‘Tomato fever’ makes news again as Kerala doctors reproach the Lancet report

The BMJ reported on September 13 that The Lancet has refused to publish a letter by doctors from Kerala, urging that the ‘unscientific article’ be retracted

The BMJ reported on September 13 that The Lancet has refused to publish a letter by doctors from Kerala, urging that the ‘unscientific article’ be retracted

The recent Hand, Foot and Mouth Disease (HFMD) outbreak in Kerala gained international traction when the reputed medical journal, The Lancet Respiratory Medicinechose to publish a letter by Chavda et al on August 17 that “a new virus known as tomato flu, or tomato fever, has emerged in India in the State of Kerala”

The story was carried widely by every media, prompting the Union Health Ministry to issue a circular to the State’s Health Department.

The incident is making headlines yet again, this time with another venerable medical journal, the British Medical Journal (BMJ) reporting on September 13 that The Lancet has refused to publish a letter by doctors from Kerala, urging that the “unscientific article” be retracted

R. Aravind, the Head of Infectious Diseases, Government Medical College, Thiruvananthapuram, said that he, along with two other doctors, Tony Lawrence and Mariyam Alex, had written to The Lanceton August 28, clearly listing the reasons why the article by Chavda et al was misleading and requesting the editorial board “to retract this unscientific article at the earliest with a proper clarification to its audience”.

Also read: Lancet warns about ‘Tomato Flu’ in India among children

They pointed out that “tomato fever” is nothing but HFMD and that “it is neither a new virus nor a rare disease and neither did it originate in Kerala as the authors have stated”.

However, on September 6 they received information from the Editor of Lancet Respiratory Medicine, rejecting their letter, Dr. Aravind said.

“We wrote to The Lancet because that article was quite damaging for Kerala because it created panic and misinformation among the public. We had a tough time issuing clarifications that we were not dealing with anything new or dangerous. The samples of what the vernacular media called ‘tomato fever’ had already been profiled by the Institute of Advanced Virology (IAV) in Thiruvananthapuram as Coxsackie virus A 6 and A 16, which is very well known to cause HFMD in Kerala as well as other States,” Dr. Aravind said.

The correspondence by Chavda et al, published by the Lancet had said that “Tomato flu could be an after-effect of chikungunya or dengue fever in children rather than a viral infection”. It said in the same breath that “the virus could also be a new variant of the viral hand, foot, and mouth disease, a common infectious disease targeting mostly children aged 1-5 years”

In their letter to The Lancet, Dr. Aravind and others said that the August 17 article seemed to have been based on media reports rather than scientific facts or official statements.

Following media reports about “tomato fever” or “thakkali pani”, Kerala Health Department had issued a press release on July 9 itself that the so-called mystery disease was HFMD, a very common, self-limiting viral disease of children, reported from almost all parts of the world.

They pointed out that the relaxation of pandemic-related restrictions and reopening of schools and daycare centers in early 2022 in Kerala probably triggered the current surge in HFMD cases. They also felt that Chavda et al were totally misleading the readers regarding the symptomatology of HFMD and that statements like ‘blisters gradually increase in size to that of a tomato’ were ludicrous

“Overall, this article has become a source of media sensation, medical misinformation, and unnecessary alarm in India”, the letter concluded.

“I am quite aware of the fact that correspondence to the Lancet is not peer reviewed as a study is. But more editorial caution should have been applied, especially as the letter spoke about a “new virus” that had “emerged” in Kerala. The journal commands so much respect and credibility that the media went to town with it without questions,” pointed out Dr. Aravind

BMJ report quoted a statement from the The Lancet Group: “Scientific discussion and debate are an important part of the scientific process, and the Lancet’s journals welcome responses from readers and the wider scientific community to content we have published. We have shared the questions raised around this published correspondence with the authors to ensure any decisions made are evidence based and factually accurate. We will continue to monitor the situation closely.”

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