title: Mortality due to Hymenoptera stings in Costa Rica, 1985-2006.
abstract: OBJECTIVE
  To analyze mortality due to Hymenoptera stings in Costa Rica during 1985-2006.
  
  
  METHODS
  Records of deaths due to Hymenoptera stings in 1985-2006 were retrieved from Instituto Nacional de Estadística y Censos (National Statistics and Census Institute). Mortality rates were calculated on the basis of national population reports, as of 1 July of each year. Information for each case included age, gender, and the province in which the death occurred. In addition, reports of Hymenoptera sting accidents received by the Centro Nacional de Intoxicaciones (National Poison Center, CNI) in 1995-2006 were obtained to assess exposure to these insects.
  
  
  RESULTS
  Over the 22-year period analyzed, 52 fatalities due to Hymenoptera stings were recorded. Annual mortality rates varied from 0-1.73 per 1 million inhabitants, with a mean of 0.74 (95% confidence interval: 0.46-0.93). The majority of deaths occurred in males (88.5%), representing a male to female ratio of 7.7:1. A predominance of fatalities was observed in the elderly (50 years of age and older), as well as in children less than 10 years of age. The province with the highest mortality rate was Guanacaste. The CNI documented 1,591 reports of Hymenoptera stings (mostly by bees) in 1995-2006, resulting in an annual average of 133 cases, with only a slight predominance of males over females (1.4:1).
  
  
  CONCLUSIONS
  Stings by Hymenoptera, mostly by bees, constitute a frequent occurrence in Costa Rica that can be life-threatening in a small proportion of cases, most often in males and the elderly. The annual number of fatalities fluctuated from 0-6, averaging 2.4 deaths per year. Awareness should be raised not only among the general population, but also among health care personnel that should consider this risk in the clinical management of patients stung by Hymenoptera.
authors.affiliation: Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica.
authors.forename: Mónica
authors.initials: M
authors.lastname: Prado
authors.forename: Damaris
authors.initials: D
authors.lastname: Quirós
authors.forename: Bruno
authors.initials: B
authors.lastname: Lomonte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003364:Costa Rica / Q000453:epidemiology; D005260:Female; D006801:Humans; D006927:Hymenoptera; D007223:Infant; D007299:Insect Bites and Stings / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult