Scorpion envenomation in the state of São Paulo, Brazil: Spatiotemporal analysis of a growing public health concern

Abstract

Scorpion envenomation is a significant public health concern in São Paulo, Brazil, and its incidence and mortality have increased in recent decades. The present study analyzed documented scorpion envenomation notifications from 2008 to 2018 throughout the 645 municipalities of São Paulo. Annual incidence and mortality rates were calculated and stratified according to sex and age. The local empirical Bayesian method and Getis-Ord Gi* statistic were used to represent standardized incidence rates in the municipalities and to identify high- and low-risk agglomerates. The incidence rate of scorpion envenomation quintupled between 2008 and 2018. Overall, the risk was higher for man, and increased with age. Deaths due to envenomation, however, were concentrated almost entirely in children 0–9 years of age. Incidence maps showed that the risk of envenomation increased in almost all regions and municipalities of São Paulo throughout the study period. The highest incidence rates were found in the western, northwestern and northern regions of the state, in contrast to the São Paulo metropolitan area and southern and coastal regions. Hot spots were identified in the Presidente Prudente, Barretos, São José do Rio Preto, and Araçatuba regional health districts, which over time formed a single high-risk cluster. In spatial terms, however, deaths were randomly distributed. In this study, we identified areas and populations at risk of scorpion envenomation and associated–fatalities, which can be used to support decision-making by health services to reduce human contact with these arachnids and avoid fatalities, especially in children.

Scorpion envenomation in Brazil: Current scenario and perspectives for containing an increasing health problem

“…Interestingly, the percentage of urbanization was not different between the lower-and higher-risk areas, despite areas with less natural vegetation can be implied to be more urbanized [40]. More studies evaluating the correlation between rates of scorpionism, climate, and other environmental factors are important to predict future trends and to help to cope with the current epidemic [39,40] Considering the demographic characteristics of envenomed victims, the main profile has not change much between 2007 and 2019 (Fig 2). The proportion of accidents involving adults (20 to 64 years) and the elderly (>65 years) raised about 3%, whereas for the young population (10 to 19 years) and children (0 to 9 years), it has decreased at approximately the same rate (Fig 2A).…”

“…Interestingly, the percentage of urbanization was not different between the lower- and higher-risk areas, despite areas with less natural vegetation can be implied to be more urbanized [ 40 ]. More studies evaluating the correlation between rates of scorpionism, climate, and other environmental factors are important to predict future trends and to help to cope with the current epidemic [ 39 , 40 ]…”

“…Notwithstanding, school-based interventions can be effective in promoting behavioral changes toward adopting preventive measures against urban pests [ 129 , 130 ]. Communication through popular media channels could also help to inform the general population in a more massive way [ 39 ], and it is remarkable that, in the period of higher incidence of scorpionism, accidents and related deaths are frequently present in newspapers and in the television. However, these media channels could be more intensively used to educate the population about prevention.…”

“…Since scorpions are affected by the environment, some studies have claimed that climate factors, such as global warming, could increase scorpion proliferation, maturation, and distribution [36][37][38], contributing to the observed accidents' raise. Lacerda and colleagues [39] evaluated geographic and epidemiological characteristics of scorpion envenomation in São Paulo state and identified environmental factors that may be associated with these incidents. All the detected higher-risk areas presented lower precipitation, warmer temperatures, and a lower percentage of natural vegetation coverage, indicating a possible association of these factors with the occurrence of scorpion accidents.…”

Scorpion envenomation-associated myocarditis: A systematic review

“…Additionally, a growing concern is being mounted as factors like climate change are projected to alter the spatiotemporal distribution of clinically significant scorpion populations and human-scorpion interactions [4][5][6]. The incidence and mortality of scorpion envenomation have reportedly increased in the last decade [7][8][9].…”