Oropouche virus disease across Latin America during the 2023–2025 epidemic: a multi-country case series

Background​: The 2023-2025 epidemic of Oropouche virus (OROV) disease across Latin America raised public health concerns due to its expansion into previously unaffected regions, alongside reports of increased clinical severity and vertical transmission. Methods: We established a multi-country research network to characterise the clinical presentation, outcomes, risk factors, and virological features of OROV disease during the 2023-2025 epidemic. Analyses were descriptive. Findings: We describe 2,716 cases reported between January 31st, 2024, and November 4th, 2025, across ten states in Brazil, Panama, and Peru. Median age was 38 years (IQR 25-51); 51% were women. Most common symptoms were fever (89%), headache (88%), and myalgia (59%), followed by retro-orbital pain (47%) and nausea (33%). Clinical presentation varied by age, and one-fourth of participants reported symptoms’ duration beyond one week. Most cases were mild (94%), although severe complications and one death occurred. Haemorrhagic manifestations were reported in 2%, and <1% developed systemic organ involvement. Among 108 pregnant women, 15 (14%) had adverse pregnancy outcomes, including abortions, preterm births, stillbirths, and symptomatic newborns; no congenital malformations were observed. Older age, comorbidities, warning signs, and laboratory abnormalities, but not viral load, were more frequently observed among participants with severe disease. Prolonged viraemia beyond seven days was observed in serum and urine. Interpretation: Although most OROV disease cases were mild, severe disease and adverse pregnancy outcomes occur and may be under-recognised. These findings support the need for improved clinical recognition, risk stratification, and diagnostics, particularly for high-risk groups, and highlight priorities for surveillance and future research.