An outbreak of Oropouche virus (OROV) is currently affecting several countries in the Americas. The virus, which is transmitted primarily by biting midges (Culicoides paraensis) and mosquitoes, causes Oropouche fever, a disease characterized by symptoms such as fever, headache, myalgia, joint pain, and gastrointestinal issues.

Key outbreak details:

1. Bolivia: So far this year, more than 400 confirmed cases were reported, in the departments of La Paz, Beni, and Pando.
2. Brazil: As of late July 2024, Brazil has reported 7,284 cases, primarily in the Amazon region. Two deaths were reported in the state of Bahia, the first known fatal cases associated with acute Oropouche virus infection in Brazil.
3. Colombia: 74 confirmed cases were reported in the departments of Amazonas, Caquetá, and Meta, with no associated deaths.
4. Cuba: The first outbreak in Cuba occurred in May 2024, with 74 confirmed cases in Santiago de Cuba and Cienfuegos provinces.
5. Peru: 290 confirmed cases have been reported in five departments, including Loreto and Madre de Dios, the highest number recorded in the country to date.
6. United States: 21 travel-associated cases have been reported among U.S. residents who traveled to Cuba. The CDC has advised travelers to areas with known Oropouche virus activity to take precautions against insect bites to prevent further spread of the virus upon their return to the U.S.

Symptoms of Oropouche virus disease:

• Fever: An abrupt onset of high fever is common.
• Headache: Severe headaches, often with pain behind the eyes (retro-orbital pain).
• Muscle Pain (Myalgia): Generalized muscle aches are frequent.
• Joint Pain (Arthralgia): Pain in the joints, sometimes with swelling.
• Rash: A maculopapular rash may develop in some patients.
• Photophobia: Sensitivity to light.
• Gastrointestinal Symptoms: Nausea, vomiting, and diarrhea can occur in some cases.
• Neurological Symptoms: In rare cases, OROV infection may lead to neuroinvasive disease, presenting with symptoms such as a stiff neck, altered mental status, seizures, or limb weakness.

Recurrent symptoms: Unlike many other arboviral infections, symptoms of Oropouche virus disease may recur after initial recovery. Some patients experience a relapse of fever, myalgia, or headache days to weeks after the first episode of illness resolves.

Care and management: There are no vaccines to prevent or medicines to treat Oropouche. The best way to protect yourself from Oropouche is to prevent bites from biting midges and mosquitoes. Management of Oropouche virus disease is primarily supportive, as there is no specific antiviral treatment.

Supportive Care:

1. Rest and hydration: Adequate rest and fluid intake are crucial to prevent dehydration, especially in cases with fever or gastrointestinal symptoms.
2. Pain and fever relief: Use acetaminophen (paracetamol) to reduce fever and alleviate pain. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen, to reduce the risk of bleeding complications.
3. Avoid further insect bites: Patients should use mosquito nets, insect repellents, and wear long-sleeved clothing to prevent being bitten by vectors (mosquitoes or midges), especially during the first week of illness to avoid further transmission​.
4. Clinical monitoring: Monitor for severe or unusual symptoms, especially signs of neuroinvasive disease (e.g., stiff neck, seizures) or complications like severe bleeding or liver involvement.
5. Pregnant patients: Should receive additional monitoring due to the risk of vertical transmission and potential adverse pregnancy outcomes, such as fetal death or congenital malformations.

Oropouche Virus and Pregnancy:

Oropouche virus (OROV) infection during pregnancy is a growing concern, especially given recent reports of potential vertical transmission (transmission from mother to fetus). The Pan American Health Organization (PAHO) issued an epidemiological alert in July 2024 regarding this potential risk, following reports of adverse pregnancy outcomes associated with Oropouche virus infection, including fetal deaths and congenital malformations​.

Potential risks to pregnant individuals:

1. Vertical Transmission: There is a potential for the Oropouche virus to be transmitted from a pregnant person to the fetus, like other arboviruses like Zika virus. This transmission could occur at any stage of pregnancy and may lead to severe consequences, including fetal loss, congenital anomalies, or other pregnancy complications​.
2. Adverse Pregnancy Outcomes: Ongoing studies are evaluating whether Oropouche virus infection during pregnancy can lead to adverse outcomes, such as stillbirths or developmental issues in newborns. The evidence is currently limited, but the concern arises from similar patterns seen with other arboviral infections.

Recommendations for pregnant travelers:

• Avoid travel to affected areas: Pregnant individuals are advised to avoid non-essential travel to regions experiencing Oropouche virus outbreaks, particularly areas with documented transmission in South America and the Caribbean.
• Prevent insect bites: If travel is unavoidable, pregnant travelers should take stringent precautions to prevent insect bites:
  1. Use EPA-registered insect repellents.
  2. Wear long-sleeved shirts, long pants, and socks.
  3. Stay in air-conditioned or screened-in accommodations.
  4. Use bed nets if sleeping outdoors or in an unscreened environment.

Clinical Management and Monitoring:

• Close Monitoring: Pregnant persons with a suspected or confirmed Oropouche virus infection should be closely monitored by healthcare providers for potential complications. This may include ultrasound examinations to assess fetal health and additional laboratory tests.
• Supportive Care: Since there is no specific antiviral treatment for Oropouche virus, supportive care is essential. Fever and pain management with acetaminophen is recommended, while avoiding NSAIDs to minimize the risk of bleeding​

Public Health Actions:

• Enhanced Surveillance and Research: Health organizations like the CDC and PAHO are increasing surveillance and research efforts to better understand the impact of Oropouche virus on pregnancy and to establish more concrete guidelines for care and prevention.

If you are pregnant and considering traveling to an area with Oropouche virus transmission, consult with your healthcare provider to discuss the risks and appropriate preventive measures.

For further details on travel advisories, symptom management, and prevention measures, you can visit the CDC and WHO websites.

Reference: https://www.cdc.gov/oropouche/about/index.html