Health Advisory

Summary

• On August 16, 2024, the Centers for Disease Control and Prevention (CDC) issued a Health Advisory to notify clinicians about an increased risk of Oropouche virus disease in travelers from affected countries: Brazil, Bolivia, Colombia, Cuba, and Peru.
• In 2024, over 8,000 cases have been reported, including two deaths in young, otherwise healthy persons and five cases of vertical transmission resulting in fetal death or congenital anomalies, including microcephaly. Twenty-one cases have been reported in U.S. travelers returning from Cuba.
• Providers should consider Oropouche virus disease in patients with clinically compatible illness who have spent time in an area with known or suspected transmission within two weeks of symptom onset.

Suggested Actions

• Patients with a compatible clinical illness (abrupt onset of fever, headache, myalgia, arthralgia, retroorbital pain, photophobia, or signs/symptoms of neuroinvasive disease) and no respiratory symptoms who have tested negative for dengue should be tested for Oropouche virus.
• Report all suspected Oropouche virus disease infections immediately to the Fairfax County Health Department by calling 702-246-2433 or by emailing hdcd@fairfaxcounty.gov. Health Department staff can facilitate testing which is not commercially available at this time.
• Patients with suspect Oropouche virus disease should manage fever and pain with acetaminophen. Aspirin and NSAIDS should not be used to reduce the risk of hemorrhage.
• Inform pregnant patients considering travel to an area with reported Oropouche virus transmission of possible risks to the fetus, including death and congenital anomalies.
• Pregnant individuals are recommended to reconsider non-essential travel to areas with a Level 2 Travel Health Notice (currently only Cuba). If a pregnant individual decides to travel, they should be advised to avoid insect bites.
• 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 US.

Additional Information

• Oropouche virus disease is transmitted by biting midges (Culicoides paraenesis) or mosquitoes (Culex quinquefasciatus) in the Amazon basin. In the last 25 years, cases have been reported in Bolivia, Brazil, Colombia, Ecuador, French Guinea, Panama, and Peru. While both vectors for the Oropouche virus are found in Virginia, no cases have been reported in the Fairfax Health District.
• Recent outbreaks in Brazil have raised concern because deaths and cases of vertical transmission have been reported for the first time. Additionally, outbreaks in areas without previous endemic transmission, such as Cuba, are occurring.
• Humans are not a dead-end host and person-to-person transmission via vector may occur, highlighting the importance of using insect repellent for 3 weeks after travel to an area with Oropouche virus transmission.
• Symptoms typically begin 3-10 days after exposure and occur in 60% of cases. Initial symptoms include fever, chills, headache, myalgia, and arthralgia. Other symptoms include photophobia, retroorbital pain, nausea/vomiting, diarrhea, fatigue, maculopapular rash, and abdominal pain. Symptoms usually resolve in a few days; in approximately 70% of cases, recurrent symptoms develop days to weeks after the resolution of initial illness.
• Illness is typically mild but in about 5% of cases, hemorrhagic manifestations or neuroinvasive disease develop. This is not well understood but people at risk for developing severe disease are likely similar to those at higher risk for other severe viral vector-borne diseases and include people over the age of 65 and those with underlying medical conditions.
• No specific treatments or vaccines are available for Oropouche virus disease. Patients who develop more severe illness should be hospitalized for observation and supportive treatment. Pregnant people with laboratory evidence of infection should be monitored during pregnancy and live-born infants will require careful evaluation.