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First diagnoses of Oropouche virus in Europe: how can we strengthen communication and preparedness globally?

2024; Elsevier BV; Volume: 24; Issue: 10 Linguagem: Inglês

10.1016/s1473-3099(24)00496-1

1474-4457

Concetta Castilletti, Antonio Mori, Elena Pomari, Andrea Matucci, Giulia Martelli, Salvatore Curiale, Andrea Angheben, Federico Gobbi,

Viral Infections and Outbreaks Research

Preparedness and communication are key to preventing and tackling existing and future epidemics, whether caused by known, lesser-known, or unknown pathogens. We need to strengthen and speed up cooperation among health authorities at regional, national, and international levels and, more importantly, we should remain alert and open minded. In the past few months, there has been increased detection of infections with Oropouche virus in some areas of the Americas. In response, the Pan American Health Organization and WHO shared recommendations for Oropouche virus differential diagnosis in February, 2024, strengthening vector-control and personal-protection measures for the population.1Pan American Health OrganisationEpidemiological alert—Oropouche in the region of the Americas—2 February 2024.https://www.paho.org/en/documents/epidemiological-alert-oropouche-region-americas-2-february-2024Date: 2024Date accessed: July 16, 2024Google Scholar In the past 2 months also, Cuba reported the first outbreak of Oropouche fever.2WHOOropouche virus disease—Cuba.https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON521Date: 2024Date accessed: July 10, 2024Google Scholar In The Lancet Infectious Diseases, Wesselmann and colleagues3Wesselmann KM Postigo-Hidalgo I Pezzi L et al.Emergence of Oropouche fever in Latin America: a narrative review.Lancet Infect Dis. 2024; 24: e439-e452Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar called for surveillance and response within strengthened health-care systems, long-term syndromic surveillance, improved access to diagnostics, and monitoring of fine-scale human mobility.3Wesselmann KM Postigo-Hidalgo I Pezzi L et al.Emergence of Oropouche fever in Latin America: a narrative review.Lancet Infect Dis. 2024; 24: e439-e452Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar Moreover, a number of knowledge gaps on Oropouche virus remain, including patient care, risk assessment, vector competence, and effective public health measures.4Toledo ME 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. 2024; 24: e484Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar The detection of Oropouche virus does not only concern Latin America. Our laboratory at Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore Don Calabria Hospital (Verona, Italy) diagnosed in late May and early June, 2024, two epidemiologically unrelated cases of Oropouche fever in two travellers returning from Cuba (figure).5Castilletti C Mori A Matucci A et al.Oropouche fever cases diagnosed in Italy in two epidemiologically non-related travellers from Cuba, late May to early June 2024.Euro Surveill. 2024; 292400362Crossref Scopus (1) Google Scholar To our knowledge, these are the first reports of Oropouche virus infection outside of Latin America. Traveller 1 began experiencing general malaise with fever and diarrhoea upon return to Verona on May 26, 2024, from a 2-week trip to Ciego de Ávila province. Traveller 2 visited friends and relatives in Havana and later in Santiago de Cuba from early May to early June, 2024. 2 after their return to Italy on June 4, 2024, Traveller 2 developed symptoms and on June 7, 2024, visited the emergency room of Azienda Unità Sanitaria Locale della Romagna, Forlì and Cesena Hospitals (Forlì, Italy). Clinical samples were sent to our laboratory for further examination. The diagnosis for both people was done on whole blood, serum, and urine. Traveller 1 showed whole blood and serum samples positive and urine negative, whereas Traveller 2 showed whole blood and urine samples positive and serum negative (figure). Of note, the Pan American Health Organisation indicates as diagnostic sampling only serum and eventually cerebrospinal fluid for people presenting with aseptic meningitis, a rare complication of Oropouche fever.1Pan American Health OrganisationEpidemiological alert—Oropouche in the region of the Americas—2 February 2024.https://www.paho.org/en/documents/epidemiological-alert-oropouche-region-americas-2-february-2024Date: 2024Date accessed: July 16, 2024Google Scholar Both people provided written informed consent for scientific dissemination of the data. After our diagnoses became public, other Italian laboratories returned positive Oropouche virus results in travellers coming from Latin America. What might we expect in the immediate future? We would like to emphasise two points: first, use of whole blood and urine, as well as serum and cerebrospinal fluid, increases the possibility of a definite diagnosis. Second, virus spread might be greater than officially reported. In fact, Ciego de Avila province, where Traveller 1 came from, was not among Cuban areas where WHO reported Oropouche virus at the time of our diagnosis.2WHOOropouche virus disease—Cuba.https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON521Date: 2024Date accessed: July 10, 2024Google Scholar On June 24, 2024, Cuban health authorities confirmed presence of Oropouche virus in nine of Cuba's 16 provinces (ie, Matanzas, Mayabeque, Villa Clara, Sancti Spíritus, Ciego de Ávila, Holguín, Guantánamo, Santiago de Cuba, and Cienfuegos), totalling more than half of Cuba's population.8Republica de Cuba Ministerio de Salud PúblicaInforman autoridades del Minsap sobre situación epidemiológica en Cuba.https://salud.msp.gob.cu/informan-autoridades-del-minsap-sobre-situacion-epidemiologica-en-cuba/Date: 2024Date accessed: July 18, 2024Google Scholar Large human movements could offer Oropouche virus the opportunity to expand its reach. As reported from the European Centre for Disease Prevention and Control, a mean of 39 000 flight passengers arrived per month from Cuba to Europe during January to April, 2024, and, on the basis of records from the past 2 years, we can expect a peak of just less than 50 000 travellers in August.9European Centre for Disease Prevention and ControlCommunicable disease threats report, 6–12 July 2024, week 28.https://www.ecdc.europa.eu/en/publications-data/communicable-disease-threats-report-6-12-july-2024-week-28Date: 2024Date accessed: July 15, 2024Google Scholar In addition to this routine traffic, we can expect some 30 million pilgrims, many of them from Latin America, to join the Jubilee that will open in December, 2024, in Rome and will continue for 1 year. We strongly support the conclusions of Wesselmann and colleagues3Wesselmann KM Postigo-Hidalgo I Pezzi L et al.Emergence of Oropouche fever in Latin America: a narrative review.Lancet Infect Dis. 2024; 24: e439-e452Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar and suggest further studies on arthropods that are prevalent in the temperate zone to detect their potential Oropouche virus transmission competence and the potential effects of Oropouche virus infections among people who are pregnant.10Pan American Health OrganisationEpidemiological alert Oropouche in the Region of the Americas: vertical transmission event under investigation in Brazil—17 July 2024.https://www.paho.org/en/documents/epidemiological-alert-oropouche-region-americas-vertical-transmission-event-underDate: 2024Date accessed: July 22, 2024Google Scholar We firmly believe that timely identification and countering of epidemic emergencies cannot be left to the lucky inspirations of a research group, but should be the result of constant communication and collaboration between hospitals, research centres, and national and international health authorities such as WHO, the Pan American Health Organisation, and the European Centre for Disease Prevention and Control. This work was supported by the Italian Ministry of Health Fondi Ricerca corrente–L1P3, paid to Istituto di Ricovero e Cura a Carattere Scientifico Sacro Cuore Don Calabria Hospital; Fondi 5 per mille 2021 (project number 5M-2021–23684029); and EU funding within the National Recovery and Resilience Plan, Italian Ministry of University–NextGenerationEU extended partnership initiative on emerging infectious diseases (project number PE00000007 INF-ACT). We declare no competing interests. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps.