofen if dehydrated. Use age-appropriate doses.
• Skin care: Calamine lotion or cool compresses for rashes; keep blisters clean and uncovered to avoid infection. Do not pop them.
• Rest and isolation: Bed rest for 5–7 days; isolate the child to prevent spread.
• Diet: Soft, non-acidic foods to ease mouth pain.

Most children recover fully without hospitalization. Consult a doctor if symptoms worsen (e.g., high fever >3 days, severe dehydration, or neurological signs). In rare cases, hospitalization may be needed for IV fluids.

Prevention

Simple hygiene measures are key, as there’s no vaccine:

• Handwashing: Frequent soap-and-water handwashing, especially after diaper changes or before meals.
• Avoid sharing: Don’t share utensils, towels, or toys with infected children.
• Disinfection: Clean surfaces and laundry with soap/disinfectant.
• Isolation: Keep symptomatic children home from school/daycare for at least 7 days or until blisters heal.
• Mosquito control: Though not mosquito-borne, reduce breeding sites to avoid confusion with dengue/chikungunya.

Parents should monitor for early signs and seek prompt medical advice, especially in endemic areas like Kerala, India.

Current Status (as of October 2025)

The 2022 outbreak in India (over 100 cases in Kerala, Tamil Nadu, and Odisha) was contained without major escalation, and no global spread occurred. Recent health updates emphasize it’s a seasonal, endemic illness in tropical regions, with no new epidemics reported. If you’re concerned about a specific case, consult local health authorities or a pediatrician for testing (e.g., PCR for enterovirus).