Epidemiology of accidents involving venomous animals in the State of Ceará, Brazil (2007-2019)

Braga, Jacqueline Ramos Machado; Souza, Marta Maria Caetano de; Melo, Iva Maria Lima de Araújo; Faria, Luis Eduardo Meira; Jorge, Roberta Jeane Bezerra

doi:10.1590/0037-8682-0511-2020

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Revista da Sociedade Brasileira de Medicina Tropical

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Major Article • Rev. Soc. Bras. Med. Trop. 54 • 2021 • https://doi.org/10.1590/0037-8682-0511-2020 copy

Epidemiology of accidents involving venomous animals in the State of Ceará, Brazil (2007-2019)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Envenomation remains a neglected public health problem in most tropical countries. Epidemiological studies on accidents caused by venomous animals are scarce in the Northeast region of Brazil, mainly in the state of Ceará. The present study aimed to describe the epidemiological features of envenomation cases involving venomous animals in the State of Ceará, Northeastern Brazil, from 2007 to 2019.

METHODS:

The online Notifiable Diseases Information System was consulted for data on all envenomation cases involving venomous terrestrial animals. Data collected were evaluated for the number of accidents/year, number of accidents/zoological group, antivenom therapy, zone of occurrence, sex, age-group distribution, and deaths.

RESULTS:

A total of 54,980 cases were recorded, with the highest incidence being that of scorpion stings (67.2%), predominantly in women (52.4%; odds ratio=3.6; 95% confidence interval=3.5-3.8), equally affecting people aged 10-19 years and 40-59 years (21.4%), in the urban areas (odds ratio=10.3; 95% confidence interval=9.9-10.8), especially in the rainy months. Snakebites (16.7%) had an incidence of 8.1/100,000 inhabitants, but the highest case-fatality rates were observed in bee stings (1.3%) and spider bites (0.5%). Regarding therapeutic variables, a small percentage of people had access to serotherapy (5.3%).

CONCLUSIONS

This study highlights the accidents caused by terrestrial venomous animals as a public health problem that must be monitored in Ceará. Thus, our findings suggest that preventive actions against scorpion and bee stings should be intensified during the months of higher incidence to improve public policies for patient care.

Keywords:
Snakebite; Public health; Venom; Brazil

	Venomous animal
Variables	Unknown	Snake	Spider	Scorpion	Caterpillar	Bee	Others	Total
Sex*
								54,358	100
Male		7,184	729	13,912	165	2,823	660	25,800	46.9
Female		2,008	822	23,694	197	1,552	612	29,175	53.1
Age range (years)								n	%
								54,979	100
<1	10	109	29	551	10	66	27	802	1.5
1-4	37	191	62	2048	49	280	86	2,753	5.0
5-9	43	341	65	2044	37	317	96	2,943	5.4
10-14	45	657	83	2123	24	235	86	3,253	5.9
15-19	68	855	164	2984	21	371	98	4,561	8.3
20-39	221	3,101	636	13,017	101	1,995	442	19,513	35.5
40-59	132	2,714	359	9,753	75	791	272	14,096	25.6
60-64	30	434	42	1,576	15	98	43	2,238	4.1
65-69	16	325	32	1,359	11	73	40	1,856	3.4
70-79	14	355	55	1,536	8	99	54	2,121	3.9
≥80	5	107	22	611	11	50	26	832	1.5
Unknown	0	4	1	4	0	0	2	11	0.0
Occurence area*								n	%
								53,332	100
Urban zone		1,801	881	32,075	253	2,586	777	38,373	72.0
Rural zone		7,085	603	4,851	100	1632	445	14,715	27.6
Periurban		55	16	113	9	39	13	244	0.46

	Venomous animal
Variables	Unknown	Snake	Spider	Scorpion	Caterpillar	Bee	Others	Total
Time from bite until assistance (h)								n	%
								54,980	100
Unknown	124	549	160	1,986	30	483	117	3,449	6.3
0-1	121	2,622	325	13,598	123	1,471	346	18,606	33.8
1-3	122	3,311	309	12,473	105	1,106	284	17,710	32.2
3-6	50	1,419	145	4,592	55	341	150	6,752	12.3
6-12	40	639	101	2,686	17	209	89	3,781	6.9
12-24	59	375	183	1,600	17	332	140	2,706	4.9
≥24	105	278	328	671	15	433	146	1,976	3.6
Antivenom								n	%
								51,894	100
Yes	105	7,006	248	1,863	8	42	56	9,328	18.0
No	469	2,617	1,201	32,996	328	3,847	1,108	42,566	82.0
Case evolution								n	%
								54,980	100
Unknown	135	1334	213	1760	22	316	124	3,940	7.2
Cured	484	7,816	1,326	35,822	340	4,049	1148	50,985	92.7
Death due to the notified condition	0	29	7	2	0	50	0	88	0.2
Death due to another condition	2	4	2	1	0	1	0	10	0.0
Classification of case								n	%
								54,980	100
Unknown	157	779	139	1,002	17	270	95	2,459	4.5
Mild	382	5,716	1,103	35,391	323	3,559	1080	47,554	86.5
Moderate	72	2,322	288	1,137	22	512	91	4,444	8.1
Severe	10	376	21	76	0	34	6	523	1.0

	Snake			Spider			Bee			Scorpion*	Caterpillar*
Year	Incidence	Mortality	Lethality (%)	Incidence	Mortality	Lethality (%)	Incidence	Mortality	Lethality (%)	Incidence	Incidence
2007	7.34	0.01	0.3	0.67	0.00	1.8	1.08	0.05	4.4	8.10	0.04
2008	8.06	0.02	0.3	0.59	0.00	0.0	0.99	0.04	3.6	5.48	0.06
2009	10.12	0.04	0.3	0.68	0.01	0.0	1.77	0.09	5.3	8.41	0.05
2010	9.94	0.05	0.1	0.60	0.00	0.0	1.46	0.02	1.6	13.04	0.02
2011	7.73	0.02	0.2	1.04	0.02	0.0	4.09	0.06	1.4	26.63	0.11
2012	6.50	0.05	0.7	0.91	0.00	0.0	2.66	0.01	0.4	27.38	0.14
2013	5.11	0.02	0.4	1.05	0.00	0.0	2.86	0.02	0.8	38.66	0.24
2014	4.98	0.01	0.7	1.15	0.00	0.0	3.95	0.02	0.6	37.19	0.40
2015	6.86	0.04	0.2	1.12	0.02	0.0	2.52	0.07	2.7	32.10	0.25
2016	8.56	0.03	0.3	1.44	0.03	2.3	1.85	0.03	1.8	43.33	0.44
2017	9.07	0.06	0.2	2.34	0.01	0.9	4.58	0.06	1.2	47.13	0.44
2018	9.35	0.01	0.1	2.39	0.00	0.0	8.35	0.02	0.3	64.05	0.78
2019	11.38	0.08	0.6	3.46	0.01	0.3	13.06	0.08	0.6	71.50	1.08
Average	8.08	0.03	0.3	1.34	0.01	0.4	3.79	0.04	1.9	32.54	0.31

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[1] Corresponding author: Dra. Jacqueline Ramos Machado Braga. e-mail:jacquebraga@ufrb.edu.br