A virus spread by biting midges and certain mosquitoes is increasing in the Americas and evidence suggests it can cause severe outcomes if passed from a pregnant person to a fetus.
The Centers for Disease Control and Prevention released a health advisory Friday on Oropouche virus with recommendations for clinicians and travelers.
More than 8,000 Oropouche cases have been reported this year in Brazil, Bolivia, Colombia, Cuba and Peru, according to the advisory. Cases also have been seen in people in the U.S. and Europe who have traveled to Cuba and Brazil.
Two people have died from Oropouche and there have been five cases of transmission from a pregnant person to a fetus that have been associated with fetal death or congenital abnormalities including microcephaly.
Symptoms of Oropouche are similar to dengue, Zika and Chikungunya and include fever, severe headache, chills, muscle aches and joint pain. Some patients experience eye pain, light sensitivity, nausea, vomiting, diarrhea, fatigue, maculopapular rash, conjunctival injection and abdominal pain. Patients also may have lymphopenia and leukopenia, elevated C-reactive protein and slightly elevated liver enzyme. Many patients experience recurrent symptoms days to weeks after their initial illness has resolved.
Most cases are mild. Less than 5% of patients develop hemorrhagic manifestations or neuroinvasive disease. People of older age and those with underlying conditions are believed to be at higher risk of severe disease. There are no vaccines or treatments for Oropouche. People can protect themselves by preventing insect bites.
The CDC made the following recommendations for clinicians.
- Consider infection in a patient who has been in an area with documented or suspected Oropouche virus circulation within two weeks of initial symptom onset and all of the following
- Abrupt onset of reported fever, headache, and one or more of the following: myalgia, arthralgia, photophobia, retroorbital/eye pain, or signs and symptoms of neuroinvasive disease (e.g., stiff neck, altered mental status, seizures, limb weakness, or cerebrospinal fluid pleocytosis); AND
- No respiratory symptoms (e.g., cough, rhinorrhea, shortness of breath); AND
- Tested negative for other possible diseases, in particular dengue. If strong suspicion of Oropouche virus disease exists based on the patient’s clinical features and history of travel to an area with virus circulation, do not wait for negative testing for other infections before contacting your state, tribal, local, or territorial health department.
- Contact your state, tribal, local, or territorial health department to facilitate diagnostic testing.
- Rule out dengue virus infection in travelers with suspected Oropouche virus infection.
- Monitor pregnancies in people with laboratory evidence of Oropouche virus infection and provide thorough infant evaluations.
- Inform pregnant people of the possible risks to the fetus when considering travel to areas with reported Oropouche virus transmission. Counsel these patients to consider the destination, reason for traveling, and their ability to prevent insect bites.
- Pregnant people are currently recommended to reconsider non-essential travel to areas with an Oropouche virus Level 2 Travel Health Notice. If a pregnant person decides to travel, counsel them to strictly prevent insect bites during travel.
- Manage travelers with suspect Oropouche virus disease with acetaminophen as the preferred first-line treatment for fever and pain. Aspirin and other NSAIDS should not be used to reduce the risk of hemorrhage.
- Direct all travelers going to areas with Oropouche virus transmission to use measures to prevent insect bites during travel and for 3 weeks after travel, or if infected, during the first week of illness to mitigate additional spread of the virus and potential importation into unaffected areas in the United States.
- Report all suspected Oropouche virus disease infections to your state, tribal, local, or territorial health department to facilitate diagnosis and mitigate risk of local transmission. For after-hours contact information for health departments please visit https://www.cste.org/page/EpiOnCall. Follow standard procedures for reporting during normal business hours.
The CDC also provided recommendations for travelers.
- Protect yourself from Oropouche, dengue, Zika, and other viruses transmitted by insects by preventing insect bites, including using an Environmental Protection Agency-registered insect repellent; wearing long-sleeved shirts and pants; and staying in places with air conditioning or that use window and door screens.
- Pregnant travelers should discuss travel plans, reasons for travel, steps to prevent insect bites, and potential risk with their healthcare provider.
- Pregnant people considering travel to countries with an Oropouche virus Level 2 Travel Health Notice should reconsider non-essential travel. If travel is unavoidable, pregnant travelers should strictly follow Oropouche virus prevention recommendations to prevent insect bites during travel.
- Travelers who have been in areas with Oropouche virus transmission should prevent insect bites for 3 weeks after travel.
- Travelers to areas with Oropouche virus transmission, including South America or the Caribbean, who develop fever, chills, headache, joint pain, or muscle pain during or within 2 weeks after travel, should:
- Seek medical care and tell their healthcare provider when and where they traveled.
- Not take aspirin or other NSAIDS (e.g., ibuprofen) to reduce the risk of bleeding.
- Continue to prevent insect bites during the first week of illness to avoid further spread, especially in areas where mosquitoes or biting midges are active.
Earlier this summer, the CDC also warned of increasing dengue virus infections. Case counts in the U.S. have risen to 3,624. While most are in Puerto Rico, cases have been reported in 53 jurisdictions.
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