Abstract
BACKGROUND: Oropouche virus (OROV) is an emerging arbovirus primarily transmitted by biting midges and is increasingly recognized as a public health threat in Central and South America. With over 11,000 confirmed cases reported in 2024, a ten-fold increase from the previous year, its transmission dynamics and true burden remain poorly understood due to diagnostic challenges and fragmented surveillance systems. OBJECTIVE: This systematic review and meta-analysis (SRMA) synthesizes OROV prevalence data in humans and summarizes the available data for vectors and animal hosts sampled between 2000 and 2024 to provide updated estimates and identify key surveillance gaps. METHODS: We systematically searched Web of Science, PubMed, Embase, Medline, and LILACS for OROV seroprevalence and viral prevalence studies in human, insect, and animal populations, published up to September 12, 2024. The review protocol was registered with PROSPERO (CRD42024551000). Studies were extracted in duplicate, and data were meta-analyzed using generalized linear mixed-effects models. Risk of bias was appraised using a modified Joanna Briggs Institute checklist. RESULTS: We included 71 articles reporting serological or viral prevalence of OROV across nine countries. Between 2000-2024, pooled human seroprevalence among individuals with febrile illness or suspected of Oropouche infection was 12.6% [95% CI 5.3-26.9%] across four South American countries and seroprevalence of 1.1% [95% CI 0.5-2.3%] was observed in asymptomatic groups. Viral prevalence among individuals with febrile illness or suspected of Oropouche infection was 1.5% [0.8-3.0%] across seven South American countries and Haiti. Most studies used convenience sampling and RT-PCR or hemagglutination assays. In vector populations, positive OROV prevalence in Aedes aegypti and Culex quinquefasciatus was reported in two of 18 sources, while 10.0% and 7.5% animal host prevalence was reported in dogs and cattle, respectively. We found high risk of bias in 11.3% of studies in our critical appraisal, with most animal, human, and vector studies falling in the moderate risk of bias range. CONCLUSIONS: Despite rising numbers of OROV reported cases, prevalence estimates remain limited by sparse surveillance and variable methodology. This review highlights the urgent need for standardized serological assays, community-based studies, and expanded surveillance in animal and vector reservoirs. A One Health approach is essential to monitor OROV transmission and inform regional preparedness efforts.