What We Know about Sting-Related Deaths? Human Fatalities Caused by Hornet, Wasp and Bee Stings in Europe (1994-2016)

Abstract

Epidemiology of Hymenopteran-related deaths in Europe, based on official registers from WHO Mortality Database (Cause Code of Death: X23), are presented. Over a 23-year period (1994-2016), a total of 1691 fatalities were recorded, mostly occurring in Western (42.8%) and Eastern (31.9%) Europe. The victims tended to concentrate in: Germany (n = 327; 1998-2015), France (n = 211; 2000-2014) and Romania (n = 149; 1999-2016). The majority of deaths occurred in males (78.1%) between 25-64 years (66.7%), and in an "unspecified place" (44.2%). The highest X23MR (mortality rate) were recorded in countries from Eastern Europe (0.35) followed by Western (0.28), Northern (0.23) and Southern Europe (0.2). The countries with the highest and lowest mean X23MR were Estonia (0.61), Austria (0.6) and Slovenia (0.55); and Ireland (0.05), United Kingdom (0.06) and the Netherlands (0.06), respectively. The X23 gender ratio (X23GR; male/female) of mortality varied from a minimum of 1.4 for Norway to a maximum of 20 for Slovenia. Country-by-country data show that the incidence of insect-sting mortality is low and more epidemiological data at the regional level is needed to improve our understanding of this incidence. With the expansion of non-native Hymenopteran species across Europe, allergists should be aware that their community's exposures are continually changing.

Keywords: Hymenoptera; bee; epidemiology; fatalities; hornet; insect; public health; venomous animals; wasp.

Figure 1

Map of Europe comprising the countries (n = 32) included in the study with the four regions assignment: Eastern Europe (in orange): (n = 6), (numerical code 151): Bulgaria (BG), Czech Republic (CZ), Hungary (HU), Poland (PL), Romania (RO) and Slovakia (SK). Northern Europe (in green): (n = 9), (numerical code 154): Estonia (EE), Finland (FI), Iceland (IS), Ireland (IE), Latvia (LV), Lithuania (LT), Norway (NO), Sweden (SE) and United Kingdom (UK). Southern Europe (in red): (n = 10), (numerical code 039): Bosnia and Herzegovina (BA), Croatia (HR), Greece (EL), Italy (IT), Malta (MT), Montenegro (ME), Portugal (PT), Serbia (RS), Slovenia (SI) and Spain (ES). Western Europe (in green): (n = 7), (numerical code 155): Austria (AT), Belgium (BE), France (FR), Germany (DE), Luxembourg (LU), Netherlands (NL), and Switzerland (CH). Countries are labelled by their ISO 3166-1 alpha-2 codes [24]. Countries were grouped in four regions, based on the “Standard Country or Area Codes for Statistical Use” (M49) [25], from United Nations geographic scheme for the continent of Europe (numerical code 150), created by the United Nations Statistics Division (UNSD).

Figure 2

Map of Europe showing the average Hymenopteran sting-related mortality rates (X23MR) during the studied period (1994–2016). The X23MR are expressed in terms of annual rates (i.e., per year) and per 1,000,000 inhabitants, based in the dataset range for each country.