
==== Front
New Microbes New Infect
New Microbes New Infect
New Microbes and New Infections
2052-2975
Elsevier

S2052-2975(24)00244-0
10.1016/j.nmni.2024.101460
101460
Letter to the Editor
Oropouche fever rears its head in Cuba: What lies beneath the surface?
Escobedo Angel A. dr.angel.escobedo1967@gmail.com
⁎
Masters of Epidemiology and Communication, Department of Epidemiology, Institute of Gastroenterology, Havana City, La Habana, Cuba
Rodríguez-Morales Alfonso J.
Masters of Climate Change and Clinical Epidemiology and Biostatistics Program, Universidad Cientifica del Sur, Lima, Peru
Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
⁎ Corresponding author. dr.angel.escobedo1967@gmail.com
22 8 2024
12 2024
22 8 2024
62 10146024 7 2024
14 8 2024
16 8 2024
© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Handling Editor: Patricia Schlagenhauf
==== Body
pmcArthropod-borne viruses, also known as arboviruses, are essential contributors to the global burden of infectious diseases due to their epidemic potential and their ability to adapt to the host, vector, and environment. This can result in significant health, social, and economic impacts. Human activities that create favourable ecosystems for vector-host interaction, travel, trade, transport, climate change, globalisation, and ever-increasing trends towards urbanisation and landscape conversion have facilitated the expansion of these viruses. Some have emerged and re-emerged in the New World in recent decades (i.e., Zika and Chikungunya).

On May 27th, the National Director of Epidemiology from the Cuban Ministry of Public Health (MPH) declared the presence of locally transmitted cases of Oropouche fever in the eastern region of Cuba. This neglected arthropod-borne zoonotic disease, caused by the Oropouche virus (OROV), is responsible for several outbreaks of febrile disease in Central and South America. This virus, identified in Trinidad and Tobago in 1955 for the first time, belongs to the Orthobunyavirus genus of the Peribunyaviridae family, one of the largest and most diversified families of RNA virus [1]; it is transmitted to humans through the bite of infected Culicoides paraensis midges and mosquitoes such as Coquillettidia venezuelensis, Aedes serratus, Culex quinquefasciatus (Cx. quinquefasciatus) [1]. Until May 27, 2024, the MPH in Cuba reported 74 confirmed cases, in Santiago de Cuba (54) and Cienfuegos (20). For the Americas region, the Pan American Health Organization, reported until Epidemiological Week 29, updated on August 1, 2024, a total of 8,078 confirmed cases of OROV infection (https://www.paho.org/es/file/148432/download?token=heVPIuLT).

While Oropouche fever typically presents with mild symptoms such as fever, chills, headache/retro-orbital pain, photophobia, arthralgia, myalgia, backache, nausea, vomiting, dizziness, and, on rare occasions, skin rash, it's important to note that aseptic meningoencephalitis and hemorrhagic phenomena have been reported in some patients. Symptoms usually begin 4–8 days after being bitten by an infected vector and can last for one week, although some experience symptoms for as long as 1 month. Interestingly, some cases can relapse after recovery [1]. This underscores the potential severity of the disease and the need for vigilance.

Unfortunately, as a neglected disease, there is a limited understanding of the ecological and epidemiological drivers of OROV transmission. One of the significant concerns with OROV is that this infection may be either undiagnosed (due to its self-limiting, asymptomatic and mild manifestations) or misdiagnosed (especially during early clinical stages, due to clinical characteristics similar to other co-endemic, mosquito-transmitted febrile diseases, i.e., dengue, yellow fever, Zika, chikungunya, or Mayaro fevers); otherwise, it is not clear how some of these infections/diseases would alter the clinical manifestations of Oropouche fever. Another critical concern is the presence of Cx. quinquefasciatus, an animal- and human-feeding vector that, although regarded as a less critical anthropophilic vector for OROV, may allow the establishment of the disease [2]. Additionally, an experimental study showed that OROV was able to infect, efficiently replicate and be transmitted by two other anthropophilic and urban species of mosquitoes, Aedes aegypti and Aedes albopictus, when systemically injected (but not when orally ingested), providing evidence that OROV is restricted by the midgut barrier of these significant urban mosquito species, but, if this restriction is overcome, could be efficiently transmitted to vertebrate hosts [3]. The last but not least crucial public health concern is the risk of autochthonous transmission of this virus by returning and probably asymptomatic viremic travellers to their non-endemic home countries or to geographical areas where suitable vectors could be present. In those cases, it seems necessary to avoid forgetting the importance of travellers as infectious disease sentinels [4].

Could OROV become established in Cuba? Technically, OROV could become established in Cuba because some of the conditions needed for infection are present. Ecological and epidemiological conditions could provide both the settling and subsequent propagation of the virus, along with many susceptible human hosts. However, being prepared to face new, emerging or re-emerging infectious threats, especially vector-borne infectious diseases, has become necessary for Cubans. Indeed, a potential vector (Cx. quinquefasciatus) is widely distributed on the island, and there are symptomatic cases and an unknown number of asymptomatic people dispersed in the community. However, several factors may hamper the occurrence of significant outbreaks. Cx. quinquefasciatus, the species present on the island, is a much less efficient vector than Culicoides paraensis. The universal Cuban healthcare system is widely perceived as solid and efficient and is supported by the political will. It has years of experience in a highly effective dengue prevention and control program, which has generated evidence of active community participation and rapid mobilisation of intersectoral efforts that allowed Cuba's early and successful response to Zika, avoiding its establishment in the national territory [5].

Since there is no vaccine for Oropouche fever, prevention, clinically proven therapeutics, and personal protection measures, they seem to be many years out. In response to the spread of OROV, it is necessary to consider -and sustain-the following measures: a) implementation and maintenance of permanent active surveillance programmes for detection and monitoring of this and other high-priority arboviruses; b) strengthening of control or elimination measures for the vectors (midge and mosquito populations); c) preparedness of healthcare settings and services for the management of complicated OROV cases, including surveillance of febrile and central nervous system syndromes; d) risk communication and raise public awareness; e) training and capacity building of health professionals for clinical and laboratory diagnosis, vector control, communication and intersectoral mobilisation; and f) research.

OROV's ongoing geographical expansion and potential for epidemics deserve greater attention [6]. Its arrival in Cuba implies a new challenge to the health care system and the community, both of which are called to fulfil the needed measures for prevention and control.

Funding

None.

Ethical approval

Not required.

CRediT authorship contribution statement

Angel A. Escobedo: Writing – review & editing, Writing – original draft, Conceptualization. Alfonso J. Rodríguez-Morales: Writing – review & editing, Writing – original draft, Conceptualization.

Declaration of competing interest

The two authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
==== Refs
References

1 Sakkas H. Bozidis P. Franks A. Papadopoulou C. Oropouche fever: a review Viruses 10 2018 175 29617280
2 Hoch A.L. Pinheiro F.P. Roberts D.R. Gomes M.L. Laboratory transmission of Oropouche virus by Culex quinquefasciatus say Bull Pan Am Health Organ 21 1987 55 61 3607353
3 de Mendonça S.F. Rocha M.N. Ferreira F.V. Leite T.H.J.F. Amadou S.C.G. Sucupira P.H.F. Marques J.T. Ferreira A.G.A. Moreira L.A. Evaluation of Aedes aegypti, Aedes albopictus, and Culex quinquefasciatus mosquitoes competence to Oropouche virus infection Viruses 13 5 2021 755 33923055
4 Branda F. Ciccozzi M. Scarpa F. Oropouche virus presenting in Italy after travel to Cuba New Microbes New Infect 60–61 2024 101450
5 Toledo M.E. Monteagudo-Diaz S. Montenegro-Calderón T. Kreppel K. Van Damme E. Vanlerberghe V. Preparedness for emerging epidemic threats: detection of Oropouche circulation in Cuba Lancet Infect Dis 24 8 2024 e484
6 Sah R. Srivastava S. Kumar S. Golmei P. Rahaman S.A. Mehta R. Ferraz C. Apostolopoulos V. Rodriguez-Morales A.J. Oropouche fever outbreak in Brazil: an emerging concern in Latin America Lancet Microbe S2666–5247 24 2024 00136-8
