Kasturiratne Anuradhani, Wickremasinghe A Rajitha, de Silva Nilanthi, Gunawardena N Kithsiri, Pathmeswaran Arunasalam, Premaratna Ranjan, Savioli Lorenzo, Lalloo David G, de Silva H Janaka
Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
PLoS Med. 2008 Nov 4;5(11):e218. doi: 10.1371/journal.pmed.0050218.
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.
蛇咬伤导致的中毒是许多热带和亚热带国家的一个重要公共卫生问题。很少有人尝试对这一负担进行量化，而且最近的估计都缺乏客观且可重复的方法。为了提供对这一全球问题规模的准确、最新估计，我们开发了一种新方法来估计蛇咬伤导致的疾病负担。
全球估计基于区域估计，而区域估计又源自特定区域内各国可得的数据。采用了三种主要策略来获取原始数据：电子搜索关于蛇咬伤的出版物、从联合国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识别灰色文献。根据《2005年全球疾病负担》研究（世界银行全球疾病负担项目），将各国分为21个尽可能在流行病学上同质的不同地理区域。从出版物中提取中毒发病率数据，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病率。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，则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，全球每年至少发生42.1万次中毒和2万例死亡。这些数字可能高达184.1万次中毒和9.4万例死亡。基于每四例蛇咬伤中约有一例发生中毒这一事实，每年可能发生120万至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。最高负担存在于南亚、东南亚和撒哈拉以南非洲。
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