Taiwan's venomous snakebite: epidemiological, evolution and geographic differences.

Located at the juncture of tropical and subtropical regions, Taiwan has a warm and humid climate with abundant precipitation and food, which coupled with the island's diverse vegetation and landscape, makes it a suitable environment for many snake species. Among these, Naja atra, Bungarus multicinctus, Deinagkistrodon acutus, Trimeresurus mucrosquamatus, Trimeresurus stejnegeri, Daboia russelii siamensis are the 6 principal venomous species, and have caused significant injuries and death over the years. The natural environment of Taiwan has changed tremendously in the last 20-30 years, which is likely to have affected the number and distribution of venomous snakes, thus indirectly affecting incidence of snakebite. A retrospective analysis of 286 snakebite cases at a medical center in central Taiwan analyzed the snakebite-related epidemiological data in the past 30 years. The results showed that the bite rates of various venomous snakes vary geographically, which is related to the overlapping of the human living environment and snakes' habitat. In Taiwan, T. mucrosquamatus and T. stejnegeri bites are most common. Bites by Deinagkistrodon acutus and Daboia russelii siamensis generally occur in the south and east parts of the island and attacks by Naja atra are most common in central Taiwan. Aggressive antivenom treatment can reduce snakebite mortality rate, but for Bungarus multicinctus bites, maintaining the patient's airway and supporting their ventilation is vital to reducing mortality rate in addition to antivenom treatment.