‘Tomato flu’ (HFMD): Transmission, Prevention, and Treatments

The most recent news has everyone talking about the ‘tomato flu’ – but should you be concerned? In today’s world, as we face new and emerging infectious diseases, scientists and medical professionals are paying close attention. Because of this watchfulness, a great concern arises when diseases that show similar traits to COVID-19 and monkeypox appear. Careful monitoring of infectious diseases globally may help protect us against the next pandemic.

What is the ‘Tomato flu’?

Recent reports in India of the ‘tomato flu’ have people talking. In India, reports of a rash-causing illness with sores that look like red tomatoes first arose in May 2022. Concerns abound with the most recent global outbreaks of monkeypox, which also causes sores, rashes, and other flu-like symptoms. So, researchers have taken a closer look to see what has caused all the chatter.

But is this ‘tomato flu’ worth all the commotion? It is too soon to say. The ‘Kerala Tomato Flu,’ named for the sores and the location where the disease was first seen, appears to be caused simply by a commonly seen childhood virus, Hand, Foot, and Mouth disease (HFMD). Initial non-scientifically supported reports by the Lancet suggested a new disease was the cause. However, further data and tests have identified this common childhood ailment as the culprit.

‘Tomato flu’ – new virus or a type of HFMD?

The ‘tomato flu’ was initially thought to be a new virus or disease. Kids were demonstrating elevated temperatures, tiredness, with whole body aches. But more concerning was the additional presence of a rash. We have seen these sets of signs in patients with both COVID-19 and monkeypox. So, concern for a new bug or a complication from another disease, such as dengue fever or chikungunya, was suspected.

Kids ages 1-5 and adults with compromised immune systems showing self-limiting disease presented to healthcare workers in India, with over 80 cases reported to date. Why the concern? India also reports increasing cases of COVID-19 and humans sick with swine flu. While the disease hasn’t occurred outside of India, infectious disease specialists and others continue to monitor the situation to ensure travel related cases and changes in the disease do not lead to new conditions or concerns.

A few case reports mention the presence of disease in the United Kingdom; however, the kids affected had recently traveled to Karela and were exposed while vacationing. This highlights that travel history, contact with people outside the norm, and any other unusual exposures need to be reported to healthcare professionals to properly identify diseases.

What is hand, foot, and mouth disease (HFMD)

The emergence of the ‘Tomato flu’ may have you concerned. Learning about HFMD and knowing how to recognize it, manage those with symptoms, and prevent disease spread, improve your chances of avoiding the disease in your family.

HFMD is not to be confused with the animal-only disease that affects pigs, sheep, and cattle, known as Foot and Mouth Disease (FMD). Thankfully, FMD doesn’t naturally exist in the U.S. But one can easily see how HFMD and FMD could easily be confused. While the terminology may be tricky, remember that humans cannot get FMD from animals, and animals cannot get HFMD from people.

What we are talking about today, HFMD is a common childhood ailment. What causes it? A virus from the Enterovirus family, Coxsackievirus A16, commonly causes U.S. HFMD in kids, though other related viruses also cause disease. Because a few different viruses within the same family can cause illness, a person can be infected more than once.

When do we see HFMD in the U.S.?

HFMD exists globally, but no U.S. cases of the ‘Tomato flu’ have occurred to date. However, run-of-the-mill HFMD frequently arises in the summer and fall months, though it can happen anytime.


Generally, HFMD leads to mild illness for most. Typically, children younger than five show symptoms of the disease. While the condition may be mild, it is extremely contagious.

HFMD spreads with ease via contact with various contaminated things and then touching one’s hands, nose, and mouth, spreading the virus and allowing infection to occur. Spread may occur with contact with any of the following

  • Secretions from coughing, sneezing (respiratory droplets, saliva, mucus, drool)
  • Contact with an infected individual’s poop (feces) (e.g., when changing diapers)
  • Contact with fluid from open sores or scabs
  • Direct contact between individuals
  • Touching and rubbing against contaminated objects and surfaces like countertops, toys, and clothing
  • Though rare, swallowing pool water or other contaminated, untreated water, when contaminated with feces, can lead to infection.

As a rule, during the first week with symptoms, people are most likely to infect others. However, some can remain infectious (capable of spreading the disease to others) for days, even weeks, after signs resolve. Still, others may have no evidence of outward disease but may serve as a source of infection for others.


Kids may demonstrate the following signs and symptoms with HFMD

  • Mouth sores (ulcers) - They may drool more, only want cool things to drink, and not want to eat
  • Skin rash - most commonly on the palms and feet soles; less commonly on the legs, arms, and rear end
  • Fever
  • Flu-like symptoms - they feel yukky; they may eat or drink less; complaint of a sore throat

The skin rash tends to be non-itchy and often starts with bumps (elevated red spots) that may blister. Remember that even the blisters and scabs can infect others when popped or scratched open. Symptoms generally resolve on their own (self-limiting) within 7-10 days.

Treatments and prevention

Again, remember, this disease is highly spreadable. As with many viral infections, no specific treatment exists, so recognizing signs and preventing spread remains key.

Steps you can take to protect yourself from getting sick and your child can take to prevent the spread include

  • As always, practice proper hygiene - hand washing or alcohol-based hand sanitizers
  • Assist young kids in washing hand and instruct on proper technique and contact time
  • Routinely clean/disinfect any common areas like doorknobs and toys or any shared items
  • Don’t share utensils
  • Don’t touch your nose, mouth, or eyes with dirty hands, especially after touching a sore or handling dirty diapers
  • Avoid close, direct contact with others - no hugging or kissing, or cuddling those with disease
  • Keep sores clean and dry
  • Ensure proper hydration and food intake

Remember, no treatment exists, so recognizing signs and preventing spread remains key. Manage flu-like symptoms as you would with any viral disease. Use mouthwashes that can soothe mouth sores when needed. Keep your child comfortable. For kids with underlying conditions, those who fail to resolve after 10 days, or for kids less than six, you should contact a healthcare specialist sooner rather than later.

Can kids go to school with HFMD?

If your child has no fever, doesn’t typically drool (mouth sores can spread disease), and feels well enough to participate in school, kids do not usually need to be kept home. However, individual school policies vary. If many kids show the disease, your local public health department may require kids to be kept out of school until they are disease-free, even if they feel well enough.

HFMD = ‘tomato flu’

Remember, ‘the tomato flu’ was identified as a commonly seen childhood disease, HFMD. The strain identified also occurs quite frequently. In this hyper-observant era, with COVID-19 and monkeypox concerns, scientists, infectious disease specialists, and others constantly monitor for new and emerging diseases. We do not want another pandemic to surprise us. Reports of this ‘tomato flu’ were initially reported without scientific evidence. With testing and proper identification of HFMD as the cause, the ‘tomato flu’ is nothing to be feared. Knowing the signs and symptoms of HFMD and how to prevent it gives you a leg up on protecting your family.

Key takeaways

‘Tomato flu’ from India is a form of HFMD, a common childhood illness.

HFMD generally causes mild, self-limiting disease in children under five.

HFMD symptoms may include fever, rash, mouth sores, and flu-like complaints.

HFMD is readily transmissible but preventable.


The Pediatric infectious disease journal. https://journals.lww.com/pidj/fulltext/9900/kerala_tomato_flu___a_manifestation_of_hand_foot.160.aspx

The Lancet respiratory medicine. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00300-9/fulltext

The Centers for Disease Control and Prevention. https://stacks.cdc.gov/view/cdc/13593/

The Centers for Disease Control and Prevention. https://www.cdc.gov/dengue/index.html

The Centers for Disease Control’s Yellowbook. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/hand-foot-and-mouth-disease

The Centers for Disease Control and Prevention. https://www.cdc.gov/hand-foot-mouth/index.html

The Centers for Disease Control and Prevention. https://www.cdc.gov/hand-foot-mouth/about/transmission.html

The Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/diseases/hand-foot-and-mouth-disease

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