The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.
TL;DR: It is estimated that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite, with the highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.
Abstract: Background Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites. Methods and Findings The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant countryspecific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually.
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TL;DR: A new large-scale phylogeny of squamate reptiles is presented that includes new, resurrected, and modified subfamilies within gymnophthalmid and scincid lizards, and boid, colubrid, and lamprophiid snakes.
Abstract: The extant squamates (>9400 known species of lizards and snakes) are one of the most diverse and conspicuous radiations of terrestrial vertebrates, but no studies have attempted to reconstruct a phylogeny for the group with large-scale taxon sampling. Such an estimate is invaluable for comparative evolutionary studies, and to address their classification. Here, we present the first large-scale phylogenetic estimate for Squamata. The estimated phylogeny contains 4161 species, representing all currently recognized families and subfamilies. The analysis is based on up to 12896 base pairs of sequence data per species (average = 2497 bp) from 12 genes, including seven nuclear loci (BDNF, c-mos, NT3, PDC, R35, RAG-1, and RAG-2), and five mitochondrial genes (12S, 16S, cytochrome b, ND2, and ND4). The tree provides important confirmation for recent estimates of higher-level squamate phylogeny based on molecular data (but with more limited taxon sampling), estimates that are very different from previous morphology-based hypotheses. The tree also includes many relationships that differ from previous molecular estimates and many that differ from traditional taxonomy. We present a new large-scale phylogeny of squamate reptiles that should be a valuable resource for future comparative studies. We also present a revised classification of squamates at the family and subfamily level to bring the taxonomy more in line with the new phylogenetic hypothesis. This classification includes new, resurrected, and modified subfamilies within gymnophthalmid and scincid lizards, and boid, colubrid, and lamprophiid snakes.
1,381 citations
Cites background from "The global burden of snakebite: a l..."
...Squamates are key study organisms in numerous fields, from evolution, ecology, and behavior [3] to medicine [5,6] and applied physics [7]....
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TL;DR: It is discovered that evidence for the benefits of interacting with nature is geographically biased towards high latitudes and Western societies, potentially contributing to a focus on certain types of settings and benefits.
Abstract: There is mounting empirical evidence that interacting with nature delivers measurable benefits to people. Reviews of this topic have generally focused on a specific type of benefit, been limited to a single discipline, or covered the benefits delivered from a particular type of interaction. Here we construct novel typologies of the settings, interactions and potential benefits of people-nature experiences, and use these to organise an assessment of the benefits of interacting with nature. We discover that evidence for the benefits of interacting with nature is geographically biased towards high latitudes and Western societies, potentially contributing to a focus on certain types of settings and benefits. Social scientists have been the most active researchers in this field. Contributions from ecologists are few in number, perhaps hindering the identification of key ecological features of the natural environment that deliver human benefits. Although many types of benefits have been studied, benefits to physical health, cognitive performance and psychological well-being have received much more attention than the social or spiritual benefits of interacting with nature, despite the potential for important consequences arising from the latter. The evidence for most benefits is correlational, and although there are several experimental studies, little as yet is known about the mechanisms that are important for delivering these benefits. For example, we do not know which characteristics of natural settings (e.g., biodiversity, level of disturbance, proximity, accessibility) are most important for triggering a beneficial interaction, and how these characteristics vary in importance among cultures, geographic regions and socio-economic groups. These are key directions for future research if we are to design landscapes that promote high quality interactions between people and nature in a rapidly urbanising world.
730 citations
Cites background from "The global burden of snakebite: a l..."
...For example, bites from venomous snakes show a very strong bias toward equatorial regions [28], and zoonotic diseases are similarly geographically biased [29], suggesting that some of the more important negative aspects of interacting with nature might be overlooked if the research is biased toward high...
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TL;DR: Through advances in 'omic' technologies, venom composition data have recently become available for several venomous lineages, revealing considerable complexity in the processes responsible for generating the genetic and functional diversity observed in many venoms.
Abstract: Venoms have evolved on numerous occasions throughout the animal kingdom. These 'biochemical weapon systems' typically function to facilitate, or protect the producing animal from, predation. Most venomous animals remain unstudied despite venoms providing model systems for investigating predator-prey interactions, molecular evolution, functional convergence, and novel targets for pharmaceutical discovery. Through advances in 'omic' technologies, venom composition data have recently become available for several venomous lineages, revealing considerable complexity in the processes responsible for generating the genetic and functional diversity observed in many venoms. Here, we review these recent advances and highlight the ecological and evolutionary novelty of venom systems.
723 citations
01 Jan 2016
TL;DR: The main message emerging from this new comprehensive global assessment is that premature death and disease can be prevented through healthier environments – and to a significant degree.
Abstract: The main message emerging from this new comprehensive global assessment is that premature death and disease can be prevented through healthier environments – and to a significant degree. Analysing the latest data on the environment-disease nexus and the devastating impact of environmental hazards and risks on global health, backed up by expert opinion, this report covers more than 130 diseases and injuries.
585 citations
TL;DR: Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.
Abstract: BACKGROUND: India has long been thought to have more snakebites than any other country. However, inadequate hospital-based reporting has resulted in estimates of total annual snakebite mortality ranging widely from about 1,300 to 50,000. We calculated direct estimates of snakebite mortality from a national mortality survey. METHODS AND FINDINGS: We conducted a nationally representative study of 123,000 deaths from 6,671 randomly selected areas in 2001-03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. Discrepancies were resolved by anonymous reconciliation or, failing that, by adjudication. A total of 562 deaths (0.47% of total deaths) were assigned to snakebites. Snakebite deaths occurred mostly in rural areas (97%), were more common in males (59%) than females (41%), and peaked at ages 15-29 years (25%) and during the monsoon months of June to September. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6-4.5), with higher rates in rural areas (5.4/100,000; 99% CI 4.8-6.0), and with the highest state rate in Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). CONCLUSIONS: Snakebite remains an underestimated cause of accidental death in modern India. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Community education, appropriate training of medical staff and better distribution of antivenom, especially to the 13 states with the highest prevalence, could reduce snakebite deaths in India.
464 citations
Cites background from "The global burden of snakebite: a l..."
...Snakebites and snakebite fatalities peak during the monsoon season in India [33,36] and worldwide [10], probably reflecting agricultural activity, flooding, increased snake activity, and abundance of their natural prey....
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...Our data suggest underestimation in recent global estimates of mortality from snakebite deaths [10]: the upper bounds of recent annual estimates were 94,000 deaths globally and 15,000 deaths in India....
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References
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TL;DR: New data and improved understanding of typhoid fever epidemiology enabled us to refine the global typhoid burden estimate, which remains considerable.
Abstract: OBJECTIVE: To use new data to make a revised estimate of the global burden of typhoid fever, an accurate understanding of which is necessary to guide public health decisions for disease control and prevention efforts. METHODS: Population-based studies using confirmation by blood culture of typhoid fever cases were sought by computer search of the multilingual scientific literature. Where there were no eligible studies, data were extrapolated from neighbouring countries and regions. Age-incidence curves were used to model rates measured among narrow age cohorts to the general population. One-way sensitivity analysis was performed to explore the sensitivity of the estimate to the assumptions. The burden of paratyphoid fever was derived by a proportional method. FINDINGS: A total of 22 eligible studies were identified. Regions with high incidence of typhoid fever (>100/100,000 cases/year) include south-central Asia and south-eastAsia. Regions of medium incidence (10-100/100,000 cases/year) include the rest of Asia, Africa, Latin America and the Caribbean, and Oceania, except for Australia and New Zealand. Europe, North America, and the rest of the developed world have low incidence of typhoid fever (<10/100,000 cases/year). We estimate that typhoid fever caused 21,650,974 illnesses and 216,510 deaths during 2000 and that paratyphoid fever caused 5,412,744 illnesses. CONCLUSION: New data and improved understanding of typhoid fever epidemiology enabled us to refine the global typhoid burden estimate, which remains considerable. More detailed incidence studies in selected countries and regions, particularly Africa, are needed to further improve the estimate.
1,872 citations
Journal Article•
TL;DR: The present article is an attempt to draw the attention of health authorities to snake envenomations and urges them to prepare therapeutic protocols adapted to their needs.
Abstract: The true global incidence of envenomations and their severity remain largely misunderstood, except for a few countries where these accidents are rare or are correctly reported. Nevertheless, this information is essential for drawing up guidelines for dealing with snake-bites, to plan drug supplies, particularly antivenin, and to train medical staff on snake-bite treatments. Since the comprehensive review by Swaroop & Grab in 1954 no global survey has been carried out on snake-bite epidemiology. The present article is an attempt to draw the attention of health authorities to snake envenomations and urges them to prepare therapeutic protocols adapted to their needs.
831 citations
"The global burden of snakebite: a l..." refers background in this paper
...Chippaux [3] and White [4] do not give any details of the methodology used to calculate their estimates....
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...5 million envenomings and over 125,000 deaths annually’’ [3], ‘‘more than 3 million bites per year resulting in more than 150,000 deaths’’ [4], or ‘‘several million bites and envenomings annually with tens of thousands of deaths’’ [5]....
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...The most often quoted currently available estimates of the global burden of snakebite [3,4] are subject to the major limitation that the methodology of estimation is not given and so cannot be reproduced....
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...Since the reviews by Swaroop and Grab in 1954 [6] and Chippaux in 1998 [3], and a global overview of bites and stings from venomous animals by White [4], no comprehensive global assessment has been made of snakebite epidemiology....
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TL;DR: The paper describes the evolution of the GBD, summarizes the methodological improvements incorporated into GBD revisions for the years 2000–2004 carried out by the World Health Organization, and examines priorities and issues for the next major GBD study, funded by the Bill & Melinda Gates Foundation, and commencing in 2007.
Abstract: Reliable, comparable information about the main causes of disease and injury in populations, and how these are changing, is a critical input for debates about priorities in the health sector. Traditional sources of information about the descriptive epidemiology of diseases, injuries, and risk factors are generally incomplete, fragmented, and of uncertain reliability and comparability. The Global Burden of Disease (GBD) study has provided a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability, the disability-adjusted life year (DALY).
This paper describes key features of the Global Burden of Disease analytic approach, which provides a standardized measurement framework to permit comparisons across diseases and injuries, as well as risk factors, and a systematic approach to the evaluation of data. The paper describes the evolution of the GBD, starting from the first study for the year 1990, summarizes the methodological improvements incorporated into GBD revisions for the years 2000–2004 carried out by the World Health Organization, and examines priorities and issues for the next major GBD study, funded by the Bill & Melinda Gates Foundation, and commencing in 2007.
The paper presents an overview of summary results from the Global Burden of Disease study 2002, with a particular focus on the neglected tropical diseases, and also an overview of the comparative risk assessment for 26 global risk factors. Taken together, trypanosomiasis, Chagas disease, schistosomiasis, leishmaniasis, lymphatic filariasis, onchocerciasis, intestinal nematode infections, Japanese encephalitis, dengue, and leprosy accounted for an estimated 177,000 deaths worldwide in 2002, mostly in sub-Saharan Africa, and about 20 million DALYs, or 1.3% of the global burden of disease and injuries. Further research is currently underway to revise and update these estimates.
483 citations
"The global burden of snakebite: a l..." refers methods in this paper
...Two hundred twenty-seven countries were grouped into 21 distinct geographical regions in this study, according to the classification used for the Global Burden of Disease (GBD) 2005 study (Global Burden Project of the World Bank) [ 81 ]....
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...The formalization of methods for the assessment of disease burden provides a framework for standardized methodology [ 81 ]....
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TL;DR: An attempt is made to evaluate the phytochemical properties of the venomous materials used in the making of venomous snake venom, which have the potential to have a positive impact on human health.
Abstract: articulo (arbitrado) -- Universidad de Costa Rica, Instituto de Investigaciones Clodomiro Picado, 2006
457 citations
"The global burden of snakebite: a l..." refers background in this paper
...5 million envenomings and over 125,000 deaths annually’’ [3], ‘‘more than 3 million bites per year resulting in more than 150,000 deaths’’ [4], or ‘‘several million bites and envenomings annually with tens of thousands of deaths’’ [5]....
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...Many estimates from these countries are based on hospital returns or incomplete central databases, and are bound to be underestimates, because many victims do not seek hospital treatment and prefer traditional remedies [5]....
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Book•
22 Oct 1995
TL;DR: Venomous and Poisonous animals-A Biologist's View, J. Meier Poisonous and Venomous Animals-The Physician's View; and Clinical Toxicology of Spider Bites and Antivenom Therapy.
Abstract: Venomous and Poisonous Animals-A Biologist's View, J. Meier Poisonous and Venomous Animals-The Physician's View, J. White Biology and Distribution of Poisonous Marine Animals, D. Mebs Clinical Toxicology of Shellfish Poisoning, D. Smart Clinical Toxicology of Ciguatera Poisoning, P. Glaziou, M. Chinain, and A.-M. Legrand Clinical Toxicology of Fugu Poisoning, N. Kaku and J. Meier Biology and Distribution of Venomous Marine Animals, D. Mebs Clinical Toxicology of Marine Coelenterate Injuries, J. Williamson and J. Burnett Clinical Toxicology of Conus Snail Stings, L.J. Cruz and J. White Clinical Toxicology of Sea Urchin and Starfish Injuries, C. Acott and J. Meier Clinical Toxicology of Venomous Stingray Injuries, C. Acott and J. Meier Clinical Toxicology of Venomous Scorpaenidae and Other Selected Fish Stings, J. Williamson Clinical Toxicology of Sea Snake Bites, J. White Clinical Toxicology of Blue-Ringed Octopus Bites, J. White Biology and Distribution of Ticks of Medical Importance, A. Aeschlimann and T.A. Freyvogel Clinical Toxicology of Tick Bites, J. White Biology and Distribution of Scorpions of Medical Importance, S.M. Lucas and J. Meier Clinical Toxicology of Scorpion Stings, M. Dehesa-Davila, A.C. Alagon, and L.D. Possani Biology and Distribution of Spiders of Medical Importance, S.M. Lucas and J. Meier Clinical Toxicology of Spider Bites, J. White, J.L. Cardoso, and H.W. Fan Biology and Distribution of Hymenopterans of Medical Importance, Their Venom Apparatus, and Venom Composition, J. Meier Clinical Toxicology of Hymenopteran Stings, H. Mosbech Clinical Toxicology of Helodermatidae Lizard Bites, D. Mebs Biology and Distribution of Venomous Snakes of Medical Importance and the Composition of Snake Venoms, J. Meier and K.F. Stocker Clinical Toxicology of Snakebite in Europe, H. Persson Clinical Toxicology of Snakebite in Africa and the Middle East/Arabian Peninsula, D.A. Warrell Clinical Toxicology of Snakebite in Asia, D.A. Warrell Clinical Toxicology of Snakebite in Australia and New Guinea, J. White Clinical Toxicology of Snakebite in North America, H.F. Gomez and R.C. Dart Clinical Toxicology of Snakebite in Central America, J.M. Gutierrez Clinical Toxicology of Snakebite in South America, J.L. Cardoso Commercially Available Antivenoms ("Hyperimmune Sera", "Antivenins", "Antisera") and Antivenom Therapy, J. Meier and J. White Index
427 citations