Vulnerability to snakebite envenoming: a global mapping of hotspots.

BACKGROUND: Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed. METHODS: We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality. FINDINGS: We provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia. INTERPRETATION: Identifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease. FUNDING: Bill & Melinda Gates Foundation.

Use of moxibustion as an auxiliary treatment in wound healing of the snake Eunectes murinus (anaconda): case report / Uso da moxabustão como tratamento auxiliar em ferimentos na serpente Eunectes murinus (anaconda): relato de caso

Large snakes of the Boidae family, such as Eunectes murinus, require special techniques to facilitate their care when they are sick. Thus, an acupuncture technique called moxibustion was applied that utilizes burning of the weed Artemisia vulgaris for heating at specific points on the skin without handling the animals. The objective of this case report was to describe the use of moxibustion acupuncture as an auxiliary treatment for snakes. A female, 4.0 meters long and weighing about 30 kg, belonging to a Biological Museum of the Butantan Institute, showed symptoms of weight loss, anorexia and hyperemia in the ventral region. The snake was examined and treated with ciprofloxacin antibiotics and a month showed an area of necrosis that exposed the muscles in the dorsal cranial region. The female was treated with moxibustion and application of silver sulfadiazine cream at the site of the lesion. After seven months of treatment, the animal showed signs of good healing with complete wound closure. This technique of moxibustion could be easily applied without restraint, an important detail given the size of the snake, and with successful closure of the lesion.(AU)

Grandes serpentes da família Boidae, como Eunectes murinus, requerem técnicas especiais para facilitar seus cuidados quando estão doentes. Assim, uma técnica de acupuntura, chamada de moxabustão, foi aplicada utilizando-se a queima da erva Artemisia vulgaris para aquecer pontos específicos na pele, sem manusear os animais. O objetivo deste relato de caso foi descrever o uso da acupuntura moxabustão como um tratamento auxiliar para serpentes. Uma fêmea com 4,0m de comprimento e pesando cerca de 30kg, pertencente ao Museu Biológico do Instituto Butantan, apresentou sintomas de perda de peso, anorexia e hiperemia na região ventral. A serpente foi examinada e tratada com o antibiótico ciprofloxacina e um mês depois mostrou uma área de necrose, que expôs os músculos da região dorsal cranial. A fêmea foi tratada com moxabustão e aplicação do creme de sulfadiazina de prata no local da lesão. Depois de sete meses de tratamento, o animal mostrou sinais de boa cicatrização, com fechamento completo da ferida. Essa técnica de moxabustão pode ser facilmente aplicada sem restrição, um detalhe importante dado o tamanho da serpente, e com fechamento bem-sucedido da lesão.(AU)

Evaluation of injuries caused by anthropic action in snakes from Brazil.

Human behavior toward wild animals is defined by cultural influences and often is affected by lack of knowledge, mainly in situations of confrontation. The present study was conducted between 2008 and 2013, involving analysis of snakes that had suffered injuries belonging to the reptile collections of Centro Universitário de Lavras and Universidade Federal de Juiz de Fora. The injuries were classified according to location on the body. Among the 449 specimens analyzed, 245 specimens showed injury to some part of the body. The nonvenomous snakes were the most representative and had a higher rate of injury (66.3%) than the venomous ones (18.2%). The body region where the greatest percentage of injuries was recorded was the anterior (39.6%), followed by the middle (36.5%) and posterior (8.4%). We believe this fact may have resulted due the lack of knowledge on how to differentiate species. Studies of the relationship between schooling level and contact with environmental education activities demonstrate reduction of attacks on these animals. This fact indicates that the preservation of many species is related to awareness and education of the population.

Evaluation of injuries caused by anthropic action in snakes from Brazil / Avaliação das lesões causadas pela ação antrópica em serpentes do Brasil

AbstractHuman behavior toward wild animals is defined by cultural influences and often is affected by lack of knowledge, mainly in situations of confrontation. The present study was conducted between 2008 and 2013, involving analysis of snakes that had suffered injuries belonging to the reptile collections of Centro Universitário de Lavras and Universidade Federal de Juiz de Fora. The injuries were classified according to location on the body. Among the 449 specimens analyzed, 245 specimens showed injury to some part of the body. The nonvenomous snakes were the most representative and had a higher rate of injury (66.3%) than the venomous ones (18.2%). The body region where the greatest percentage of injuries was recorded was the anterior (39.6%), followed by the middle (36.5%) and posterior (8.4%). We believe this fact may have resulted due the lack of knowledge on how to differentiate species. Studies of the relationship between schooling level and contact with environmental education activities demonstrate reduction of attacks on these animals. This fact indicates that the preservation of many species is related to awareness and education of the population.

ResumoO comportamento humano para com os animais selvagens é definido por influências culturais e muitas vezes é afetado por falta de conhecimento, principalmente em situações de confronto. Podendo levar à matança indiscriminada, consequentemente a um estado de declínio. O presente estudo foi realizado entre 2008 e 2013, envolvendo a análise de serpente que sofreram lesões pertencentes às coleções de répteis do Centro Universitário de Lavras e Universidade Federal de Juiz de Fora. As lesões foram classificadas de acordo com a localização no corpo. Entre os 449 espécimes analisados, 245 mostram lesões. As serpentes não peçonhentas foram as mais representativas e apresentaram uma maior taxa de lesão (66,3%) do que os peçonhentos (18,2%). A região do corpo onde ocorreu a maior percentagem de lesões registada foi a anterior (39,6%), seguido pelo meio (36,5%) e posterior (8,4%). Acreditamos que este fato pode ter resultado devido a falta de conhecimento sobre como diferenciar espécies. Estudos sobre a relação entre nível de escolaridade e contato com atividades de educação ambiental demonstram redução dos ataques a esses animais. Este fato indica que a preservação de muitas espécies está relacionado à conscientização e educação da população.

Morbidity and Mortality of Reptiles Admitted to the Australian Wildlife Health Centre, Healesville Sanctuary, Australia, 2000-13.

Medical records of 931 reptiles admitted to the Australian Wildlife Health Centre, Healesville Sanctuary, Healesville, Victoria, Australia, from 2000 to 2013 were reviewed to determine the causes of morbidity and mortality. Thirty-nine species were presented; the most common were the common long-neck turtle (Chelodina longicollis; n = 311, 33.4%), the eastern bluetongue lizard (Tiliqua scincoides; n = 224, 4.1%), the blotched bluetongue lizard (Tiliqua nigrolutea; n = 136, 14.6%), and the lowland copperhead (Austrelaps superbus; n = 55, 5.9%). Trauma was the most significant reason for admissions, accounting for 73.0% of cases. This was followed by not injured (11.7%), displacement (6.4%), snake removal (4.2%), human interference (3.1%), introduced species (1.1%), sick/diseased (0.2%), and illegal pet (0.2%). Within the category of trauma, impact with motor vehicle (41.0% of trauma cases) and domestic animal attack (33.2% of trauma cases) were the most common subcategories. Our results indicate that indirect anthropogenic factors are a significant cause of morbidity and mortality in Australian reptiles.

Ética sobre el envenenamiento ofídico en el paisaje agrario de Guatemala / Ethics of snakebite envenoming in agrarian landscapes of Guatemala

El envenenamiento ofídico es una enfermedad accidental, no infecciosa o contagiosa, causada por los efectos de los venenos de serpientes de las familias Viperidae, Elapidae y Colubridae. Esta enfermedad representa un problema de salud pública a nivel mundial, afectando principalmente a los trabajadores agrícolas. A pesar de derivarse de una relación ecológica antagónica natural entre humanos y serpientes el accidente ofídico es moralmente juzgado como algo malo. En tal sentido, el examen de esta relación supone un componente ético. En el presente ensayo se discute cuál es el significado moral de las serpientes venenosas bajo las perspectivas antropocentrista y biocentrista. Se abordan los temas de riesgo ocupacional y vulnerabilidad del trabajador agrícola a la enfermedad, se elabora sobre las causas de la desatención de esta enfermedad y se reflexiona sobre cuál es la responsabilidad ética del estado, del empresario y del consumidor, en la existencia de ésta enfermedad. Finalmente se discute el papel de la epidemiología social, como una herramienta generadora de información útil para la comprensión de la realidad multidimensional del envenenamiento ofídico.

Snakebite envenoming is an accidental, non-infectious, non-contagious disease, caused by the effects of snake venoms. This disease is a relevant worldwide public health problem in tropical countries. Agricultural workers are highly exposed and therefore, commonly affected. The occurrence of snake envenoming involves some ethics concerns. In this assay, the moral significance of venomous snakes under anthropocentric and biocentric perspectives is discussed. Occupational risk and vulnerability of agricultural workers are also addressed. The ethical roles of government, agricultural enterprises and consumers in the occurrence of the disease are analyzed to try to explain why snakebite envenoming is a neglected disease. Finally, the role of the emerging social epidemiology as the contributor factor to gain involvement of stakeholders ‒which should be responsible for mitigation, prevention, treatment and control of snakebite envenoming‒ is discussed.

Morbidity and mortality of reptiles admitted to the Wildlife Center of Virginia, 1991 to 2000.

Medical records from 694 reptiles admitted to the Wildlife Center of Virginia (WCV; Waynesboro, Virginia, USA) from 1991 to 2000 were reviewed to determine causes of morbidity and mortality. Eighteen species were represented but the majority of cases were four species; eastern box turtle (Terrapene carolina) (66%), eastern painted turtle (Chrysemys picta) (11%), common snapping turtle (Chelydra serpentina) (10%), and rat snake (Elaphe sp.) (6%). There was a significant increase in reptile cases during the study period both in absolute number and in proportion to the total caseload. Trauma (74%) was the most frequent cause of morbidity and mortality followed by unknown or undetermined (13%), aural abscessation (7%), infectious diseases (2%), and one nutritional disorder (0.1%). In addition, 3% of the cases were healthy animals that had been removed from the wild and consequently brought to the WCV. Causes of morbidity and mortality differed between the four most numerous species. Impact with a motor vehicle was the most frequent cause of trauma for eastern box turtles, eastern painted turtles, and common snapping turtles; however, garden-equipment-related trauma was the most frequent cause for rat snakes. Aural abscessation was only seen in eastern box turtles. Eighty percent of cases occurred between May and September and 65% occurred within the five counties closest to the WCV. The majority of morbidity and mortality was the result of human activities. The expanding human population in Virginia likely will continue to have an impact on the health of wild reptiles.