Re-emergence of Oropouche virus as a novel global threat

Abstract

Oropouche fever is a viral infectious disease caused by the Oropouche virus (OROV), primarily transmitted by the biting midge Culicoides paraensis. Historically considered endemic to the Amazon region, particularly in Brazil, Peru, and Ecuador, Oropouche fever has resulted in an estimated 500,000 recorded infections. However, its true burden has remained largely unknown for over seven decades, serving as a classic example of a neglected tropical disease. In 2024, however, OROV rapidly expanded beyond its traditional Amazonian hotspots, spreading across Brazil and into other parts of South and Central America. Imported cases have also been reported in North America and Europe, underscoring its emergence as an escalating global public health concern. This literature review explores the historical epidemiology of Oropouche fever while shedding light on its rising public health relevance and emerging clinical challenges. The ongoing 2023-2025 outbreak has significantly affected Brazil, Peru, Bolivia, Cuba, and Panama and is linked to a novel reassortant OROV lineage that originated in the Brazilian Amazon. This new lineage has since established transmission chains throughout South and Central America, with international spread likely driven by increased human mobility and air travel. As of early 2025, over 23,000 confirmed cases have been reported worldwide, including five fatalities and clear evidence of viral expansion into previously unaffected regions. Alongside this viral geographic spread, OROV infection is increasingly associated with severe clinical outcomes, including Guillain-Barré syndrome and vertical transmission leading to miscarriage and congenital anomalies. The ongoing outbreak OROV reassortant lineage also demonstrates increased virulence, immune evasion, and enhanced viral fitness, likely contributing to their epidemic potential. Despite advances in surveillance during the current outbreak, critical gaps remain, including the absence of a standardized global lineage classification system, underscoring the urgent need for strengthened genomic surveillance, deeper insights into pathogenesis, expanded vector competence research, and innovative strategies for disease and vector control.

Keywords: Arbovirus; Congenital abnormalities; Epidemiology; Genomic surveillance; Oropouche.

Graphical abstract

Fig. 1

Number of confirmed cases of Oropouche virus infections reported globally until 2022. The data was compiled from studies available on PubMed and were cited throughout the text.

Fig. 2

Global distribution of confirmed Oropouche fever cases reported between 1954 and 2022 (left) and during the current outbreak from 2023 to 2025 (right). Countries shown in red reported imported cases only during the 2023–2025 Oropouche virus outbreak.

Fig. 3

Oropouche virus introductions reported in the literature during the ongoing Oropouche fever outbreak. Colored lines represent international introduction events, with each line originating from the presumed source country and pointing toward the destination. Line thickness is proportional to the number of reported introductions.

Fig. 4

Nextstrain global phylogeny of Oropouche virus. The phylogenetic trees represent the evolutionary relationships of Oropouche virus across its three genome segments (M, L, and S). The phylogenetic reconstruction was built, maintained, and made publicly available at Nextstrain (Hadfield et al., 2018; Sagulenko et al., 2018) (https://nextstrain.org/oropouche) by Miguel Paredes and the Nextstrain team. The visualization shown was accessed on April 1, 2025, based on a dataset updated on March 14, 2025, which includes 626 Oropouche virus sequences sourced from GenBank. A full list of sequence contributors is provided in the Supplementary Material. This figure is used under the Creative Commons CC-BY-4.0 license.