Oropouche virus disease – Cuba





Situation at a glance

On May 27, 2024, the Cuban Ministry of Public Health reported outbreaks of Oropouche virus disease in two provinces, Santiago de Cuba and Cienfuegos. Oropouche virus disease is an arboviral disease caused by the Oropouche virus (OROV). It is transmitted to humans through mosquitoes (small flies) or mosquito bites. To date, there is no evidence of human-to-human transmission of the Oropouche virus. This is the first detection of the disease in the country, so the population is likely to be highly susceptible and there is a significant risk of additional cases being detected.






Description of the situation.

On May 27, 2024, the Cuban Ministry of Public Health reported the first outbreak of Oropouche virus disease. A total of 74 confirmed cases were reported in the Province of Santiago de Cuba (n=54) and in the Province of Cienfuegos (n=20). These cases were detected through strengthened monitoring and surveillance actions after an increase in cases with non-specific febrile illness in the provinces of Santiago de Cuba, with the municipalities of Santiago de Cuba and Songo La Maya reporting 29 and 25 cases each; and in the province of Cienfuegos where eight cases were reported in Cienfuegos, five in Rodas, five in Abreu, one in the municipalities of Aguada de Pasajeros and one in Cumanayagua. OROV was identified in 74 samples of the 89 analyzed at the national reference laboratory of the Pedro Kourí Institute (IPK).

The appearance of symptoms of confirmed cases was reported between May 2 and 23, with a peak of cases observed in epidemic week 21 (week ending May 24). The most frequently reported symptoms were fever, low back pain, headache, loss of appetite, vomiting, weakness, joint pain, and eye pain. Of the 74 confirmed cases, 36 are men and 38 women, and the median age is 34 years (range 6-72 years). The most represented age range is 15 to 19 years (12 cases).

All cases showed signs of recovery between the third and fourth day after the onset of symptoms. As of June 5, no serious or fatal cases have been reported.

Figure 1: Number of cases of Oropouche virus disease in Cuba by province






Epidemiology

Oropouche virus disease is an arboviral disease caused by Oropouche virus (OROV), a segmented single-stranded RNA virus that is part of the genus Orthobunyavirus of the Peribunyaviridae family. The virus has been found to be circulating in Central and South America and the Caribbean. OROV can be transmitted to humans primarily through the bite of the Culicoides paraensis mosquito, found in wooded areas and around bodies of water, or certain Culex quinquefasciatus mosquitoes. Viral circulation is suspected to include both epidemic and jungle cycles. In the sylvatic cycle, primates, sloths, and perhaps birds are the vertebrate hosts, although a definitive arthropod vector has not been identified. In the epidemic cycle, humans are the amplifying host and OROV is transmitted mainly through the bite of the Culicoides paraensis mosquito. To date, there is no evidence of human-to-human OROV transmission.

The symptoms of the disease are similar to those of dengue and begin four to eight days (three to 12 days) after the infectious bite. The onset is sudden, usually with fever, headache, joint stiffness, pain, chills, and sometimes persistent nausea and vomiting, for up to five to seven days. Severe clinical presentation is rare, but may cause aseptic meningitis. Most cases recover within seven days; However, in some patients, convalescence may take weeks. There is no specific antiviral treatment or vaccine for Oropouche virus disease.






Public health response

Local and national health authorities are implementing the following public health measures:

The country has established a plan to confront arboviruses, which includes integrated and comprehensive actions by various entities, namely: Organization and Control of Contingency Actions; Vector Control and Entomological Surveillance; Epidemiological surveillance; Medical assistance; Environment and Community Participation; Investigation and development; and Logistics.

Plan actions include:

  • Temporary work groups were activated to analyze the epidemiological situation and carry out field operations.
  • Definition of criteria for suspected and confirmed cases of the disease.
  • Train all personnel of the National Public Health System in arboviruses, including OROV.
  • Strengthening human resources for medical care in health areas with transmission.
  • Reinforcement of vector control actions including focal treatment in transmission areas and very high risk blocks, adulticidal treatment and increased entomological surveillance in transmission areas.
  • Intensification of environmental sanitation actions.
  • An information note was issued about the situation.






WHO risk assessment

This is the first detection of the disease in the country, so the population is likely to be highly susceptible and there is a significant risk of detecting additional cases. To date, there is no evidence of human-to-human transmission of the Oropouche virus.

In the Region of the Americas, outbreaks of Oropouche virus disease have occurred over the last 10 years, mainly in the Amazon region. The virus is endemic in many South American countries, in both rural and urban communities. Outbreaks are periodically reported in Brazil, Bolivia, Colombia, Ecuador, French Guiana, Panama, Peru, and Trinidad and Tobago.

There is a risk of the disease spreading internationally, as Cuba is an international tourist destination and the suspected vector is widely distributed in the Americas region. In addition, there are currently other countries with active circulation of OROV.






WHO Council

The proximity of mosquito vector breeding sites to human habitations is an important risk factor for OROV infection. Prevention strategies are based on measures to control or eradicate arthropod vectors and personal protection measures. Vector control measures are based on reducing mosquito populations through the eradication of breeding sites, which is achieved by reducing the number of natural and artificial water-filled habitats that support mosquito larvae, thus reducing adult mosquito populations around at-risk communities. Personal protection measures are based on the prevention of mosquito bites using mechanical barriers (mosquito nets), insect repellent devices, repellent-treated clothing and mosquito repellents. Chemical insecticides such as deltamethrin and N,N-diethyl-meta-toluamide (DEET) have been shown to be effective in controlling culicoides and Culex species.

Given its clinical presentation and considering that we are at the beginning of the dengue season in the Caribbean and other vector-borne diseases in the Region of the Americas, laboratory diagnosis is essential to confirm cases, characterize an outbreak and monitor trends. of the illness.

As it is an emerging and poorly identified arbovirus in the Americas, the detection of a positive sample and the confirmation of a case requires the use of Annex 2 of the IHR and its consequent notification through the channels established in the International Health Regulations (IHR). ).

WHO advises against applying any travel or trade restrictions based on the current information available about this event.






More information

  • Pan American Health Organization / World Health Organization. Guidelines for the detection and surveillance of emerging arboviruses in the context of the circulation of other arboviruses. May 4, 2024. Washington, DC: PAHO/WHO; 2024.
  • Pan American Health Organization / World Health Organization. Tool for the diagnosis and care of patients with suspected arboviral diseases. Washington, DC: PAHO; 2017.
  • Romero-Álvarez D, Escobar LE. Oropouche fever, an emerging disease of the Americas. Microbes and infections. March 2018; 20(3):135-46.
  • Sakkas H, Bozidis P, Franks A, Papadopoulou C. Oropouche fever: a review. Virus. 2018; 10(4):175.
  • Amazonas Health Surveillance Foundation “Dra. Romero Costa Pinto” (FVSRCP). Epidemiological Alert No. 1/2024. Manaus; 2024.
  • Karl A. Ciuoderis, Michael G. Berg, Lester J. Perez, Abbas Hadji, Laura S. PerezRestrepo, Leidi Carvajal Aristizabal, Kenn Forberg, Julie Yamaguchi, Andres Cardona, Sonja Weiss, Xiaoxing Qiu, Juan Pablo Hernandez-Ortiz, Francisco Averhoff , Gavin A. Cloherty and Jorge E. Osorio (2022). The Oropouche virus as an emerging cause of acute febrile illness in Colombia, Emerging Microbes & Infections, 11:1, 2645-2657. 2022. DOI: 10.1080/22221751.2022.2136536

References:

  • Ministry of Public Health. Information note, May 27, 2024. Republic of Cuba; 2024.
  • Pan American Health Organization / World Health Organization. Epidemiological alert Outbreaks – Oropouche in the Region of the Americas, February 2, 2024. Washington, DC: PAHO/WHO; 2024.
  • Pan American Health Organization / World Health Organization. Epidemiological alert Outbreaks – Oropouche in the Region of the Americas, May 9, 2024. Washington, DC: PAHO/WHO; 2024.
  • National Focal Point of the International Health Regulations of Cuba. Email communication dated May 31, 2024. Washington DC, 2024. Unpublished.
  • Pan American Health Organization / World Health Organization. Epidemiological alert Beginning of the season of increased circulation of dengue in the Central American isthmus, Mexico and the Caribbean, May 24, 2024. Washington, DC: PAHO/WHO; 2024.

Citable reference: World Health Organization (June 11, 2024). News about disease outbreaks; Oropouche virus disease in Cuba Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON 521