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Oropouche in Children: Key Information for Healthcare Providers

Published October 16, 2024
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Overview of Outbreak

Oropouche virus is an arthropod-borne, single-stranded negative-sense RNA virus that was first discovered in 1955 and has been reported in parts of South America, Central America, and the Caribbean since that time. In June 2024, there was the first confirmed report in Cuba. Currently, Oropouche virus is being transmitted in South America and the Caribbean.

In July 2024, the Pan American Health Organization (PAHO) issued an epidemiological alert associating vertical transmission in Brazil with adverse pregnancy outcomes, including fetal deaths and congenital abnormalities.  At this time, it is unknown if Oropouche virus can be shed in breast milk.

As of late September 2024, Oropouche virus disease has been reported in more than 70 individuals from five states; California, Colorado, New York, Kentucky, and Florida.  Case numbers and the states where cases are identified are increasing each week.  At this time, all cases involved US travelers.

 

Transmission

Primary route of transmission is by the bite of biting midges (also known as no-see-ums); however, some mosquitoes can also spread the virus. Currently, there is no evidence of local transmission in the US.

Laboratory, healthcare, and other workers may be at risk for Oropouche exposure from contact with the blood and other body fluids of infected patients. Standard precautions are effective for preventing occupational exposure and should be followed by all healthcare workers.

Diagnosis

Oropouche virus infection should be considered in patients who have traveled to affected areas within the last 2 weeks and have abrupt onset of fever with other symptoms as defined below.

The optimal test depends on the duration of illness at time of testing. Molecular evidence of the virus can be detected in serum by PCR within the first week of illness, and serological evidence can be detected after 6 days of infection. Specimens can be submitted using general CDC arboviral testing guidance. For patients with neuroinvasive disease, cerebrospinal fluid can also be sent for testing. Providers should work with their local department of health to assist with coordination of testing through the CDC.

Symptoms and Complications

Patients will develop an abrupt fever with headache, chills, myalgia, and arthralgia.  Other symptoms may include photophobia, dizziness, eye pain, nausea and vomiting, and maculopapular rash that starts on the trunk and may spread to extremities.

Neuroinvasive disease may occur in up to 4% of patients.  Symptoms include intense occipital pain, dizziness, confusion, lethargy, photophobia, nuchal rigidity, and nystagmus.

The incubation period is 3-10 days.  Symptoms typically last 2-7 days, and symptoms recurrence may occur after initially improving.

Oropouche virus infection symptoms overlap with those of other arboviral diseases, such as dengue, chikungunya, and Zika viruses. The disease can also mimic malaria or rickettsial infection. Based on the travel and exposure history of the patient, these illnesses may also need to considered in the differential diagnosis.

Laboratory Findings

Lymphopenia, leukopenia, elevated C-reactive protein, and mildly elevated liver enzymes have been documented. Cerebrospinal fluid abnormalities, such as pleocytosis and elevated protein, have been noted in patients with neuroinvasive disease. 

Prevention

There is no vaccine for Oropouche virus. Avoiding exposure to infected insects is the key to prevention. This includes avoiding travel to impacted areas, especially for those at high risk of complications such as pregnant women, and taking measures to avoid insect bites.

EPA-registered insect repellents and wearing light-colored long-sleeved shirts and long pants while outside are recommended.  EPA-registered repellents should be labeled for flies, biting flies, or Culicoides (biting midges, punkies, granny nippers, and no-see-ums).  For young children, ensure the specific repellent is safe, as not all repellents are recommended are safe in all age groups. Window and door screens can help prevent midges and mosquitoes from entering your home.  

Treatment

There are no medicines to treat Oropouche virus disease.  Supportive care, such as rest, fluids, analgesics, and antipyretics, are important.  Hospitalization is reserved for patients who develop more severe symptoms. If dengue virus infection is in the differential diagnosis, salicylate-containing and other nonsteroidal anti-inflammatory drugs should be avoided to reduce the risk of bleeding.

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