title: Snakebites as a largely neglected problem in the Brazilian Amazon: highlights of the epidemiological trends in the State of Amazonas.
abstract: Envenoming snakebites are thought to be a particularly important threat to public health worldwide, especially in rural areas of tropical and subtropical countries. The true magnitude of the public health threat posed by snakebites is unknown, making it difficult for public health officials to optimize prevention and treatment. The objective of this work was to conduct a systematic review of the literature to gather data on snakebite epidemiology in the Amazon region and describe a case series of snakebites from epidemiological surveillance in the State of Amazonas (1974-2012). Only 11 articles regarding snakebites were found. In the State of Amazonas, information regarding incidents involving snakes is scarce. Historical trends show an increasing number of cases after the second half of the 1980s. Snakebites predominated among adults (20-39 years old; 38%), in the male gender (78.9%) and in those living in rural areas (85.6%). The predominant snake envenomation type was bothropic. The incidence reported by the epidemiological surveillance in the State of Amazonas, reaching up to 200 cases/100,000 inhabitants in some areas, is among the highest annual snakebite incidence rates of any region in the world. The majority of the cases were reported in the rainy season with a case-fatality rate of 0.6%. Snakebite envenomation is a great disease burden in the State of Amazonas, representing a challenge for future investigations, including approaches to estimating incidence under-notification and case-fatality rates as well as the factors related to severity and disabilities.
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Esaú Samuel
authors.initials: ES
authors.lastname: Feitosa
authors.affiliation: Fundação de Vigilância em Saúde, Manaus, AM, Brazil.
authors.forename: Vanderson
authors.initials: V
authors.lastname: Sampaio
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Jaqueline
authors.initials: J
authors.lastname: Sachett
authors.affiliation: Fundação de Vigilância em Saúde, Manaus, AM, Brazil.
authors.forename: Daniel Barros de
authors.initials: DB
authors.lastname: Castro
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Maria das Dores Nogueira
authors.initials: Md
authors.lastname: Noronha
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Jorge Luis López
authors.initials: JL
authors.lastname: Lozano
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Emiro
authors.initials: E
authors.lastname: Muniz
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Luiz Carlos de Lima
authors.initials: LC
authors.lastname: Ferreira
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Marcus Vinícius Guimarães de
authors.initials: MV
authors.lastname: Lacerda
authors.affiliation: Programa de Pós-Graduação em Medicina Tropical, Escola de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
authors.forename: Wuelton Marcelo
authors.initials: WM
authors.lastname: Monteiro
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012621:Seasons; D017678:Sex Distribution; D012909:Snake Bites / Q000453:epidemiology*; D055815:Young Adult