Vulnerability to snakebite envenoming: a global mapping of hotspots
Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health ca...
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| Veröffentlicht in: | The Lancet (British edition) 2018-08, Vol.392 (10148), p.673-684 |
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| creator | Longbottom, Joshua Shearer, Freya M Devine, Maria Alcoba, Gabriel Chappuis, Francois Weiss, Daniel J Ray, Sarah E Ray, Nicolas Warrell, David A Ruiz de Castañeda, Rafael Williams, David J Hay, Simon I Pigott, David M |
| description | Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed.
We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but |
| doi_str_mv | 10.1016/S0140-6736(18)31224-8 |
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We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality.
We provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia.
Identifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease.
Bill & Melinda Gates Foundation.</description><identifier>ISSN: 0140-6736</identifier><identifier>ISSN: 1474-547X</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(18)31224-8</identifier><identifier>PMID: 30017551</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Africa, Northern - epidemiology ; Analysis ; Animals ; Antivenins - therapeutic use ; Antivenom ; At risk populations ; Biological products ; Bites and stings ; Charities ; Data collection ; Disease ; Ecological effects ; Environmental risk ; Geographic Mapping ; Health care ; Health Resources - economics ; Health Resources - statistics & numerical data ; Health Services Accessibility - standards ; Humans ; Indonesia - epidemiology ; Medical care ; Morbidity ; Mortality ; Neglected Diseases - drug therapy ; Neglected Diseases - epidemiology ; Neglected Diseases - prevention & control ; New records ; Populations ; Provisioning ; Public health ; Public Health - education ; Quality management ; Quality of Health Care - standards ; Snake bites ; Snake Bites - drug therapy ; Snake Bites - epidemiology ; Snake Bites - mortality ; Snake Bites - prevention & control ; Snakes ; Snakes - classification ; Snakes - injuries ; Species ; Tropical diseases ; United Kingdom ; Venom ; Venomous snakes ; Vulnerable Populations - statistics & numerical data ; Websites</subject><ispartof>The Lancet (British edition), 2018-08, Vol.392 (10148), p.673-684</ispartof><rights>2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license</rights><rights>Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2018. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. This work is published under https://creativecommons.org/licenses/by/3.0/ (theLicense”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-b5af933dc04eca0bf5eacde20cce43bc408948193c8afe37ff7c610738f0f133</citedby><cites>FETCH-LOGICAL-c526t-b5af933dc04eca0bf5eacde20cce43bc408948193c8afe37ff7c610738f0f133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673618312248$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30017551$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Longbottom, Joshua</creatorcontrib><creatorcontrib>Shearer, Freya M</creatorcontrib><creatorcontrib>Devine, Maria</creatorcontrib><creatorcontrib>Alcoba, Gabriel</creatorcontrib><creatorcontrib>Chappuis, Francois</creatorcontrib><creatorcontrib>Weiss, Daniel J</creatorcontrib><creatorcontrib>Ray, Sarah E</creatorcontrib><creatorcontrib>Ray, Nicolas</creatorcontrib><creatorcontrib>Warrell, David A</creatorcontrib><creatorcontrib>Ruiz de Castañeda, Rafael</creatorcontrib><creatorcontrib>Williams, David J</creatorcontrib><creatorcontrib>Hay, Simon I</creatorcontrib><creatorcontrib>Pigott, David M</creatorcontrib><title>Vulnerability to snakebite envenoming: a global mapping of hotspots</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed.
We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality.
We provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia.
Identifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease.
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hotspots</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2018-08-25</date><risdate>2018</risdate><volume>392</volume><issue>10148</issue><spage>673</spage><epage>684</epage><pages>673-684</pages><issn>0140-6736</issn><issn>1474-547X</issn><eissn>1474-547X</eissn><abstract>Snakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed.
We assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality.
We provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia.
Identifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease.
Bill & Melinda Gates Foundation.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>30017551</pmid><doi>10.1016/S0140-6736(18)31224-8</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2018-08, Vol.392 (10148), p.673-684 |
| issn | 0140-6736 1474-547X 1474-547X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6115328 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Africa, Northern - epidemiology Analysis Animals Antivenins - therapeutic use Antivenom At risk populations Biological products Bites and stings Charities Data collection Disease Ecological effects Environmental risk Geographic Mapping Health care Health Resources - economics Health Resources - statistics & numerical data Health Services Accessibility - standards Humans Indonesia - epidemiology Medical care Morbidity Mortality Neglected Diseases - drug therapy Neglected Diseases - epidemiology Neglected Diseases - prevention & control New records Populations Provisioning Public health Public Health - education Quality management Quality of Health Care - standards Snake bites Snake Bites - drug therapy Snake Bites - epidemiology Snake Bites - mortality Snake Bites - prevention & control Snakes Snakes - classification Snakes - injuries Species Tropical diseases United Kingdom Venom Venomous snakes Vulnerable Populations - statistics & numerical data Websites |
| title | Vulnerability to snakebite envenoming: a global mapping of hotspots |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T10%3A45%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Vulnerability%20to%20snakebite%20envenoming:%20a%20global%20mapping%20of%20hotspots&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Longbottom,%20Joshua&rft.date=2018-08-25&rft.volume=392&rft.issue=10148&rft.spage=673&rft.epage=684&rft.pages=673-684&rft.issn=0140-6736&rft.eissn=1474-547X&rft_id=info:doi/10.1016/S0140-6736(18)31224-8&rft_dat=%3Cgale_pubme%3EA551627606%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2092478522&rft_id=info:pmid/30017551&rft_galeid=A551627606&rft_els_id=S0140673618312248&rfr_iscdi=true |