European viper envenomation recorded by French poison control centers: A clinical assessment and management study

Abstract

IntroductionImmunotherapy is the gold standard treatment for patients bitten by European vipers in France; it significantly decreases morbidity, frequency and severity of complications and length of stay. A national prospective study was performed by all Poison Control Centers (PCC) to validate the emergency protocol for viper envenomations. MethodsThis prospective study included all cases of viper bites in France, treated or not with Viperfav® in 2013. ResultsIn 2013, 277 cases of viper bites were collected: ratio M/F 2.1; mean aged 43 years (<15 years 25% 15–65 63% > 65 12%). The final severity was divided into 68 grades 0, 58 grades I, 62 grades IIA, 71 grades IIB and 18 grades III. One death was reported. Five patients had neurological signs. For the 114 patients who received Viperfav®, all systemic signs disappeared in 5 h and in 24 h for biological and neurological signs. No severe anaphylactic reaction with Viperfav® was reported. Late Viperfav® administration increased the risk of functional impairment 15 days after the bite (OR = 3.21 p = 0.043). The administration of Low Molecular Weight Heparin (LMWH) increased the frequency of functional impairment to 15 days after the bite (OR = 6.38 p = 0.064), although Viperfav® was given in the first 18 h. DiscussionThis study confirms the efficiency, safety and recommendation of an early administration of a single dose of Viperfav®, LMWH should not be used. It also shows the extension of neurotoxic venom of vipers in France.