title: Snakebites notified to the poison control center of Morocco between 2009 and 2013.
abstract: BACKGROUND
  Snakebites cause considerable death and injury throughout the globe, particularly in tropical regions, and pose an important yet neglected threat to public health. In 2008, the Centre Anti Poison et de Parmacovigilance du Maroc (CAPM) started to set up a specific strategy for the control of snakebites that was formalized in 2012. The aim of the present study is to describe and update the epidemiological characteristics of snakebites notified to CAPM between 2009 and 2013.
  
  
  METHODS
  This retrospective five-year study included all cases of snakebites notified to CAPM by mail or phone.
  
  
  RESULTS
  During the study period, 873 snakebite cases were reported to CAPM, an average incidence of 2.65 cases per 100,000 inhabitants with 218 cases each year. The highest incidence was found in Tangier-Tetouan region with 357 cases (40.9 %) followed by Souss Massa Draa region with 128 cases (14.6 %). The average age of patients was 26.8 ± 17.2 years. The male to female sex ratio was 1.67:1 and 77 % of cases occurred in rural areas. The bites occurred mainly in spring (44 %) followed by summer (42 %). Snake species was identified in 54 cases (6.2 %): colubrids represented 31 % (n = 18) and vipers 67 % (n = 36), mainly Daboia mauritanica, Bitis arietans and Cerastes cerastes. In 311 cases (35.6 %), the patients showed viper syndrome. Thrombocytopenia was observed in 23.5 % of viper syndrome cases, whereas, compartment syndrome was observed in 7.6 % patients. FAV-Afrique® was administered in 41 patients (5 %). In patients treated with antivenom, 38 patients recovered and three died. Twenty-seven deaths were reported (3.9 %).
  
  
  CONCLUSIONS
  Despite specific efforts to better understand the epidemiology of snakebites in Morocco (incidence, severity, snake species involved), it remains underestimated. Therefore, further work is still necessary to ensure accessibility of appropriate antivenom against venomous species and to improve the management of envenomation in Morocco.
authors.affiliation: Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc ; Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc.
authors.forename: Fouad
authors.initials: F
authors.lastname: Chafiq
authors.affiliation: Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc.
authors.forename: Faiçal
authors.initials: F
authors.lastname: El Hattimy
authors.affiliation: Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc ; Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc.
authors.forename: Naima
authors.initials: N
authors.lastname: Rhalem
authors.affiliation: UMR 216, Mère et enfant face aux infections tropicales, Institut de Recherche pour le Développement, Cotonou, Bénin, and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Chippaux
authors.affiliation: Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc.
authors.forename: Abdelmajid
authors.initials: A
authors.lastname: Soulaymani
authors.affiliation: Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc.
authors.forename: Abdelrhani
authors.initials: A
authors.lastname: Mokhtari
authors.affiliation: Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc ; Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc.
authors.forename: Rachida
authors.initials: R
authors.lastname: Soulaymani-Bencheikh
keywords: Envenomation; Epidemiology; Morocco; Snakebite; Viper