Oropouche
Oropouche virus disease is an arbovirosis caused by Oropouche virus (OROV), an RNA virus of the genus Orthobunyavirus, family Peribunyaviridae.
The probability of importation of cases into continental Europe is considered low. In the event that a case is imported, the probability of observing secondary transmission within continental Europe is considered very low, as the competent vectors commonly described in the Americas are absent in continental Europe.
Oropouche virus is most likely carried from a forested area to an urban environment by an infected person. Stinging midges are believed to be primarily responsible for transmitting the virus from an infected person to an uninfected person in an urban area. Culex quinquefasciatus has also been implicated as a potential urban vector.
Oropouche virus can be transmitted to humans primarily through the bite of a small hematophagous dipteran (similar to a gnat) found only in Central and South America, Culicoides paraensis, or certain mosquito species (Coquillettidia venezuelensis, Aedes serratus, and Culex quinquefasciatus). In endemic areas, a wild cycle is possible, in which the virus probably circulates in wild animals (birds and mammals, such as sloths, rodents, and primates), transmitted by different mosquito species, and an urban epidemic cycle in which humans are the amplifying host and OROV is transmitted primarily through the bite of Culicoides paraensis. To date, there is no evidence of direct interhuman transmission of OROV.
The virus is endemic in many South American countries, both in rural and urban communities. Periodic outbreaks are reported in Brazil, Bolivia, Colombia, Ecuador, French Guiana, Panama, Peru, and Trinidad and Tobago.
On May 27, 2024, Cuba's Ministry of Public Health first reported an outbreak of Oropouche virus disease in the country, with 74 confirmed cases.
As of July 16, 2024, the Pan American Health Organization reported 7,688 confirmed cases of infection in five countries in the Region of the Americas: Bolivia (n= 313), Brazil (n= 6,976), Colombia (n= 38), Cuba (n= 74), and Peru (n= 287). Six possible cases of vertical transmission of OROV associated with spontaneous abortion, fetal death, and/or microcephaly were also identified in Brazil.
In Europe, as of July 12, 2024, 8 imported cases of infection have been reported, 3 from Spain and 5 from Italy (the latter all imported from Cuba and Brazil)
Infection in humans presents as an acute febrile illness, with dengue-like symptoms usually beginning 4 to 8 days (range 3 to 12 days) after the infected sting. The onset is sudden, usually with high fever, headache, joint stiffness, pain, chills, and sometimes persistent nausea and vomiting, lasting 5 to 7 days. Less frequently, patients experience rashes, anorexia, retro-orbital pain, and general malaise. Hemorrhagic phenomena such as epistaxis, gingival bleeding or petechiae have also been described.
A biphasic clinical course is common (60% of cases) with a relapse of symptoms within two weeks of initial clinical improvement with a similar but sometimes more intense symptomatic picture. Most cases heal spontaneously within about seven days.
Severe clinical presentation is rare and manifests as neuro-invasive forms (aseptic meningitis or encephalitis) usually with a good prognosis and no sequelae. In these cases, the virus can be detected in the CSF.
Preliminary diagnosis is based on clinical signs and especially the history of any travel to areas endemic for the virus.
During the acute phase of the disease, (usually 2 to 7 days), virus genetic material (RNA) can be detected by molecular methods (RTPCR) in various biological samples (serum, urine, whole blood) and, in cases with aseptic meningitis, also in cerebrospinal fluid (CSF). It is recommended that the collection of biological specimens be repeated weekly until the molecular tests for OROV detection are negative. As for serological methods, antibodies to OROV can generally be detected in serum from the fifth day after the onset of symptoms.
No specific antiviral treatment or vaccine is currently available. Therefore, the therapeutic approach is symptomatic and focused on anti-pyretics and possibly antiemetics. Steroidal and nonsteroidal anti-inflammatory drugs are not recommended.
Staying in dwellings equipped with mosquito nets
Make use of clothing that covers legs and arms
Reduce outdoor activities at dawn and dusk
Making use of repellents containing DEET, IR3535 or Icaridine
Make use of bed mosquito nets (whether or not treated with insecticide)
Suggest that women who are pregnant, or who plan to become pregnant, and who intend to travel to countries/areas where there is documented transmission of oropouche, consider procrastinating travel about possible vertical transmission of the disease (mother to fetus)
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The information presented is general in nature, is published for general audiences and is not a substitute for the relationship between patient and physician.