Amid COVID-19 and monkeypox: tomato flu outbreak in India
Year: 2023
Type: article
Abstract: Just as India is dealing with the probable fourth wave of the Coronavirus disease 19 (COVID-19), and the sudden outbreak of monkeypox cases, the emergence of a rare new virus known as tomato flu in Kerala and many other cities in India. Tomato flu has affected the lives primarily of children who are younger than 5 years causing hand, foot, and mouth disease1. Due to the population and resulting overcrowding, the synergism of COVID-19 and monkeypox has a threatening effect with tomato flu on the go. Tomato fever is a common infection caused by a group of enteroviruses—Enterovirus-A (EV-A), EV-B, and EV-C species2. In 1997, the first human case of tomato flu was recorded in Sarawak, Malaysia3. Currently, the tomato flu infection is in an endemic state and is considered a nonthreatening disease, however, India’s health care system is trying its best to prevent the spread of this infection4. Epidemiology Arising in the Kollam district of Kerala, a strain of tomato flu virus was first reported on May 6, 20221. As the country is dealing with the ongoing pandemic and the emergence of monkeypox cases, the re-emergence of tomato fever has burdened the Indian healthcare system with both preventive and control measures to safeguard the people. In addition, other areas in Kerala that have been infected include Aryankavu, Anchal, and Neduvathoor1. Tamil Nadu, a neighboring state of Kerala, and the state of Odisha which is over 1800 km away from Kerala have also reported cases of tomato flu5. As of October 10, 2022, there have been 11,984 confirmed cases of COVID-19 in India which is ~10 times lesser than the cases reported to WHO on October 11, 20216. It can be stated that India’s health care system has been successfully battling the dangers imposed by the COVID-19 pandemic and the monkeypox cases, however, the sudden appearance of tomato fever can tend to overwhelm the health care system. Symptoms The term “tomato fever” or “tomato flu” has been given to this infection due to the eruption of red-colored painful blisters that resemble tomatoes, and which are seen throughout the affected individual’s body1. The fever is characterized by symptoms such as tomato-like red blisters on the skin along with rashes and irritation. Constitutional symptoms include fever, fatigue, dehydration, and pain in joints that are commonly seen in COVID-19 which unfortunately coincides with cases of tomato flu5. It has been reported that the blisters observed in the cases of tomato flu resemble the blisters observed in young individuals who have been infected by the monkeypox virus1. There have been cases where the virus has continued to be present in the body in the latent form, even after weeks of treatment and there are not clinical symptoms of the infection5. Current efforts and challenges in response to tomato flu in India, in the presence of COVID-19 and monkeypox Given that India has a large population, early prevention is crucial. Strict actions need to be carried out diligently. In the impacted areas like Kerala, Tamil Nadu, and Odisha, mass testing must be carried out. Screening booths and campaigns must be ensured wherever necessary. If tomato flu is suspected as the etiology, the patient should be quarantined immediately as the disease is very contagious like the influenza flu. The duration of quarantine should be 7-10 days. However, with accurate treatment, the patient should recover within 8–10 days7. Children are especially vulnerable to tomato flu because viral infections are widespread due to their poor knowledge and skills in maintaining personal hygiene as well as overcrowding such as in play schools, nurseries, or even in villages where children are made to interact with other kids. If the tomato flu outbreak in children is not controlled and prevented, the infection can spread to adults, and hence there could be significant repercussions which for a country like India having a huge population is very difficult to control1. Prevention through proper education about the disease; the symptoms, signs, control, and impacts, and through knowledge of maintaining good personal hygiene in multiple languages spoken across the country with billboards, audio-visuals, and campaigns is necessary. The role of quarantine and social distancing when necessary is crucial as it can help in attributing less spread of the virus as it is the most difficult task in trying to spread it through a large population of India. As with any other outbreak such as COVID-19 or the monkeypox surge, increasing the number of hospital beds in impacted areas, as well as doctors and medical staff, provision of medications, functioning laboratories, and appropriate equipment is needed. Maintaining the disposal of the test samples, the waste generated from the hospitals due to the disease must be managed with utmost precision as it can lead to more nuisance than required if not done adequately. Children should be screened at regular health camps at district levels, checking for early symptoms and educating the parent/guardian about the disease is a way to tackle the problem early. Since it is already difficult to fully understand how a child expresses their symptoms and painful to watch them go through it, it becomes a taxing task on its own. It is important to be mindful enough to strike a balance between providing useful information rather than unnecessarily creating havoc about the disease which only leads to fear, and anxiety about the condition making the person hypervigilant and in some people shameful as they tend to find it difficult to cope up with the changes in their body and mind due to effects of the disease as we have a population ranging from uneducated to highly educated in different parts of India. Appropriate traveling protocols be it road, rail, air, or sea with extreme sanitary conditions must be adhered to. Everyone must be well informed about all the different and new advancements if so in the disease, and any updates regarding the new disease in a neutral light without bringing confusion and stress through the local newspapers, regional government officials, and local news channels across India. Different strategic systems need to be developed to deal with flu outbreaks and they must go hand in hand at all levels to ensure the right usage of manpower and labor, let alone the health of the community. All non-affected states in India should have their standard operating procedures (SOPs) ready5 and if needed may keep a curfew. As COVID-19 and monkeypox are still active, the tomato flu can harm the community’s mental health, with the sudden change in their lifestyle, the newly added diseases, loss of lives, fear of it, and the aggression in the consequences mentally perturbed the society and it is crucial that we save them and not let their mental health deplete them before the actual disease if it were to deplete them. Collaboration and cooperation amongst various government authorities, health professionals, and the public are important in dealing with the “tomato flu” outbreak during COVID-19 and monkeypox time. Ethical approval None. Sources of funding None. Author contributions J.N.S. and R.O.A.: research conceptualization and design. R.O.A.: methodology. J.N.S. and R.O.A.: data acquisition; draft manuscript preparation and revision. All the authors read and approved the final draft before submission. Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor Ridwan O. Adesola.
Authors: Joanna N. D’ Souza, Ridwan O. Adesola
Institutions: R.V. College of Engineering, University of Ibadan
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4353048837