title: European viper envenomation recorded by French poison control centers: A clinical assessment and management study.
abstract: BACKGROUND
  Immunotherapy is the gold standard treatment for patients bitten by European vipers in France; it significantly decreases morbidity, frequency and severity of complications and length of stay. A national prospective study was performed by all Poison Control Centers (PCC) to validate the emergency protocol for viper envenomations.
  
  
  METHODS
  This prospective study included all cases of viper bites in France, treated or not with Viperfav(®) in 2013.
  
  
  RESULTS
  In 2013, 277 cases of viper bites were collected: ratio M/F 2.1; mean aged 43 years (<15 years 25% 15-65 63% > 65 12%). The final severity was divided into 68 grades 0, 58 grades I, 62 grades IIA, 71 grades IIB and 18 grades III. One death was reported. Five patients had neurological signs. For the 114 patients who received Viperfav(®), all systemic signs disappeared in 5 h and in 24 h for biological and neurological signs. No severe anaphylactic reaction with Viperfav(®) was reported. Late Viperfav(®) administration increased the risk of functional impairment 15 days after the bite (OR = 3.21 p = 0.043). The administration of Low Molecular Weight Heparin (LMWH) increased the frequency of functional impairment to 15 days after the bite (OR = 6.38 p = 0.064), although Viperfav(®) was given in the first 18 h.
  
  
  CONCLUSIONS
  This study confirms the efficiency, safety and recommendation of an early administration of a single dose of Viperfav(®), LMWH should not be used. It also shows the extension of neurotoxic venom of vipers in France.
authors.affiliation: Poison Control Center, Angers University Hospital, France.
authors.forename: V
authors.initials: V
authors.lastname: Jollivet
authors.affiliation: Clinical Research Center, Angers University Hospital, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Hamel
authors.affiliation: Poison Control Center, Marseille University Hospital, France.
authors.forename: L
authors.initials: L
authors.lastname: de Haro
authors.affiliation: Poison Control Center, Bordeaux University Hospital, France.
authors.forename: M
authors.initials: M
authors.lastname: Labadie
authors.affiliation: Poison Control Center, Lyon University Hospital, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Sapori
authors.affiliation: Poison Control Center, Toulouse University Hospital, France.
authors.forename: L
authors.initials: L
authors.lastname: Cordier
authors.affiliation: Poison Control Center, Paris University Hospital, France.
authors.forename: A
authors.initials: A
authors.lastname: Villa
authors.affiliation: Poison Control Center, Lille University Hospital, France.
authors.forename: P
authors.initials: P
authors.lastname: Nisse
authors.affiliation: Poison Control Center, Nancy University Hospital, France.
authors.forename: E
authors.initials: E
authors.lastname: Puskarczyk
authors.affiliation: Poison Control Center, Strasbourg University Hospital, France.
authors.forename: L
authors.initials: L
authors.lastname: Berthelon
authors.affiliation: Poison Control Center, Angers University Hospital, France.
authors.forename: P
authors.initials: P
authors.lastname: Harry
authors.affiliation: Poison Control Center, Angers University Hospital, France. Electronic address: daboels@chu-angers.fr.
authors.forename: D
authors.initials: D
authors.lastname: Boels
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012909:Snake Bites / Q000453:epidemiology* / Q000628:therapy; D017819:Viperidae
chemical_list: D000997:Antivenins
keywords: Antivenom; Envenomation; European viper; Neurotoxicity; Viperfav(®)