Abstract
Snakebites represent an important, though neglected, public health problem especially in the Northeast of Brazil. There is still a large number of underreported cases, the collection of epidemiological data is deficient, and the ecological and epidemiological knowledge of this envenomation remains limited due to the lack of updated regional and local information. This study describes the epidemiological profile of snakebites recorded by the Notifiable Diseases Information System from 2008 to 2018 in the state of Ceará. The data were organized according to the municipalities of the health macro-regions, considering the variables: sex, snake, gravity and deaths. A total of 8,233 cases was found, with an annual incidence of 8.6/100,000 inhabitants, and a higher prevalence of accidents caused by Bothrops snakes (64%), in men (87.4%) in the Sobral region (25.5%). However, the highest incidence rate was found in the Sertão Central (299.7/100,000). Most cases were considered mild (62%), but the mortality rate was 0.07/100,000 and the case-fatality rate was 0.8%. Among the most affected municipalities, cities like Tauá (1.3%), Sobral (8.1%) and Fortaleza (8.5%) are concerning, considering that the case-fatality rates were above the national average (1%). Snakebites in Ceará follow a pattern similar to that of other states in the Northeast, with a high frequency of incidents where the causative snake is not identified (16%). Considering the gravity of snakebites, studies that evaluate the anthropic and environmental influence in the distribution of cases may help to define priority risk areas, to improve health surveillance and patient care.
Highlights
Every day, an average of 7400 people are bitten by snakes, representing between 81,000 and 138,000 deaths, annually, worldwide, with about 400,000 disabilities such as amputations and post-traumatic stress disorder (Minghui et al, 2019, Gutiérrez et al, 2017)
In 2009 the World Health Organization (WHO) included snake bite on the list of Neglected Tropical Diseases (NTDs), it left this list in 2013, returning in 2017 as a global strategy to have the number of deaths and disabilities caused by this envenomation by 2030 (WHO, 2019)
Among the South American countries, Brazil is the one that reports the highest number of cases of snakebites per year (Gutiérrez et al 2017), registering 265,701 incidents in 2019 (Sinan, 2019)
Summary
An average of 7400 people are bitten by snakes, representing between 81,000 and 138,000 deaths, annually, worldwide, with about 400,000 disabilities such as amputations and post-traumatic stress disorder (Minghui et al, 2019, Gutiérrez et al, 2017). Most of these accidents are distributed in tropical and subtropical regions of the world, where there is a great diversity of snakes coexisting with the human peasant population with limited access to health and rural technology (Chippaux, 2012, Mise et al, 2016). The ecological and epidemiological knowledge of snakebites remains limited mainly in the states of the Northeast region, since there is still a lack of updated regional and local information, compatible with medical relevance, which hinders efforts to accurately map and mitigate these incidents (Murray et al, 2020)
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