The international view of envenoming in Brazil: myths and realities

Abstract

Being distant from Brazil's great natural diversity, from its long tradition in the study of snakebites and from the fact that it is one of the few countries which has a national information system for monitoring incidents involving venomous animals, non-Brazilian researchers face risks when estimating the incidence of these accidents in the country. The present work offers a critical review of the main estimates undertaken since 1954. It is interesting to note contradictions between textual and graphic information within the same article, variations over time in the work of a same researcher and differences among distinct authors, and that all these issues remain unmentioned or undiscussed. Comparison among such estimates and the data available at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN) creates an opportunity to identify the degree of imprecision present in those articles, and draws attention to the need for the production of studies at both the regional and national levels, based on concrete data collected at national, state and municipal levels, which has been available on the internet since 2001.

Figure 1

Snakebite morbidity per 100,000 inhabitants. Reprinted from “Les complications locales des morsures de serpents” by J. P. Chippaux, Médecine Tropicale, 1982, 42(2), 177–183 [2]. Copyright by J. P. Chippaux and Médecine Tropicale. Reprinted with permission.

Figure 2

Map showing the global distribution of snakebite morbidity. Reprinted from “Snake-bites: appraisal of the global situation” by J. P. Chippaux, Bulletin of the World Health Organization, 1998, 76(5), 515–24 [8]. Copyright by WHO.

Figure 3

Annual incidence of snakebites in the world. Reprinted from “Incidence et mortalité par animaux venimeux dans les pays tropicaux” by Jean-Philippe Chippaux, Médecine Tropicale, 2008, 68(4), 334–39 [29]. Copyright by J. P. Chippaux and Médecine Tropicale. Reprinted with permission.

Figure 4

Regional estimates of envenomings due to snakebite (low estimate). Reprinted from “The global burden of snakebite: a literature analysis and modeling based on regional estimates of envenoming and deaths” by A. Kasturiratne et al., PLOS Medicine, 2008, 5(11), e218 [37]. Creative Commons Attribution License (CCAL).

Figure 5

Regional estimates of deaths due to snakebite (low estimate). Reprinted from “The global burden of snakebite: a literature analysis and modeling based on regional estimates of envenoming and deaths” by A. Kasturiratne et al., PLOS Medicine, 2008, 5(11), e218 [37]. CCAL.

Figure 6

Incidence of scorpionism in the world. Reprinted from “Envenimations et intoxications par les animaux venimeux ou vénéneux. I. Généralités” by J. P. Chippaux and M. Goyffon, Médecine Tropicale, 2006, 66(3), 215–220 [28]. Copyright by J. P. Chippaux and Médecine Tropicale. Reprinted with permission.

Figure 7

Annual incidence of scorpionism in the world (per 100,000 inhabitants). Reprinted from “Incidence et mortalité par animaux venimeux dans les pays tropicaux” by J. P. Chippaux, Médecine Tropicale, 2008, 68(4), 334–39 [29]. Copyright by J. P. Chippaux and Médecine Tropicale. Reprinted with permission.

Figure 8

Worldwide scorpion distribution (white solid line). In red, areas with severe problems of scorpionism. Reprinted from “The evolution of scorpionism in Brazil in recent years” by W. R. Lourenço et al., The Journal of Venomous Animals and Toxins, 1996; 2(2): 121–134 [58]. Copyright by CEVAP/UNESP. Reprinted with permission.

Figure 9

Areas with high rates of scorpionism worldwide. Reprinted from “Peut-on parler d’une biogéographie du scorpionisme” by W. R. Lourenço, Compte-Rendu des Séances de la Société de Biogéographie, 1988, 64(4), 137–143 [59]. Copyright by W. R. Lourenço and Société de Biogéographie. Reprinted with permission.