Fatal Snakebite Envenoming and Agricultural Work in Brazil: A Case–Control Study

Abstract

We investigated the association between fatal snakebite envenoming and agricultural work in Brazil, considering the effects of relevant covariables. A nested case-control study was performed using 1,119 fatal cases of snakebite envenoming among persons aged ³ 10 years, notified to the Brazilian official reporting system, from 2004 to 2015. As controls, 4,476 cases were randomly selected from the 115,723 nonfatal cases of snakebite, without missing data, that occurred in the same time period. The main predictor was occupation in the agriculture sector; the main outcome was death by snakebite envenoming. Logistic regression analysis was used to investigate the main association, controlling for the effects of relevant covariables. Fatal cases had a 20% greater chance (odds ratio [OR] = 1.20; 95% confidence interval [CI]: 1.00-1.39) of being among farmers than the controls. However, late (³ 6 hours) time to treatment (OR = 2.00; 95% CI: 1.70-2.36); adequate antivenom with an insufficient (OR = 1.25; 95% CI: 1.04-1.50) or excessive (OR = 4.89; 95% CI: 4.10-6.03) number of vials; inadequate antivenom and insufficient or excessive number of vials (OR = 3.87; 95% CI: 2.40-6.24); no use of antivenom (OR = 2.05; 95% CI: 1.60-2.64); and age ³ 60 years (OR = 1.98; 95% CI: 1.61-2.44) were more strongly associated with lethality. Lethality was 1.0% in the period, being 0.47% among those receiving early and adequate treatment. We concluded that in Brazil, fatal snakebite envenoming was associated with agricultural work, controlling for relevant covariates. However, quality of health care provided and greater age were much more strongly associated with lethality.

Epidemiological and clinical aspects of snakebites in the upper Juruá River region, western Brazilian Amazonia

“…Snakebites involving the upper regions of the body (14.4% of cases), could be associated, in some cases, with the presence of Bothrops bilineatus smaragdinus and young B. atrox in the vegetation, the most frequently found Bothrops individuals in forested floodplains of the upper Juruá (Turci et al 2009;Fonseca et al 2019). As observed by Moreno et al (2005) in the region of Rio Branco (capital of Acre state), the main snakebite victims in our study were farmers, highlighting the ocupational correlate of snakebite morbidity with agriculture (Mise et al 2019), and children and teenagers, confirming these groups as those at higher risk, and which should be primary targets of prevention campaigns.…”

“…There are an estimated 2.7 million cases of snake envenoming per year on the planet, resulting in 81,000 to 138,000 deaths, and 400,000 cases of amputation and other permanent sequels (Williams et al 2019). The envenomings are concentrated in rural areas, where hundreds of millions of people depend on agriculture or subsistence hunting and gathering to survive, living alongside snakes, and running the risk of suffering snakebites on a daily basis (Sharma et al 2004;Rahman et al 2010;Mise et al 2019). In Latin America, despite considerable efforts in some countries to prevent and treat snakebites, and to train staff in the management of envenomings, there still remain major challenges to reduce snakebite morbity (Gutiérrez 2014).…”

Snakebites in Rio Branco and surrounding region, Acre, Western Brazilian Amazon

“…The fact that the higher frequency of victims were male and bitten on the lower limbs corresponded to the epidemiological profile observed for the Brazilian Amazon 5,6,8,19 , as well as for the other regions of Brazil 28 .…”

“…More cases attributed to non-venomous snakes or "dry bites" were present in the urban area, where it is more common to record accidents with species that are not of medical interest 34 . A higher proportion of cases among females occurred in the urban area compared to rural areas, which may be related to the fact that a large portion of the accidents in cities occur in households 34 and in the rural area which is a more occupational setting, involving mostly farming activities and the extraction process which is carried out mainly by males 9,10,27,28 . This same hypothesis could explain the higher proportion of children (under 10 years old) bitten in the urban area (23.94%) than in the rural area (8.5%) in the present study.…”

Ofidismo no Tocantins: análise ecológica de determinantes e áreas de risco, 2007-2015 *

“…17 Lethality is known to be a complex outcome influenced by diverse factors, such as snake genus, use of tourniquets and snakebites on the extremities of the body (fingers and toes), as well as by the time elapsed between the accident and health care (above all in cases coming from the rural zone), type of serum and number of phials used, whereby these three latter factors are health service-related. 18 These factors must be considered when analyzing the 19 This situation appears to reflect the invisibility of these workers when formulating occupational health policies and protection programs. The scenario is particularly serious when snakebite is a condition that is easy to prevent by making personal protective equipment (PPE) available, but which is constantly not used during farming activities.…”