Kerala: Reports Of An Unidentified Viral Fever In Children

Kerala State -Credit Wikipedia

Caveat : Reports of `mystery' viruses are a staple in India's often bombastic media, and while these reports usually turn out to be something routine, every once in a while they can alert us to a new, or re-emerging threat.    

#16,742

Over the past several days India's media has been filled with reports of an `unidentified' viral fever affecting roughly 80 children < 5 years of age in Kerala.  Hallmarks of this illness include fever, joint paint, and large, red blisters on the skin which has induced the media to dub it `Tomato Fever' or `Tomato Flu'. 

Tomato Fever: Over 80 kids in Kerala reportedly infected - causes and symptoms 

"Tomato Flu" Reported In Kerala: Read Here About Symptoms

Many of these symptoms are similar to those seen with Chikungunya (CHKV); a mosquito-borne illness that emerged out of east-central Africa in 2004, sparking an epidemic on Reunion Island in the Indian Ocean, where it reportedly infected about 1/3rd of that island’s population (266,000 case out of pop.770,000) in a matter of a few months.

From there, apparently aided and abetted by a recent mutation that allowed it to be carried by the Aedes Albopictus `Asian tiger’ mosquito (see A Single Mutation in Chikungunya Virus Affects Vector Specificity and Epidemic Potential), it quickly cut a swath across the Indian ocean, into the Pacific, and eventually into the Americas. 

Fever, joint pain, and rash are commonly reported with CHKV, and while less common, skin blistering has been reported among small children and infants (see Severe bullous skin lesions associated with Chikungunya virus infection in small infants). 

Since India is no stranger to CHKV outbreaks, the presentation of these cases is presumably different enough to raise concerns of either a `new' viral fever, or an unusual presentation of an existing one (like CHKV). 

Previous reports of a `Tomato Fever'  have come out of Kerala, going back as far as 2007 (see ‘Tomato Fever’ Replaces Chikungunya in Kerala), and while tentatively linked to Chikungunya infection, it remains poorly understood. 

Although these reports may be overblown, the Indian Express is reporting that neighboring Tamil Nadu State has sent medical teams to the border to screen people coming in from Kerala. 

Tomato fever: Tamil Nadu on its toes after cases in Kerala

Tomato flu: A team of revenue, health and police officials have been deployed at the Walayar checkpost located on the Tamil Nadu-Kerala border to screen people coming from the neighbouring state.

While I haven't found anything on this outbreak from official sources, we'll continue to keep an eye on it.