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OVERVIEW OF SNAKEBITE IN BRAZIL: POSSIBLE DRIVERS AND A TOOL FOR RISK MAPPING
Author
Affilliation
Department of International Health, School of Nursing and Health Studies, Georgetown University. Washington, DC, USA / Universidade Federal do Rio de Janeiro. Instituto de Estudos de Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Institute of Health and Environment, Graduate School of Public Health, Seoul National University. Seoul, South Korea.
Department of Health Emergencies, Pan American Health Organization. Washington, DC, USA.
Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Brasilia, DF, Brasil.
Departamento Estadual de Saúde do Rio Grande do Sul. Divisão de Vigilância Epidemiológica. Porto Alegre, RS, Brasil.
Departamento Estadual de Saúde do Rio Grande do Sul. Divisão de Vigilância Epidemiológica. Porto Alegre, RS, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Estudos de Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Department of International Health, School of Nursing and Health Studies, Georgetown University. Washington, DC, USA .
Department of International Health, School of Nursing and Health Studies, Georgetown University. Washington, DC, USA
Ministério da Saúde do Brasil. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Ministério da Saúde do Brasil. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Institute of Health and Environment, Graduate School of Public Health, Seoul National University. Seoul, South Korea.
Department of Health Emergencies, Pan American Health Organization. Washington, DC, USA.
Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Imunização e Doenças Transmissíveis. Brasilia, DF, Brasil.
Departamento Estadual de Saúde do Rio Grande do Sul. Divisão de Vigilância Epidemiológica. Porto Alegre, RS, Brasil.
Departamento Estadual de Saúde do Rio Grande do Sul. Divisão de Vigilância Epidemiológica. Porto Alegre, RS, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Estudos de Saúde Coletiva. Rio de Janeiro, RJ, Brasil.
Department of International Health, School of Nursing and Health Studies, Georgetown University. Washington, DC, USA .
Department of International Health, School of Nursing and Health Studies, Georgetown University. Washington, DC, USA
Ministério da Saúde do Brasil. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Ministério da Saúde do Brasil. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Abstract
Snakebite envenoming affects close to 2.7 million people globally every year. In Brazil,
snakebites are reported to the Ministry of Health surveillance system and cases receive antivenom
free of charge. There is an urgent need to identify higher risk areas for antivenom distribution,
and to develop prevention activities. The objective of this study is to provide an
overview of the epidemiological situation of snakebite envenoming in Brazil and explore possible
drivers; as well as to create a flowchart tool to support decision-makers identify higher
risk areas. An ecological-type study was carried out using data by municipality (2013–2017).
Study parts: 1) Create a geocoded database and perform a descriptive and cluster analysis;
2) Statistical analysis to measure the association of snakebite and possible environmental
and socioeconomic drivers; 3) Develop a flowchart to support decision-makers and the application
of this tool in one state (Rio Grande do Sul) as an example. An average of 27,120
snakebite cases per year were reported at the country level. Clusters of municipalities with
high numbers of snakebites are mostly found in the Amazon Legal Region. The negative
binomial regression model showed association with the snakebite case count: the type of
major habitat, tropical or non-tropical; temperature; percentage of urbanization; precipitation;
elevation; GDP per capita; a weaker relation with forest loss; and with venomous snake richness.
The state where the instrument was applied reported 4,227 snakebites in the period.
Most municipalities were considered as medium risk and 56/496 as high risk according to the
tool created. Snakebite cases are distributed across the entire country with the highest concentration
in the Legal Amazon Region. This creates a complex situation both for better
understanding of the association of environmental and socioeconomic factors with snakebites
and for the distribution and maintenance of antivenom to remote areas. Research into
types of antivenom with a longer shelf life without the need for refrigeration is needed.
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