Self-Reported Incidence of Snake, Spider, and Scorpion Encounters among Deployed U.S. Military in Iraq and Afghanistan

Abstract

Much has been written about injury, diarrhea, and respiratory cases but less is known about other threats, specifically snake, scorpion, and spider encounters. To examine the risk from local fauna, a cross-sectional study using an anonymous survey was conducted among U.S. troops in Southwest Asia between January 2005 and May 2006. Among 3,265 troops, 9 cases (0.3%) of snakebites and 85 cases (2.6%) of spider stings and scorpion bites were reported, equating to an incidence of 46.1 per 10,000 person-months for scorpion/spider encounters and 4.9 per 10,000 person-months for snakebites. There was a significant association with service branch and toileting facilities for snakebites. Season, deployment location, rank, and toileting facilities were associated with differential risk of scorpion/spider encounters. Troops are at risk for local fauna encounters while deployed in the current operational environment. The potential morbidity, mortality, and operational impact of these health hazards need to be considered.

Clinical Effects and Antivenom Use for Snake Bite Victims Treated at Three US Hospitals in Afghanistan

“…Similar to past studies of envenomations in the Middle East and Southwest Asia, incidents occurred in the spring and summer (mirroring both the poikilothermic nature of snakes and increased outdoor human activities during these months), and extremity injuries predominated. [5][6][7][8] Unlike the existing survey of Afghan snakebites and reports of Israeli Defense Force and Saudi Arabia snakebite victims, our series included children and elders rather than only adults or soldiers. [6][7][8] Similar to our investigation, these past reports revealed the low occurrence of death of those patients seeking treatment as well as the low occurrence of known adverse effects of antivenom treatment.…”

“…[5][6][7][8] Unlike the existing survey of Afghan snakebites and reports of Israeli Defense Force and Saudi Arabia snakebite victims, our series included children and elders rather than only adults or soldiers. [6][7][8] Similar to our investigation, these past reports revealed the low occurrence of death of those patients seeking treatment as well as the low occurrence of known adverse effects of antivenom treatment. [6][7][8] Congruent with the complex and sometimes unpredictable effects of venom, a variety of clinical and hematologic abnormalities were observed.…”

“…To date the most comprehensive report is a voluntary, cross-sectional survey of 390 US military service members with primary duty assignment to Afghanistan, which was administered after they had departed the country. 6 Although this study revealed 7 self-reported Afghanistan snake encounters and an increased risk of snakebite in Afghanistan compared with Iraq, no questions relating to clinical visits associated with these encounters were asked. 6 Modern US military hospital facilities in Afghanistan frequently possess emergency departments (EDs) with emergency physicians, access to expert toxicology consultation, and available polyvalent snake antivenoms.…”

“…6 Although this study revealed 7 self-reported Afghanistan snake encounters and an increased risk of snakebite in Afghanistan compared with Iraq, no questions relating to clinical visits associated with these encounters were asked. 6 Modern US military hospital facilities in Afghanistan frequently possess emergency departments (EDs) with emergency physicians, access to expert toxicology consultation, and available polyvalent snake antivenoms. However, the paucity of published reports of patients treated in these facilities for Afghan snakebites is insufficient to support guidance on hospital antivenom treatment and stocking guidelines.…”

“…[1][2][3] Although nearby countries such as Pakistan and India are reported by the World Health Organization to possess the largest annual snakebite mortalities in the world with a combined estimated annual snakebite mortality of up to 70,000 deaths per year, little is known about the burden of Afghan snake envenomations. [2][3][4][5][6] In addition to the indigenous population, each year more than 100,000 US and international civilians and military service members presently work in Afghanistan and are at risk for this environmental hazard.…”