Abstract
BackgroundSnakebite envenoming is a major global health problem that kills or disables half a million people in the world’s poorest countries. Biting snake identification is key to understanding snakebite eco-epidemiology and optimizing its clinical management. The role of snakebite victims and healthcare providers in biting snake identification has not been studied globally.ObjectiveThis scoping review aims to identify and characterize the practices in biting snake identification across the globe.MethodsEpidemiological studies of snakebite in humans that provide information on biting snake identification were systematically searched in Web of Science and Pubmed from inception to 2nd February 2019. This search was further extended by snowball search, hand searching literature reviews, and using Google Scholar. Two independent reviewers screened publications and charted the data.ResultsWe analysed 150 publications reporting 33,827 snakebite cases across 35 countries. On average 70% of victims/bystanders spotted the snake responsible for the bite and 38% captured/killed it and brought it to the healthcare facility. This practice occurred in 30 countries with both fast-moving, active-foraging as well as more secretive snake species. Methods for identifying biting snakes included snake body examination, victim/bystander biting snake description, interpretation of clinical features, and laboratory tests. In nine publications, a picture of the biting snake was taken and examined by snake experts. Snakes were identified at the species/genus level in only 18,065/33,827 (53%) snakebite cases. 106 misidentifications led to inadequate victim management. The 8,885 biting snakes captured and identified were from 149 species including 71 (48%) non-venomous species.ConclusionSnakebite victims and healthcare providers can play a central role in biting snake identification and novel approaches (e.g. photographing the snake, crowdsourcing) could help increase biting snake taxonomy collection to better understand snake ecology and snakebite epidemiology and ultimately improve snakebite management.
Highlights
An estimated 5.4 million snake bites occur globally every year
Snakebite victims and healthcare providers can play a central role in biting snake identification and novel approaches could help increase biting snake taxonomy collection to better understand snake ecology and snakebite epidemiology and improve snakebite management
Twenty-three publications (15%) across 13 countries mentioned the number of victims that saw the biting snake (BSN)
Summary
An estimated 5.4 million snake bites occur globally every year About half of these cause snakebite envenoming (SBE), killing 81,000–138,000 people and disabling 400,000 more in the poorest regions [1, 2]. The identity of the biting snake (BSN) can help healthcare providers anticipate victims’ syndromes and support decision making when treating the patient (i.e. whether or not to administer antivenom or which type of antivenom) [8, 9] This decision is important because are antivenoms effective against a limited number of venomous snakes but they have potentially lethal side effects such as fatal allergic reactions and should not be used to treat bites from non-venomous snakes. Editor: Rakhi Dandona, Public Health Foundation of India, INDIA Received: November 10, 2019 Accepted: February 18, 2020
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