Brazilian Snake 2001

Brazilian Snake 2001

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Snake bite incidents are on rise in Brazil. The present study updates the current state of knowledge about snake poisoning in Brazil, following a descriptive and retrospective method. The study is based on the information on 329,180 cases registered at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de Informação de Agravos de Notificação - SINAN), for a period of 12 years starting from 2001 to 2012. The variables selected were spatial (Brazilian state) and temporal (month and year). Factors like poisoning due to genus of snake, time elapsed between the poisoning and the first emergency treatment, the age and the sex of the victim, seriousness and evolution of the poisoning etc are crucial elements that play a role in the recovery process. Poisoning incidents based on the relative risks (RR) in terms of age group for all geographic regions of the country were calculated using the Northern region as an index. The study observed an annual increase in the number of cases with seasonal variations. It exhibited a sizeable difference between the minimum and maximum monthly rates of incidents throughout the study period. As per the study, the highest number of cases occurred in the state of Pará with the greatest number of cases (5,317).The state of Tocantins witnessed the highest incidence (79.4/100,000 inhabitants) and the percentage of affected children and adolescents between 10 and 19 years of age are high in the North region (23.2%; CI95%=22.9-23.4%). Seasonal, regional and local factors must be taken into account when training the teams responsible for treating victims and in the planning of the production and distribution of stocks of antivenom serum.
Frequency of snakebites in Brazilian regions from 2001 to 2012.Data source: BRASIL/MS/SVS/SINAN [8]. Note: Snakebites for which the state of occurrence is unknown or unregistered were excluded.
Snakebites in Brazil in 2010: geographic distribution and box-plot of incidence rate (Figure 2a) and frequency of occurrence (Figure 2b).Data source: BRASIL/MS/SVS/SINAN [8] and IBGE/ Census 2010 [12]. Digital Map: Geoprocessing/ICICT/FIOCRUZ
All figure content in this area was uploaded by Claudio Machado
Content may be subject to copyright.
Content uploaded by Claudio Machado
Content may be subject to copyright.
A Profile of Snake Bites in Brazil, 2001 to 2012
Sistema Nacional de Informações Tóxico-Farmacológicas – SINITOX, Laboratório de Informação Científica e Tecnológica em Saúde, Instituto de Comunicação e
Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Brasil
Departamento de Ciências Sociais, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Brasil
Divisão de Herpetologia, Instituto Vital Brazil, Brasil
Corresponding author : Rosany Bochner, Sistema Nacional de Informações Tóxico-Farmacológicas –SINITOX, Laboratório de Informação Científica e Tecnológica em
Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, RJ, Brasil, Tel: + 55 (21) 3865-3247; E-
mail:rosany.bochner@icict.fiocruz.br
Received date: Mar 21, 2014; Accepted date: Apr 28; 2014 Published date: Apr 30, 2014
Copyright: © 2014, Bochner R et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Snake bite incidents are on rise in Brazil. The present study updates the current state of knowledge about snake
poisoning in Brazil, following a descriptive and retrospective method. The study is based on the information on
329,180 cases registered at the Brazilian Information System on Diseases of Compulsory Declaration (Sistema de
Informação de Agravos de Notificação - SINAN), for a period of 12 years starting from 2001 to 2012.
The variables selected were spatial (Brazilian state) and temporal (month and year). Factors like poisoning due to
genus of snake, time elapsed between the poisoning and the first emergency treatment, the age and the sex of the
victim, seriousness and evolution of the poisoning etc are crucial elements that play a role in the recovery process.
Poisoning incidents based on the relative risks (RR) in terms of age group for all geographic regions of the country
were calculated using the Northern region as an index. The study observed an annual increase in the number of
cases with seasonal variations. It exhibited a sizeable difference between the minimum and maximum monthly rates
of incidents throughout the study period. As per the study, the highest number of cases occurred in the state of Pará
with the greatest number of cases (5,317).The state of Tocantins witnessed the highest incidence (79.4/100,000
inhabitants) and the percentage of affected children and adolescents between 10 and 19 years of age are high in
=22.9-23.4%). Seasonal, regional and local factors must be taken into account when
training the teams responsible for treating victims and in the planning of the production and distribution of stocks of
Keywords: Snake; Poisoning; Information systems; Epidemiology;
Snakebites are amongst the neglected health issues in the world [1].
Gutierrez et al. estimated an annual occurrence of 2.5 million bites, of
which 250,000 victims are left with complications and 85,000 died in
According to the Ministry of Health, an average of 26,000 cases is
reported annually in Brazil [3]. When the snake is identified, the genus
, wide spread throughout all regions of Brazil, is responsible
for 90% of the poisoning. The genus
areas of fields, savannah and semi-arid scrub forest is responsible for
are responsible for the remaining 3% of cases registered in Brazil [4,5].
Brazilian medical aid for snakebite victims is available only at public
health clinics or other clinics affiliated with the National Health
System (SUS). These are the only establishments which stock
antivenom and they are widespread throughout the country with the
aim of making the antivenom available to the patients within few
hours of snake bite. This serves as the best model for the countries in
African that frequently affected with an increasing number of snake
bites [6]. Health clinics are also responsible for reporting incidents of
snakebite to the Ministry of Health’s Information System on Diseases
Compulsory Declaration (Sistema de Informação de Agravos de
Notificação - SINAN) [7]. The data are collected using two types of
records: the Individual Declaration Record (Ficha Individual de
Notificação - FIN), used for all health issues, which contains basic
information of the patient, and the Individual Investigation Record
(Ficha Individual de Investigação - FII) with specific reporting of
incidents involving poisonous animal bites. Starting from the year
2006, SINAN began to offer online access to the data of all cases
The continental dimensions of Brazil and its constantly changing
demographics, socio-economic and environmental diversity pose great
challenges to the effective monitoring of snakebite poisoning in the
country. It is difficult therefore to project a nationwide picture [5, 9].
In addition, non-Brazilian researchers that are new to this diversity
and complexity may often produce biased estimates by treating Brazil
as a single, homogenous territory. They by and large confine to the
data collected from few states or municipalities and attribute the
The objective of this work therefore is to update the profile of snake
poisoning in Brazil in general, with a special focus on its geographical
regions during the first twelve years of the 21st century.
Bochner et al., J Clin Toxicol 2014, 4:3
http://dx.doi.org/10.4172/2161-0495.1000194
ISSN:2161-0495 JCT, an open access journal
The study was conducted following descriptive and retrospective
analysis of the online data base available at SINAN of the Brazilian
health services on snakebite incidents in the country. The data was
based on the snakebite incidents registered at the Brazilian health
services between 2001 and 2012 [8].
The Individual Declaration Record used by SINAN up to 2006
contained 54 variables, of which 16 are available on the Internet. The
revised record since 2007 allows 64 variables, with 21 available on-line
Of the various variables mentioned in the data base, only few
variables like Type of Case or Type of Animal, spatial (Brazilian state)
and temporal (month and year) distribution of the poisonings, genus
of snake, time elapsed between the poisoning and first emergency
treatment, and age and sex of the victim, as well the seriousness and
evolution of the poisoning alone are considered for this study.
Keeping the unique and the distinct nature of the Brazilian
geographic conditions, the study has decided to consider the
geographic location where the incident took place. This was especially
meant to reflect the socio, economic, and the environmental realities
of the site where the snake bite incident took place.
Several changes to the variables listed in the database took place in
the year 2007. The variable ‘Evolution of the case’ was altered and the
category ‘Death’ was classified as ‘Death due to snake bite´ and ‘Death
due to other reasons’. The category ‘Healing with sequel’ was removed.
The Individual Investigation Record (FII) does not allow the
researchers to distinguishing between the genera
The Year 2010 is considered as index as the last national census
took place in that year [12] for the calculation of the snakebite
incidents in the Brazilian state. The distribution of these incidents was
analyzed using a box-plot graphic [13]. In addition to this, state wise
maps marking the distribution of incidents and cases by state for the
year 2010 were created. The Northern region was considered as the
reference standard for determining the relative risks (CI
occurrence of snakebites by age group for all regions.
Between 2001 and 2012, 329,180 cases of snakebite were reported in
Brazil. The average snakebite incidents for the past twelve years were
around 27,000, indicating an average annual increase of 4.1% per year.
More than 30,000 cases had been registered for treatment during the
year2009, 2010 and 2011. The 2012 data are subject to revision.
The data reveals the number of snakebite incidents over the years. It
can be seen that there occurred an increase in the number of cases
reported in all regions of Brazil (Figure 1).
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
4091 5526 7023 7545 8601 8513 8058 7860 9247 9424 9273 9049
4651 6367 6572 6206 6752 6961 6875 6792 8456 8486 8283 7034
5969 6775 7532 8237 7544 7715 6686 6789 6381 6585 7526 7339
2172 2638 2822 2755 2677 2875 3062 2750 2972 2778 2659 2459
1783 2284 2714 2679 2858 2710 2349 2735 2998 3225 3336 3182
North Northeast Southeast South Center-West
Figure 1: Frequency of snakebites in Brazilian regions from 2001 to 2012.Data source: BRASIL/MS/SVS/SINAN [8]. Note: Snakebites for
which the state of occurrence is unknown or unregistered were excluded.
Citation: Bochner R, Fiszon JT, and Machado C (2014) A Profile of Snake Bites in Brazil, 2001 to 2012. J Clin Toxicol 4: 194. doi:
ISSN:2161-0495 JCT, an open access journal
When we look at the region wise snakebite incidents, the Northern
region (7.5%) lead the number of cases registered followed by the
Center-West (5.4%), Northeast (3.8%) and Southeast (1.9%) regions.
The South region showed the lowest average annual of increase, 1.1%
The highest number of incidents were observed during 2010 in the
North, (59.4/100,000 inhabitants), followed by the Center-West,
(22.9/100,000 inhabitants), and the Northeast, (16.0/100,000
inhabitants). In the South and Southeast regions the incidence rates
remained below the national average (16.0/100,000 inhabitants), at
10.1/100,000 inhabitants and 8.2/100,000 inhabitants, respectively.
Figure 2 presents the geographic distribution of cases within the
Brazilian state. Incidences (Figure 2a) and cases (Figure 2b), referring
to snakebites which took place in 2010. It also contains the box-plot
graphics to support the manual construction of the class intervals used
to color the map. This application of box-plot deserves attention, as it
aggregates information relevant to the map.
Figure 2: Snakebites in Brazil in 2010: geographic distribution and
box-plot of incidence rate (Figure 2a) and frequency of occurrence
(Figure 2b).Data source: BRASIL/MS/SVS/SINAN [8] and IBGE/
Census 2010 [12]. Digital Map: Geoprocessing/ICICT/FIOCRUZ
Figure 2a shows that the state of Tocantins leads all other states
with 79.4 cases per 100,000 inhabitants, exceeding national average
(78.0) shown in the box-plot graphic. The lowest number of cases is
registered at Federal District (3.5) and in Rio de Janeiro (3.7). The state
with the highest number of cases in 2010 was Pará (5,317), while
Tocantins, the state with the highest incidence rate, reported 1,099
Of all the snakebite incidents recorded in Brazil between 2001 and
2012, Bothropic bites were predominant in all the regions and were
responsible for 70.5% cases followed by
0.6%. The genus of the snake was unknown or not
recorded in 15.3% of the cases and no traces of poisoning was found in
3.3% incidents. Other genera that were responsible for snakebites
mentioned in national snakebite statistics varies widely from region to
Except in the Northern region, where
cause of snakebite in all other regions, while
were responsible for less than 1.5% of cases. The proportion of
incidents in which the genus of the snake was unknown dropped in
the whole country from 19.3% in 2001 to 12.1% in 2012.
The month wise incidents of snakebites during 2001-2012
demonstrated seasonal variations in all regions (Figure 3). With the
exception of the Southeast and South that witnessed growth in the
frequency, substantial fluctuations were noted related to the number of
incidents between the months of greatest and least frequency of cases.
The highest number of bite was marked repeatedly during certain
months over the years in the Southeast in 2004. While 1,023 incidents
occurred in January and almost one third of this number, 344 cases
took place in August. The smallest fluctuation took place in the
Center-West in 2002, with a maximum of 263 incidents in February
and 115 in June. Seasonal variations occurred simultaneously with the
growth in the frequency of incidents.
Monthly frequency of snakebites, distributed by Brazilian
region, in the period from 2001 to 2012.Data source:
BRASIL/MS/SVS/SINAN [8]. Note: The monthly for 2007 and
Table 1 shows that 63% of Brazilian snakebite victims were in the
age group of 20-59 years. The sum percentages of the children and
adolescents between 10 and 19 in the North region (23.2%; CI
=22.9-23.4%) is statistically higher than those observed in other
regions, as its confidence interval does not intersect with the others:
=16.7-17.5%). In 2010, the relative risk (RR) for the
occurrence of snakebite between 10 and 19 years was varied over the
country’s five regions. The North demonstrated a RR of 3.08 (CI
2.79-3.39) compared to the Center-West; 3.80 (CI
compared to the Northeast; 6.58 (CI
:8.19-9.56) compared to the Southeast. In the
Bochner R, Fiszon JT, and Machado C (2014) A Profile of Snake Bites in Brazil, 2001 to 2012. J Clin Toxicol 4: 194. doi:
ISSN:2161-0495 JCT, an open access journal
country as a whole, 53% of victims received medical attention within
three hours of the incident, with the exception of the North, at 42%.
This statistic remains the same, even when cases are stratified by
Region North Northeast Southeast South Center-West
<1 957 1.0 883 1.1 843 1.0 231 0.7 258 0.8
1-4 1,817 1.9 1,817 2.2 1,521 1.8
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