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Epidemiology of Snakebite Accidents in the Municipalities of the State Of

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Epidemiology of Snakebite Accidents in the Municipalities of the State Of 1463 ARTIGO ARTICLE Epidemiology of snakebite accidents in the municipalities of the state of Paraíba, Brazil Epidemiologia dos acidentes ofídicos ocorridos nos municípios do Estado da Paraíba, Brasil Renner de Souza Leite 1 Isabely Tamarys Gomes Targino 1 Ysabel Arianne Cordeiro Ferreira Lopes 1 Rafaella Moreno Barros 1 Alecxandro Alves Vieira 1 Abstract Accidents involving venomous animals Resumo Acidentes por animais peçonhentos re- represent an important, albeit neglected, public presentam um importante, embora negligencia- health issue worldwide. A descriptive study was do, problema de saúde pública mundial. Neste sen- made of snakebite cases attended and recorded be- tido, foi realizado um estudo descritivo dos aci- tween 2007 and 2010 in the health units of the dentes ofídicos atendidos e registrados, entre 2007 municipalities of Cariri, State of Paraíba, north- e 2010, nas unidades de saúde dos municípios do eastern Brazil. Data was collected from the Inju- Cariri, Estado da Paraíba, Nordeste do Brasil. As ry Notification Information System data banks informações foram coletadas do banco de dados of the Health Ministry and a total of 351 records do Sistema de Informação de Agravos de Notifica- of snakebite victims were reviewed. Victims were ção do Ministério da Saúde. Um total de 351 re- predominantly male farm workers over 50. The gistros de vítimas de ataques por serpentes peço- highest incidence of snakebites occurred in rural nhentas foram analisados. As vítimas foram pre- areas, between April and June of 2007 and 2010. dominantemente trabalhadores rurais do sexo Snakes of the genus Bothrops were responsible for masculino com mais de 50 anos. As maiores inci- most cases, and victims were mostly bitten on the dências de acidentes ofídicos ocorreram em áreas feet. The majority of the victims received medical rurais, entre abril e junho de 2007 e 2010. As assistance within 1 to 3 hours after being bitten. serpentes do gênero Bothrops foram responsáveis The most common clinical manifestations were pela maioria dos casos, e as vítimas foram, em sua pain, edema and ecchymosis, which were mainly maioria, picado nos pés. A maioria das vítimas classified as mild or moderate. Two deaths were recebeu assistência médica no prazo de 1h a 3h reported. It was concluded that there is a signifi- após a picada. As manifestações clínicas mais co- cant impact of seasonality in snakebites, the prev- muns foram dor, edema e equimoses, classificadas alence of attacks caused by Bothrops, affecting the como leve ou moderada. Duas mortes foram rela- lower limbs of adult male farmers in rural areas. tadas. Os resultados deste estudo podem contri- The findings of this study may contribute to iden- buir para identificar as condições que aumentam tify the conditions that increase the risk of snake o risco dos acidentes ofídicos na Região Nordeste. 1 Unidade Acadêmica de Saúde, Centro de Educação e attacks in the northeastern region. Palavras-chave Paraíba, Serpentes peçonhen- Saúde, Universidade Federal Key words Paraíba State, Venomous snakes, tas, Envenenamento humano, Acidente ofídico, de Campina Grande. Olho Human poisoning, Snakebite accidents, Epide- Epidemiologia D‘água da Bica s/n. 58175-000 Cuité PB. miology [email protected] 1464 et al. Leite RS Introduction ronmental changes that have occurred there in recent decades. In this sense, the current study Snakebite envenomations represent a worldwide analyzed the clinical and epidemiological profile public health problem due to their high incidence, of the snakebite cases reported from 2007 to 2010 the seriousness and sequelae of the bite injuries, in the municipalities of the Cariri region, located and the fatality rate1,2. Brazil has the highest num- in the state of Paraíba, northeastern Brazil. ber of poisonous snake attacks in South America, with 20,000 cases reported every year and a case fatality rate of 0.45%3. In an effort to improve treat- Materials and Methods ments of these victims, in 1986 it became obligato- ry to notify the Brazilian Health Ministry of all Study area incidents involving poisonous animals. Neverthe- less, questions related to epidemiological research, The state of Paraíba covers an area of 56,372 access to treatment, and training of health work- km², and 98% of its territory is located within the ers have been largely left out of national public “Drought Polygon”, which is an area subjected to policies4,5. Epidemiological studies have revealed a prolonged period of drought11. The Cariri re- that, in Brazil, most snakebite victims are males, gion is located in the central-southern part of farm workers, aged between 15 and 49 years, and this state and covers 11,192 km2 12. This region that they are predominantly bitten on the feet and has a population of about 185,235 inhabitants12, hands. Snakes of the genus Bothrops have shown and the regional municipalities are small and have to be responsible for the majority of snakebite cas- low population densities. Almost the entire re- es. Attacks by snakes of the genus Crotalus are less gion has low rainfall rate, high average tempera- frequent, while attacks by Lachesis and Micrurus tures, acute water deficits, generally thin and of- are rare6. The northeastern region has 43% of the ten salty soils, and hyperxerophytic caatinga veg- snakes of medical importance in Brazil7 , with 25 etation. Increased environmental degradation, species being identified so far, including 12 of the observed in all Cariri region, have contributed to genus Bothrops (B. atrox, B. brazili, B. erythromelas, the development of desertification processes and, B. jararaca, B. jararacussu, B. leucurus, B. lutzi, B. consequently, to the reduction of natural habi- marajoensis, B. moojeni, B. muriciensis, B. neu- tats for snakes. wiedi and B. pirajai), nine Micrurus (M. brasilien- sis, M. corallinus, M. filiformis, M. hemprichii, M. Data collection ibiboboca, M. leminiscatus, M. psyches, M. surina- mensis and M. spixii), two Bothriopsis (B. bilinea- A retrospective descriptive study of the clini- ta and B. taeniata), Crotalus durissus, and Lachesis cal-epidemiological characteristics of snakebites muta. Three species of the family Colubridae was in the Cariri region was carried out. Epidemio- also identified. The most widely distributed spe- logical investigation was based on snakebite cas- cies is the Crotalus durissus, which is found in all es reported from 2007 to 2010 for the 29 munic- the northeastern states. Bothrops erythromelas and ipalities of this region (see Table 1). Data was Bothrops leucurus are found in most of the north- collected from the Second Health Sector of Mon- eastern region, with the exception of the states of teiro and the Third Health Sector of Campina Maranhão and Piauí, respectively7. Grande, using the SINAN (Injury Notification The Northeast is the region with the lowest Information System) data banks of the Health incidence of poisonous snake attacks (7.65 cases/ Ministry. It was excluded 17 patients, which not 100,000 inhabitants); however, it has the highest having age or date of birth registered in the noti- case fatality rate related to these incidents (0.81%, fication files. This research followed all the ethi- approximately double the national average of cal principles in accordance with Declaration of 0.45%)8. In the state of Paraíba, the incidence of Helsinki. Epidemiological data was analyzed in snakebites (9.53 cases/100,000 inhabitants) is low- relation to the sex and age of the victims, year er than the national average (13.9 cases/100,000 and month of the snake attack, zone of occur- inhabitants), but still higher than the average for rence (urban or rural), genus of the snake, part the northeastern region (7.65 cases/100,000 in- of the body bitten, and time elapsed between ac- habitants). In spite of a number of previous in- cident and medical assistance. The variables in- vestigations7,9,10, the epidemiology of snakebites vestigated in the clinical evaluations were: local in the northeastern Brazil is not yet well under- and systemic clinical manifestations, seriousness stood, especially in light of the social and envi- and evolution of the case, and serotherapy. As 1465 Ciência & Saúde Coletiva, 18(5):1463-1471, 2013 Table 1. Descriptive analyses of snakebite cases registered in the Cariri region, State of Paraíba, Brazil, from 2007 to 2010, according to quantitative demographic variables (n = 351). Year Variables 2007 2008 2009 2010 Total Seasonality per trimester 1st trimester 22 21 13 29 85 2nd trimester 27 14 32 42 115* 3rd trimester 28 18 29 14 89 4th trimester 18 19 11 14 62 Municipality Alcantil 0 0 0 0 0 Amparo 4 3 3 2 12 Assunção 0 0 0 0 0 Barra de Santana 2 6 3 2 13 Barra de São Miguel 4 1 2 0 7 Boqueirão 2 1 0 0 3 Cabaceiras 1 0 0 0 1 Camalaú 3 6 7 4 20 Caraúbas 3 5 1 1 10 Caturité 0 0 0 0 0 Congo 2 4 5 5 16 Coxixola 2 3 1 3 9 Gurjão 3 1 1 1 6 Livramento 2 0 0 0 2 Monteiro 9 10 18 30 67 Ouro Velho 0 0 3 2 5 Parari 6 3 1 1 11 Prata 0 1 2 7 10 Riacho de Santo Antônio 4 1 0 2 7 Santo André 4 5 0 0 9 São Domingos do Cariri 1 1 1 1 4 São João do Cariri 4 2 1 4 11 São João do Tigre 0 1 2 4 7 São José dos Cordeiros 7 2 4 2 15 São Sebastião do Umbuzeiro 0 1 3 3 7 Serra Branca 15 4 10 4 33 Sumé 5 9 11 15 40 Taperoá 12 2 3 3 20 Zabelê 0 0 3 3 6 Localities of Occurrence Urban 19 13 19 18 69 Rural 74 58 64 79 275 Unknown 2 1 2 2 7 Total number of cases 95 72 85 99 351 * p<0.05 significant when compared to the snakebite cases occurred in the fourth trimester (Tukey Test).
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