title: Occupational Snake Bites: a Prospective Case Series of Patients Reported to the ToxIC North American Snakebite Registry.
abstract: In the developing world, occupation has been identified as a risk factor for snake bite. Such an association has not been described in the USA. The objective of this study was to describe the epidemiology and clinical manifestations of occupational snake bite in patients reported to the ToxIC North American Snakebite Registry (NASBR).
  
  
  
  This was a prospective case series of patients reported to the ToxIC NASBR between January 1, 2014 and November 5, 2015. Variables collected included snake species, patient demographics, date and location of exposure, occupation, bite location, clinical manifestations, and management.
  
  
  
  Of 180 adult snake bites reported, 25 (13.9 %; 95 % CI 9.2-19.8 %) were occupational in nature. Rattlesnake envenomations were common (80 %). Most snake bites (96 %) occurred in men. Occupations most associated with snake bite were landscaping (28 %) and working directly with snakes (24 %). Fifty-six percent of bites occurred in an outdoor work environment. Seventy-six percent of envenomations were to the upper extremities. Intentional interaction occurred in 40 % of cases, all of which sustained finger envenomations. No cases presented with apparent acute ethanol intoxication.
  
  
  
  The majority of occupational snake bites occurred in men working outdoors and were unintentional injuries. Bites involving the upper extremity tended to result from intentional interactions. Acute ethanol intoxication did not appear to be involved with occupational envenomations.
authors.affiliation: Department of Medical Toxicology, Banner-University Medical Center Phoenix, 925 E. McDowell Road, 2nd Floor, Phoenix, AZ, 85006, USA. mspyres@gmail.com.
authors.forename: Meghan B
authors.initials: MB
authors.lastname: Spyres
authors.affiliation: Department of Medical Toxicology, Banner-University Medical Center Phoenix, 925 E. McDowell Road, 2nd Floor, Phoenix, AZ, 85006, USA.
authors.forename: Anne-Michelle
authors.initials: AM
authors.lastname: Ruha
authors.affiliation: New Mexico Poison Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Seifert
authors.affiliation: North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Onisko
authors.affiliation: Department of Medical Toxicology, Banner-University Medical Center Phoenix, 925 E. McDowell Road, 2nd Floor, Phoenix, AZ, 85006, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Padilla-Jones
authors.affiliation: North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA.
authors.forename: Eric Anthony
authors.initials: EA
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017836:Agkistrodon; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D017839:Crotalus; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012909:Snake Bites / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D034941:Upper Extremity / Q000293:injuries
chemical_list: D000997:Antivenins
keywords: Envenomation; Occupation; Risk factor; Snake bite