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Di Nicola MR, Crevani M, Avella I, Cerullo A, Dorne JLCM, Paolino G, Zattera C. A Guide to the Clinical Management of Vipera Snakebite in Italy. Toxins (Basel) 2024; 16:255. [PMID: 38922149 PMCID: PMC11209566 DOI: 10.3390/toxins16060255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
The genus Vipera encompasses most species of medically significant venomous snakes of Europe, with Italy harbouring four of them. Envenomation by European vipers can result in severe consequences, but underreporting and the absence of standardised clinical protocols hinder effective snakebite management. This study provides an updated, detailed set of guidelines for the management and treatment of Vipera snakebite tailored for Italian clinicians. It includes taxonomic keys for snake identification, insights into viper venom composition, and recommendations for clinical management. Emphasis is placed on quick and reliable identification of medically relevant snake species, along with appropriate first aid measures. Criteria for antivenom administration are outlined, as well as indications on managing potential side effects. While the protocol is specific to Italy, its methodology can potentially be adapted for other European countries, depending on local resources. The promotion of comprehensive data collection and collaboration among Poison Control Centres is advocated to optimise envenomation management protocols and improve the reporting of epidemiological data concerning snakebite at the country level.
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Affiliation(s)
- Matteo Riccardo Di Nicola
- Unit of Dermatology and Cosmetology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- Department of Pathobiology, Pharmacology and Zoological Medicine, Faculty of Veterinary Medicine, Wildlife Health Ghent, Ghent University, 9820 Merelbeke, Belgium
- Asociación Herpetológica Española, Apartado de correos 191, 28911 Leganés, Spain
| | - Marta Crevani
- Poison Control Centre, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Ignazio Avella
- Landes-Offensive zur Entwicklung Wissenschaftlich-ökonomischer Exzellenz-Centre for Translational Biodiversity Genomics, Senckenberganlage 25, 60325 Frankfurt Am Main, Germany
- Institute for Insect Biotechnology, Justus-Liebig University Giessen, Heinrich-Buff-Ring 26-32, 35392 Giessen, Germany
| | - Anna Cerullo
- Department of Veterinary Sciences, University of Turin, L.go Braccini 2, 10095 Grugliasco, Italy
| | - Jean-Lou C. M. Dorne
- Methodological and Scientific Support Unit, European Food Safety Authority, Via Carlo Magno 1A, 43100 Parma, Italy
| | - Giovanni Paolino
- Unit of Dermatology and Cosmetology, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Caterina Zattera
- Unit of Emergency Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo University Hospital, University of Pavia, P.Le Golgi, 19, 27100 Pavia, Italy
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Chowdhury MAW, Müller J, Ghose A, Amin R, Sayeed AA, Kuch U, Faiz MA. Combining species distribution models and big datasets may provide finer assessments of snakebite impacts. PLoS Negl Trop Dis 2024; 18:e0012161. [PMID: 38768190 PMCID: PMC11142713 DOI: 10.1371/journal.pntd.0012161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/31/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Snakebite is a major poverty-related neglected tropical disease. An integrated scientific approach is needed to understand the dynamics of this important health issue. Our objective was to estimate snakebite occurrence in a tropical area by using a blend of ecological modelling and robust statistical analysis. METHODS The present study used climatic, environmental, and human population density data to determine the area with snakebite occurrence-probability for the first time in Bangladesh. We also analysed a large, 16-year dataset of hospitalized snakebite cases to reveal the epidemiology of snakebite in the south-eastern zone of the country. FINDINGS Our results show that cobra bite is the most commonly occurring venomous snakebite in humans (around ~12% of the total yearly snakebite records), and men are more frequently bitten than women (2/3 of human victims are men). Most bites occur during the rainy season for cobra and green pit viper, while krait bites are not restricted to any particular season. As snakebite incidents are closely related to climate conditions, we can model snakebite risk using temperature and precipitation variables. Whereas there is a lack of snakebite reports from several parts of the study area in official records, our models predict that the entire study area is favourable for snakebite incidents. Based on the combined evidence we estimate that about 200,000 snakebite events occur every year in the south-eastern part of Bangladesh alone. Considering future global climate change, our model projections show that snakebite incidence in Bangladesh might not significantly decrease in the future (- 2070-); however, the distribution of probabilities might change, with a predicted increase of snakebite incidence in the hilly areas of the country. CONCLUSIONS Using climatic data to predict snakebite incidence in Bangladesh allowed us to provide estimations of the total annual number of snakebite cases in the study area. As in most countries, the scarcity of accurate epidemiological data in official records might have masked the real magnitude of this problem. Our analysis suggests that the problem of snakebite envenoming in Bangladesh might be worse than currently perceived. A long-term sustainable snakebite program plan should be designed and institutionalized, considering climatic, geographical and human demographic variables, to obtain better data and facilitate the implementation of accurate snakebite management programs for this country.
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Affiliation(s)
- Mohammad Abdul Wahed Chowdhury
- Department of Zoology, University of Chittagong, Chattogram, Bangladesh
- Museum für Naturkunde, Leibniz-Institut für Evolutions- und Biodiversitätsforschung, Berlin, Germany
- Institut für Biologie, Humboldt-Universität zu Berlin, Berlin, Germany
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
| | - Johannes Müller
- Museum für Naturkunde, Leibniz-Institut für Evolutions- und Biodiversitätsforschung, Berlin, Germany
- Institut für Biologie, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Aniruddha Ghose
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
| | - Robed Amin
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Abdullah Abu Sayeed
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
| | - Ulrich Kuch
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Mohammad Abul Faiz
- Venom Research Centre, Department of Medicine, Chittagong Medical College, Chattogram, Bangladesh
- Dev Care Foundation, Chattogram, Bangladesh
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Martinez PA, Teixeira IBDF, Siqueira-Silva T, da Silva FFB, Lima LAG, Chaves-Silveira J, Olalla-Tárraga MÅ, Gutiérrez JM, Amado TF. Climate change-related distributional range shifts of venomous snakes: a predictive modelling study of effects on public health and biodiversity. Lancet Planet Health 2024; 8:e163-e171. [PMID: 38453382 DOI: 10.1016/s2542-5196(24)00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 12/11/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Climate change is expected to have profound effects on the distribution of venomous snake species, including reductions in biodiversity and changes in patterns of envenomation of humans and domestic animals. We estimated the effect of future climate change on the distribution of venomous snake species and potential knock-on effects on biodiversity and public health. METHODS We built species distribution models based on the geographical distribution of 209 medically relevant venomous snake species (WHO categories 1 and 2) and present climatic variables, and used these models to project the potential distribution of species in 2070. We incorporated different future climatic scenarios into the model, which we used to estimate the loss and gain of areas potentially suitable for each species. We also assessed which countries were likely to gain new species in the future as a result of species crossing national borders. We integrated the species distribution models with different socioeconomic scenarios to estimate which countries would become more vulnerable to snakebites in 2070. FINDINGS Our results suggest that substantial losses of potentially suitable areas for the survival of most venomous snake species will occur by 2070. However, some species of high risk to public health could gain climatically suitable areas for habitation. Countries such as Niger, Namibia, China, Nepal, and Myanmar could potentially gain several venomous snake species from neighbouring countries. Furthermore, the combination of an increase in climatically suitable areas and socioeconomic factors (including low-income and high rural populations) means that southeast Asia and Africa (and countries including Uganda, Kenya, Bangladesh, India, and Thailand in particular) could have increased vulnerability to snakebites in the future, with potential effects on public human and veterinary health. INTERPRETATION Loss of venomous snake biodiversity in low-income countries will affect ecosystem functioning and result in the loss of valuable genetic resources. Additionally, climate change will create new challenges to public health in several low-income countries, particularly in southeast Asia and Africa. The international community needs to increase its efforts to counter the effects of climate change in the coming decades. FUNDING German Research Foundation, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, German Centre for Integrative Biodiversity Research, Ministerio de Ciencia e Innovación de España, European Regional Development Fund.
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Affiliation(s)
- Pablo Ariel Martinez
- Laboratório de Pesquisas Integrativas em Biodiversidade, Universidade Federal de Sergipe, São Cristóvão, Brazil; Instituto de Cambio Global, Universidad Rey Juan Carlos, Madrid, Spain.
| | | | - Tuany Siqueira-Silva
- Laboratório de Pesquisas Integrativas em Biodiversidade, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | - Luiz Antônio Gonzaga Lima
- Laboratório de Pesquisas Integrativas em Biodiversidade, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | - Jonatas Chaves-Silveira
- Laboratório de Pesquisas Integrativas em Biodiversidade, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
| | - Talita Ferreira Amado
- German Centre for Integrative Biodiversity Research, Leipzig, Germany; Institute of Biology, Leipzig University, Leipzig, Germany.
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Kono IS, Pandolfi VCF, Marchi MNAD, Freitas N, Freire RL. Unveiling the secrets of snakes: Analysis of environmental, socioeconomic, and spatial factors associated with snakebite risk in Paraná, Southern Brazil. Toxicon 2024; 237:107552. [PMID: 38065257 DOI: 10.1016/j.toxicon.2023.107552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023]
Abstract
The state of Paraná is home to three out of the five medically significant snake genera in Brazil and lacks of snakebite epidemiology studies. This study aimed to ascertain the spatial, environmental, and socioeconomic factors associated with snakebite risk by analyzing notification data of cases in the state of Paraná. Notification and socioeconomic data were gathered from the online platforms of the National System of Notifiable Diseases (SINAN) and the Brazilian Institute of Geography and Statistics (IBGE). Land cover and land use maps were obtained from the Mapbiomas platform in raster format and subsequently converted into vectors using QGis software. The proportions of land use and land cover in square kilometers (km2) were then calculated. All acquired data were tabulated using Microsoft Excel 365 software. For spatial analysis, GeoDa software version 1.20 was utilized to calculate the Global and Local Moran indices, assessing spatial correlations. Between 2007 and 2021, 12,877 notifications were recorded, with an average incidence of 8.22/100,000 inhabitants in the state, 8166 (63.41%) caused by Bothrops, 1534 (11.91%) caused by Crotalus, 56 (0.43%) caused by Micrurus. 1703 (13.22%) caused by non-venomous snake species, and the remaining cases did not have the identified causative species. The incidents caused by Bothrops and Crotalus showed different distribution patterns. Spatial analysis revealed that key factors contributing to snakebite risk included the presence of native forests, mangroves, apicuns, and monospecific planted forests. The population group at the highest risk comprised rural residents and workers. Furthermore, the absence of basic sanitation and proper garbage collection and disposal exhibited positive correlations with snakebites. Conversely, intensive farming practices with substantial mechanization and pastures demonstrated negative spatial correlations. This study has enabled the identification of the primary factors associated with snakebite risk, facilitating more targeted efforts to prevent snakebite accidents among vulnerable populations.
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Affiliation(s)
- Isabelli Sayuri Kono
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
| | | | - Melca Niceia Altoé de Marchi
- Departamento de Ciências Agrárias e Ambientais, Universidade Estadual de Santa Cruz, Ilhéus, 45662900, Bahia, Brazil.
| | - Nicolas Freitas
- Departamento de Geociências, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
| | - Roberta Lemos Freire
- Departamento de Medicina Veterinária Preventiva, Universidade Estadual de Londrina, Londrina, 86057970, Paraná, Brazil.
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Werner RM, Soffa AN. Considerations for the development of a field-based medical device for the administration of adjunctive therapies for snakebite envenoming. Toxicon X 2023; 20:100169. [PMID: 37661997 PMCID: PMC10474190 DOI: 10.1016/j.toxcx.2023.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/27/2023] [Accepted: 08/12/2023] [Indexed: 09/05/2023] Open
Abstract
The timely administration of antivenom is the most effective method currently available to reduce the burden of snakebite envenoming (SBE), a neglected tropical disease that most often affects rural agricultural global populations. There is increasing interest in the development of adjunctive small molecule and biologic therapeutics that target the most problematic venom components to bridge the time-gap between initial SBE and the administration antivenom. Unique combinations of these therapeutics could provide relief from the toxic effects of regional groupings of medically relevant snake species. The application a PRISMA/PICO literature search methodology demonstrated an increasing interest in the rapid administration of therapies to improve patient symptoms and outcomes after SBE. Advice from expert interviews and considerations regarding the potential routes of therapy administration, anatomical bite location, and species-specific venom delivery have provided a framework to identify ideal metrics and potential hurdles for the development of a field-based medical device that could be used immediately after SBE to deliver adjunctive therapies. The use of subcutaneous (SC) or intramuscular (IM) injection were identified as potential routes of administration of both small molecule and biologic therapies. The development of a field-based medical device for the delivery of adjunctive SBE therapies presents unique challenges that will require a collaborative and transdisciplinary approach to be successful.
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Isaacson JE, Ye JJ, Silva LL, Hernandes Rocha TA, de Andrade L, Scheidt JFHC, Wen FH, Sachett J, Monteiro WM, Staton CA, Vissoci JRN, Gerardo CJ. Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis. PLoS Negl Trop Dis 2023; 17:e0011305. [PMID: 37343007 PMCID: PMC10284398 DOI: 10.1371/journal.pntd.0011305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 04/14/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. METHODS We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. RESULTS We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. CONCLUSION Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.
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Affiliation(s)
| | - Jinny Jing Ye
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Lincoln Luís Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná, Brazil
| | - Thiago Augusto Hernandes Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | - Fan Hui Wen
- Antivenom Production Section, Butantan Institute, São Paulo, São Paulo, Brazil
| | - Jacqueline Sachett
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
| | - Wuelton Marcelo Monteiro
- School of Health Sciences, University of Amazonas State, Manaus, Amazonas, Brazil
- Tropical Medicine Foundation Dr. Heitor Vieira Dourado, Manaus, Amazonas, Brazil
| | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Charles John Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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Yousefi M, Yousefkhani SH, Grünig M, Kafash A, Rajabizadeh M, Pouyani ER. Identifying high snakebite risk area under climate change for community education and antivenom distribution. Sci Rep 2023; 13:8191. [PMID: 37210435 DOI: 10.1038/s41598-023-35314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/16/2023] [Indexed: 05/22/2023] Open
Abstract
Snakebite is one of the largest risks from wildlife, however little is known about venomous snake distribution, spatial variation in snakebite risk, potential changes in snakebite risk pattern due to climate change, and vulnerable human population. As a consequence, management and prevention of snakebite is hampered by this lack of information. Here we used habitat suitability modeling for 10 medically important venomous snakes to identify high snakebite risk area under climate change in Iran. We identified areas with high snakebite risk in Iran and showed that snakebite risk will increase in some parts of the country. Our results also revealed that mountainous areas (Zagros, Alborz, Kopet-Dagh mountains) will experience highest changes in species composition. We underline that in order to improve snakebite management, areas which were identified with high snakebite risk in Iran need to be prioritized for the distribution of antivenom medication and awareness rising programs among vulnerable human population.
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Affiliation(s)
- Masoud Yousefi
- Department of Animal Science, School of Biology, Damghan University, Damghan, Iran.
- LIB, Museum Koenig, Bonn, Leibniz Institute for the Analysis of Biodiversity Change, Adenauerallee 127, 53113, Bonn, Germany.
| | | | - Marc Grünig
- Ecosystem Dynamics and Forest Management Group, School of Life Sciences, Technical University of Munich (TUM), 85354, Freising, Germany
| | - Anooshe Kafash
- Department of Environmental Science, Faculty of Natural Resources, University of Tehran, Karaj, Iran
| | - Mahdi Rajabizadeh
- Department of Biodiversity, Institute of Science and High Technology and Environmental Sciences, Graduate University of Advanced Technology, Kerman, 7631133131, Iran
- AI.Nature Team, INRIA Startup Studio, 2 Rue Simone IFF, 75012, Paris, France
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Ochoa C, Rai M, Babo Martins S, Alcoba G, Bolon I, Ruiz de Castañeda R, Sharma SK, Chappuis F, Ray N. Vulnerability to snakebite envenoming and access to healthcare in the Terai region of Nepal: a geospatial analysis. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 9:100103. [PMID: 37383041 PMCID: PMC10306013 DOI: 10.1016/j.lansea.2022.100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/07/2022] [Accepted: 10/21/2022] [Indexed: 06/30/2023]
Abstract
Background Snakebite envenoming is a neglected tropical disease that mainly affects poor populations in rural areas. In hyperendemic regions, prevention could partially reduce the constant risk, but the population still needs timely access to adequate treatment. In line with WHO's snakebite roadmap, we aim to understand snakebite vulnerability through modelling of risk and access to treatment, and propose plausible solutions to optimise resource allocation. Methods We combined snakebite-risk distribution rasters with travel-time accessibility analyses for the Terai region of Nepal, considering three vehicle types, two seasons, two snakebite syndromes, and uncertainty intervals. We proposed localised and generalised optimisation scenarios to improve snakebite treatment coverage for the population, focusing on the neurotoxic syndrome. Findings In the Terai, the neurotoxic syndrome is the main factor leading to high snakebite vulnerability. For the most common scenario of season, syndrome, and transport, an estimated 2.07 (15.3%) million rural people fall into the high vulnerability class. This ranges between 0.3 (2.29%) and 6.8 (50.43%) million people when considering the most optimistic and most pessimistic scenarios, respectively. If all health facilities treating snakebite envenoming could optimally treat both syndromes, treatment coverage of the rural population could increase from 65.93% to 93.74%, representing a difference of >3.8 million people. Interpretation This study is the first high-resolution analysis of snakebite vulnerability, accounting for uncertainties in both risk and travel speed. The results can help identify populations highly vulnerable to snakebite envenoming, optimise resource allocation, and support WHO's snakebite roadmap efforts. Funding Swiss National Science Foundation.
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Affiliation(s)
- Carlos Ochoa
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
| | | | - Sara Babo Martins
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gabriel Alcoba
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Médecins Sans Frontières (MSF), Neglected Tropical Diseases Working Group, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Isabelle Bolon
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
- Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
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Abstract
Snakebite envenoming is an important cause of preventable death. The World Health Organization (WHO) set a goal to halve snakebite mortality by 2030. We used verbal autopsy and vital registration data to model the proportion of venomous animal deaths due to snakes by location, age, year, and sex, and applied these proportions to venomous animal contact mortality estimates from the Global Burden of Disease 2019 study. In 2019, 63,400 people (95% uncertainty interval 38,900-78,600) died globally from snakebites, which was equal to an age-standardized mortality rate (ASMR) of 0.8 deaths (0.5-1.0) per 100,000 and represents a 36% (2-49) decrease in ASMR since 1990. India had the greatest number of deaths in 2019, equal to an ASMR of 4.0 per 100,000 (2.3-5.0). We forecast mortality will continue to decline, but not sufficiently to meet WHO's goals. Improved data collection should be prioritized to help target interventions, improve burden estimation, and monitor progress.
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Melo Araújo SC, Ceron K, Guedes TB. Use of geospatial analyses to address snakebite hotspots in mid-northern Brazil - A direction to health planning in shortfall biodiversity knowledge areas. Toxicon 2022; 213:43-51. [PMID: 35390425 DOI: 10.1016/j.toxicon.2022.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/12/2022] [Accepted: 03/19/2022] [Indexed: 11/17/2022]
Abstract
Knowing the distribution of venomous snakes of medical importance is essential to identify areas at risk for snakebites. Thus, we used an integrative approach based on the application of geographic distribution data of venomous snakes, species distribution modeling (SDM), spatial organization of snakebites, and information on human population density for mapping the potential distribution of snakes and identifying areas at risk of snakebites in the state of Maranhão (mid-northern Brazil). From a compiled a database of venomous snake records deposited in biological collections and the literature, we predict the potential distribution of venomous snakes in Maranhão, a state whose diversity and geographic distribution of venomous snake species are poorly known. With this, we constructed potential distribution maps for each venomous snake species with at least one occurrence record within state boundaries, as well as generalized maps by family (Viperidae and Elapidae) and the total number of venomous snakes in Maranhão State. We also obtained data on the number of snakebites recorded in each municipality of Maranhão over a decade (2009-2019) and we ran a Generalized Linear Model to test for relationships between the number of venomous snakebites, the area of occurrence of snakes, and human population density. We obtained 1046 records of venomous snake species for Maranhão, represented by 17 viperid and elapid species. Most of the records were from Viperidae (mostly Bothrops atrox and B. marajoensis) and were concentrated mainly in the Amazonia of the northern portion of the state. The models showed accurate predictive performance for all modeled species. The entire area of Maranhão exhibits environmental conditions for the occurrence of venomous snakes, with higher suitability indices in the northern region, in the Amazon rainforest. The number of snakebites was positively correlated with high-risk areas (i.e., greater distribution of venomous snakes) and human population density. Our study is a pioneer in using species distribution modeling in mid-northern Brazil to address the scarcity of data on snakebite-causing species, directly contributing to the theme of neglected tropical diseases of the World Health Organization.
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Affiliation(s)
- Sâmia Caroline Melo Araújo
- Universidade Estadual Do Maranhão, Programa de Pós-Graduação Em Biodiversidade, Ambiente e Saúde, Caxias, MA, 65604-380, Brazil
| | - Karoline Ceron
- Universidade Estadual de Campinas, Instituto de Biologia, 13083-872, Campinas, SP, Brazil
| | - Thaís B Guedes
- Universidade Estadual Do Maranhão, Programa de Pós-Graduação Em Biodiversidade, Ambiente e Saúde, Caxias, MA, 65604-380, Brazil; University of Gothenburg, Gothenburg Global Biodiversity Center and Department of Biological and Environmental Sciences, Box 461, SE-405-30, Göteborg, Sweden.
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Dias ÊR, de Oliveira LA, Sales Lauria PS, Bordon KDCF, Rodrigues Domênico AM, da Silva Guerreiro ML, Wiezel GA, Cardoso IA, Rossini BC, Marino CL, Pimenta DC, Arantes EC, Casais-e-Silva LL, Branco A, dos Santos LD, Biondi I. Bothrops leucurus snake venom protein profile, isolation and biological characterization of its major toxin PLA2s-likeds. Toxicon 2022; 213:27-42. [DOI: 10.1016/j.toxicon.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
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Ochoa C, Pittavino M, Babo Martins S, Alcoba G, Bolon I, Ruiz de Castañeda R, Joost S, Sharma SK, Chappuis F, Ray N. Estimating and predicting snakebite risk in the Terai region of Nepal through a high-resolution geospatial and One Health approach. Sci Rep 2021; 11:23868. [PMID: 34903803 PMCID: PMC8668914 DOI: 10.1038/s41598-021-03301-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
Most efforts to understand snakebite burden in Nepal have been localized to relatively small areas and focused on humans through epidemiological studies. We present the outcomes of a geospatial analysis of the factors influencing snakebite risk in humans and animals, based on both a national-scale multi-cluster random survey and, environmental, climatic, and socio-economic gridded data for the Terai region of Nepal. The resulting Integrated Nested Laplace Approximation models highlight the importance of poverty as a fundamental risk-increasing factor, augmenting the snakebite odds in humans by 63.9 times. For animals, the minimum temperature of the coldest month was the most influential covariate, increasing the snakebite odds 23.4 times. Several risk hotspots were identified along the Terai, helping to visualize at multiple administrative levels the estimated population numbers exposed to different probability risk thresholds in 1 year. These analyses and findings could be replicable in other countries and for other diseases.
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Affiliation(s)
- Carlos Ochoa
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland.
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland.
| | - Marta Pittavino
- Research Center for Statistics (RCS), Geneva School of Economics and Management (GSEM), University of Geneva, Geneva, Switzerland
| | - Sara Babo Martins
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Gabriel Alcoba
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
- Médecins Sans Frontières (MSF), Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Isabelle Bolon
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Rafael Ruiz de Castañeda
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
| | - Stéphane Joost
- Laboratory of Geographic Information Systems (LASIG), School of Architecture, Civil and Environmental Engineering (ENAC), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland
- Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicolas Ray
- Institute of Global Health (IGH), Department of Community Health and Medicine, Faculty of Medicine, University of Geneva, Chemin des Mines 9, 1202, Geneva, Switzerland
- Institute for Environmental Sciences (ISE), University of Geneva, Geneva, Switzerland
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