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Ralph D. Feigin, M.D. Gail J. 'Demmler, M.D. J. S. Abercrombie Professor and Uhairmano Professor, Department of Pediatrics Department of Pediatrics, and Baylor College of Medicine Distinguished Service Professor, Director, Diagnostic Laboratory Baylor College of Medicine Texas Children 's Hospital Physician-in-Chiel; Houston, Texas Texas Children 's Hospital Physician-in-Chiel; Service of Pediatrics, Sheldon L. Kaplan, M.D. Ben Taub General Hospital Professor and Vice-Chairman of Clinical ChieI; Pediatric Service, Affairs, Department ofPediatrics The Methodist Hospital Baylor College of Medicine Houston, Texas Chief, lnfectious Disease Service, Texas Children's Hospital, James D. Cherry M.D., M.Sc. Houston, Texas ., Professor of Pediatrics David Geffen School of Medicine at UCLA Member, Division of lnfectious Diseases Mattel Children 's Hospita! at UCLA Los Angeles, California

'ISAUNDERSI An Imprint of Elsevier Science effect.21 The agent is sensitive to the action or sodium CHAPTER 192D deoxycholate.9 Oropouche Fever FRANCISCO P. PINHEIRO. Epidemiology AMElIA P. A. TRAV ASSOS DA ROSA- GEOGRAPHIC DISTRIBUTION PEDRO FERNANDO DA C. VASCONCELOS Thus far, the only reported cases of Oropouche rever have occurred in Brazil, Panama, Peru, and Trinidad Oropouche rever is an that causes an (Fig. 192-3). However, most cases have been limited to the acute febrile episode accompanied by headache, myalgia, Brazilian Amazon region, with none reported in other areas artbralgia, and other systemic symptoms. The symptoms of Brazil. usuaIly recur a few days after the end of the first febrile With a few exceptions, alI episodes of Oropouche rever episode, at which time they are generally less severe. Asep- have been in the form of urban , including those iQ tic meningitis may develop in some patients. Patients make Belém and Manaus, the largest cities in the Braziliaq a full recovery, without any apparent aftereffects, even in Amazon region. The city of Belém, capital of Pará State, wa8 the most serious cases. No fatalities have been confirmed as struck by three major epidemics during a 20-year period. being attributable to, Oropou,che rever. One of the most The city of Santarém and surrounding villages algo were striking ch~acteristics of Oropouche (OROV) is its affected' by a major in 1974 and 1975.19The first ability to produce epidemics in urban population centers, epidemics that occurred outside the State of Pará, those most of which reportedly,have occurred in the Brazilian striking the cities of Manaus and Barcelos in the State of Amazon tegion. Many of these outbreaks have had a major Amazonas3 and the city of Mazagão in what was then the impact on the stricken cities. , Amapá Territory, were reported early in the 1980s.13Mter a The first case of the disease was described in 1.955 in a period of quiescence lasting unti11988, new outbreaks ofthe residentofVega deOropouche, Trinidad, from whose disease struck the cities of Porto Franco and Tocantinópolis the agent was isolated.1 The disease was detected again in in the states ofMaranhão and Tocantins, respectively.26The 1961, this time in the city of Belém, Pará State, northern next reported epidemics occurred in 1991, this time in more Brazil, 'where it caused .an epidemic that affected at least distant locations, namely, in the cities of Ariquemes and 11,000 people.15This epidemic was followed by many other Ouro Preto D'Oeste in the State of Rondônia; the epidemic's epidemics, several of an explosive naLure, in urban popula- impact on these cities was so great that it was reported in tion centers throughout the Brazilian states of Pará, Amapá, the national press. In 1994., another outbreak involving at