The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.
The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths.
复制标题
DOI：
10.1371/journal.pmed.0050218
复制
发表时间：
2008-11-04
期刊：
影响因子：
15.8
通讯作者：
de Silva HJ
中科院分区：
文献类型：
--
作者：
Kasturiratne A;Wickremasinghe AR;de Silva N;Gunawardena NK;Pathmeswaran A;Premaratna R;Savioli L;Lalloo DG;de Silva HJ
蛇咬伤导致的中毒在许多热带和亚热带国家是一个重要的公共卫生问题。很少有人尝试对其负担进行量化，而且近期的估计都因缺乏客观且可重复的方法而存在缺陷。为了对这一全球问题的规模提供准确、最新的估计，我们开发了一种新方法来估计蛇咬伤所致的疾病负担。
全球估计数是基于区域估计数得出的，而区域估计数又是从特定区域内各国的现有数据推导而来。我们使用了三种主要策略来获取原始数据：电子搜索有关蛇咬伤的出版物，从联合国各组织维护的数据库中提取相关的特定国家死亡率数据，以及通过与关键信息提供者讨论来确定灰色文献。各国被分为21个不同的地理区域，这些区域在流行病学上尽可能同质，符合2005年全球疾病负担研究（世界银行的全球疾病负担项目）。中毒发生率从出版物中提取，并用于估计各个国家的中毒人数；如果某个特定国家没有数据，则使用邻国的最低发生率。在死亡登记数据可靠的地方，使用报告的蛇咬伤死亡人数；在其他国家，根据观察到的死亡率和高危人群来估计死亡人数。我们估计，全球每年至少有421,000例蛇咬伤中毒和20,000例死亡。这些数字可能高达1,841,000例中毒和94,000例死亡。基于大约每四次蛇咬伤就有一次导致中毒这一事实，每年可能发生120万到550万次蛇咬伤。
蛇咬伤在全球范围内导致相当高的发病率和死亡率。南亚、东南亚和撒哈拉以南非洲的负担最重。
贾纳卡·德席尔瓦及其同事估计，全球每年至少有421,000例蛇咬伤中毒和20,000例死亡。
世界上现存的大约3000种蛇中，约有600种是有毒的。毒蛇——除南极洲外各大洲都有——通过它们的毒牙（特殊的空心牙齿）将含有毒素的改良唾液（毒液）注入猎物组织来使猎物动弹不得。蛇也用它们的毒液进行自我防御，会咬威胁、惊吓或激怒它们的人。蝰蛇科（例如蝮蛇）和眼镜蛇科（例如金环蛇和眼镜蛇）的蛇咬伤对人特别危险。被这些蛇“中毒”（注入毒液）的潜在致命影响包括广泛出血、肌肉麻痹和咬伤部位周围的组织破坏（坏死）。被这些蛇咬伤也可能导致永久性残疾。例如，蛇咬伤受害者往往是年轻男性，可能因坏死而不得不截肢。任何蛇咬伤的最佳治疗方法是尽快将受害者送往医院，在那里可以给予抗蛇毒血清（中和毒液的抗体混合物）。
虽然蛇咬伤在世界各地都有发生，但中毒的蛇咬伤被认为对公共卫生构成了一种特别重要但在很大程度上被忽视的威胁。在热带和亚热带国家的农村地区尤其如此，那里蛇咬伤很常见，但获得医疗保健和抗蛇毒血清的机会有限。这些国家（以及世界其他地方）蛇咬伤对公共卫生构成的威胁的真实程度尚不清楚，这使得公共卫生官员很难在各自国家优化蛇咬伤的预防和治疗。因此，在这项研究中，研究人员开发并应用了一种新方法来估计蛇咬伤的全球负担。
研究人员系统地搜索了科学文献中有关蛇咬伤和蛇咬伤死亡的出版物，并从世界卫生组织（WHO）死亡率数据库中提取了各个国家蛇咬伤死亡的数据。他们还联系了各国卫生部、国家中毒中心和蛇咬伤专家，以获取有关蛇咬伤的未发表信息（“灰色”文献）。这三种方法共同提供了135个国家蛇咬伤中毒人数和162个国家蛇咬伤死亡人数的数据。然后，研究人员将世界上的227个国家分为21个地理区域，每个区域包含具有相似人口特征的国家，并利用每个区域内各个国家的研究结果来估计每个区域的蛇咬伤中毒人数和死亡人数。最后，他们将这些估计数相加，以获得蛇咬伤全球负担的估计值。使用这种方法，研究人员估计，全球每年至少有421,000例蛇咬伤中毒和20,000例蛇咬伤死亡；他们认为，实际数字可能高达180万例中毒和94,000例死亡。他们的估计还表明，蛇咬伤中毒和死亡的最高负担出现在南亚和东南亚以及撒哈拉以南非洲，印度是每年中毒人数（81,000）和死亡人数（近11,000）最高的国家。
这些发现表明，蛇咬伤在全球范围内导致了相当多的疾病和死亡。由于研究人员使用了谨慎的方法，他们对蛇咬伤中毒和死亡的全球估计可能比以前的估计更准确。然而，由于研究人员在计算中不得不做出许多假设，而且关于热带农村地区蛇咬伤和死亡人数的可靠数据很少，这些事件的真实区域和全球数量可能与这里给出的估计有很大差异。特别是，撒哈拉以南非洲东部地区的区域估计可能不准确，因为它们是基于一项单一研究得出的，该地区蛇咬伤非常常见，而且抗蛇毒血清特别难以获得。因此，研究人员呼吁进行更多关于蛇咬伤中毒和死亡的研究，以提供有效处理这一被忽视的公共卫生问题所需的信息。
请通过本摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0050218
奇波在《公共科学图书馆·医学》的一篇观点文章中进一步讨论了这项研究
MedlinePlus医学百科全书有一个关于蛇咬伤的页面（有英语和西班牙语版本）
英国国家医疗服务体系直接健康百科全书有关于蛇咬伤各个方面的详细信息
维基百科有关于毒蛇和蛇咬伤的页面（注意：维基百科是一个任何人都可以编辑的免费在线百科全书；有多种语言版本）
世界卫生组织提供关于抗蛇毒血清以及在发展中国家增加抗蛇毒血清获取途径的努力的信息（有多种语言版本）
《公共科学图书馆·医学》之前的一篇文章也讨论了被忽视的蛇咬伤中毒问题：古铁雷斯JM，西克斯顿RDG，沃雷尔DA（2006）应对被忽视的蛇咬伤中毒问题：全球伙伴关系的必要性。《公共科学图书馆·医学》3(6): e150
Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burden due to snakebites. The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant country-specific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the Global Burden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deaths were estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact that envenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually. Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa. Janaka de Silva and colleagues estimate that globally at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. Of the 3,000 or so snake species that exist in the world, about 600 are venomous. Venomous snakes—which exist on every continent except Antarctica—immobilize their prey by injecting modified saliva (venom) that contains toxins into their prey's tissues through their fangs—specialized, hollow teeth. Snakes also use their venoms for self defense and will bite people who threaten, startle or provoke them. Snakebites caused by the families Viperidae (for example, pit vipers) and Elapidae (for example, kraits and cobras) are particularly dangerous to people. The potentially fatal effects of being “envenomed” (having venom injected) by these snakes include widespread bleeding, muscle paralysis, and tissue destruction (necrosis) around the bite site. Bites from these snakes can also cause permanent disability. For example, snakebite victims, who tend to be young and male, may have to have a limb amputated because of necrosis. The best treatment for any snakebite is to get the victim to a hospital as soon as possible where antivenoms (mixtures of antibodies that neutralize venoms) can be given. Although snakebites occur throughout the world, envenoming snakebites are thought to pose a particularly important yet largely neglected threat to public health. This is especially true in rural areas of tropical and subtropical countries where snakebites are common but where there is limited access to health care and to antivenoms. The true magnitude of the public-health threat posed by snakebites in these countries (and elsewhere in the world) is unknown, which makes it hard for public-health officials to optimize the prevention and treatment of snakebites in their respective countries. In this study, therefore, the researchers develop and apply a new method to estimate the global burden of snakebite. The researchers systematically searched the scientific literature for publications on snakebites and deaths from snakebites and extracted data on snakebite deaths in individual countries from the World Health Organization (WHO) mortality database. They also contacted Ministries of Health, National Poison Centers, and snakebite experts for unpublished information (“grey” literature) on snakebites. Together, these three approaches provided data on the number of snakebite envenomings and deaths for 135 and 162 countries, respectively. The researchers then grouped the 227 countries of the world into 21 geographical regions, each of which contained countries with similar population characteristics, and used the results of studies done in individual countries within each region to estimate the numbers of snakebite envenomings and deaths for each region. Finally, they added up these estimates to obtain an estimate of the global burden of snakebite. Using this method, the researchers estimate that, worldwide, at least 421,000 envenomings and 20,000 deaths from snakebite occur every year; the actual numbers, they suggest, could be as high as 1.8 million envenomings and 94,000 deaths. Their estimates also indicate that the highest burden of snakebite envenomings and death occurs in South and Southeast Asia and in sub-Saharan Africa, and that India is the country with the highest annual number of envenomings (81,000) and deaths (nearly 11,000). These findings indicate that snakebites cause considerable illness and death around the world. Because of the careful methods used by the researchers, their global estimates of snakebite envenomings and deaths are probably more accurate than previous estimates. However, because the researchers had to make many assumptions in their calculations and because there are so few reliable data on the numbers of snakebites and deaths from the rural tropics, the true regional and global numbers of these events may differ substantially from the estimates presented here. In particular, the regional estimates for eastern sub-Saharan Africa, a region where snakebites are very common and where antivenoms are particularly hard to obtain, are likely to be inaccurate because they are based on a single study. The researchers, therefore, call for more studies on snakebite envenoming and deaths to be done to provide the information needed to deal effectively with this neglected public-health problem. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050218. This study is further discussed in a PLoS Medicine Perspective by Chippaux The MedlinePlus Medical Encyclopedia has a page on snakebites (in English and Spanish) The UK National Health Service Direct health encyclopedia has detailed information about all aspects of snakebites Wikipedia has pages on venomous snakes and on snakebites (note: Wikipedia is a free online encyclopedia that anyone can edit; available in several languages) The World Health Organization provides information about antivenoms and about efforts to increase access to antivenoms in developing countries (available in several languages) A previous article in PLoS Medicine also discusses the neglected problem of snakebite envenoming: Gutiérrez JM, Theakston RDG, Warrell DA (2006) Confronting the Neglected Problem of Snake Bite Envenoming: The Need for a Global Partnership. PLoS Med 3(6): e150
登录
查看更多内容
DOI：
10.1080/00034983.1987.11812123
发表时间：
1987-06-01
影响因子：
--
作者：
CHIPPAUX, JP;THEAKSTON, RDG
通讯作者：
THEAKSTON, RDG
影响因子：
11.4
作者：
Cheng, AC;Winkel, KD
通讯作者：
Winkel, KD
影响因子：
1.4
作者：
Basnyat, B;Subedi, D;Subedi, N
通讯作者：
Subedi, N
影响因子：
2.8
作者：
Blaylock, R
通讯作者：
Blaylock, R
DOI：
10.1016/s0035-9203(97)90091-2
发表时间：
1997-05-01
影响因子：
2.2
作者：
Coombs, MD;Dunachie, SJ;Warrell, DA
通讯作者：
Warrell, DA