Blessmann Joerg, Nguyen Thanh Phuc Nhan, Bui Thi Phuong Anh, Krumkamp Ralf, Vo Van Thang, Nguyen Hoang Lan
Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam; Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.
Institute for Community Health Research, College of Medicine and Pharmacy, Hue University, Hue, Viet Nam.
Toxicon. 2018 Dec 15;156:61-65. doi: 10.1016/j.toxicon.2018.11.009. Epub 2018 Nov 15.
The annual incidence of snakebites in Vietnam is not known and only few publications about snakebite envenoming and medically relevant snakes can be found in English language literature. The present community-based surveys provide data on incidence of snakebites in three different geographic regions of Thua Thien Hue (TT Hue) province, central Vietnam and snake species responsible for bites in this region.
METHODOLOGY/RESULTS: The cross-sectional community based surveys were conducted from March to July 2017. Multistage cluster sampling was applied and snakebite incidence was calculated at 58 snakebites per 100,000 person-years for the entire province, and 172, 69 and 10 snakebites per 100,000 person-years in the mountainous, coastal and urban region of TT Hue province, respectively. Thirty-one snakebite victims interviewed during the surveys reported 18 (58%) green pit viper bites (Trimeresurus species), 5 (16%) cobra bites (Naja kaouthia, Naja siamensis), 2 (7%) krait bites (Bungarus candidus, Bungarus fasciatus), 2 (7%) red-necked keelback bites (Rhabdophis subminiatus) and 4 bites from unidentified snakes (13%). The outcome was favourable for 28 snakebite victims (90%), two (6%) had minor sequelae and one (3%) victim died after a Malayan krait bite. Two hundred and twenty-one snakebite patients were treated in 9 district hospitals and one central hospital in TT Hue between 2014 and 2016. Eighty green pit vipers (84%), 12 cobras (13%) and 3 kraits (3%) were responsible for bites in 95 patients where snake identification was documented.
Incidence of snakebites is surprisingly low in TT Hue province in central Vietnam in comparison to other regions in Asia, particularly to neighbouring Lao PDR. However, snakebites are still a significant health problem in the mountainous region and green pit vipers and cobras cause the vast majority of bites.
越南蛇咬伤的年发病率尚不清楚，英文文献中关于蛇咬伤中毒及医学相关蛇类的出版物很少。目前基于社区的调查提供了越南中部承天顺化省（TT Hue）三个不同地理区域的蛇咬伤发病率数据，以及该地区导致咬伤的蛇类物种。
方法/结果：2017年3月至7月进行了基于社区的横断面调查。采用多阶段整群抽样方法，全省蛇咬伤发病率计算为每10万人年58例，TT Hue省山区、沿海和城市地区分别为每10万人年172例、69例和10例。调查期间采访的31名蛇咬伤受害者报告，18例（58%）为竹叶青蛇咬伤（竹叶青属物种），5例（16%）为眼镜蛇咬伤（眼镜王蛇、暹罗眼镜蛇），2例（7%）为金环蛇咬伤（银环蛇、双带环蛇），2例（7%）为红脖颈槽蛇咬伤（红脖颈槽蛇），4例为不明蛇类咬伤（13%）。28名蛇咬伤受害者预后良好（90%），2例（6%）有轻微后遗症，1例（3%）受害者被马来环蛇咬伤后死亡。2014年至2016年期间，TT Hue的9家district医院和1家中心医院共治疗了221例蛇咬伤患者。在有蛇类鉴定记录的95例患者中，80条竹叶青蛇（84%）、12条眼镜蛇（13%）和3条环蛇（3%）导致了咬伤。
与亚洲其他地区，特别是邻国老挝相比，越南中部TT Hue省的蛇咬伤发病率出奇地低。然而，蛇咬伤在山区仍然是一个严重的健康问题，竹叶青蛇和眼镜蛇导致了绝大多数咬伤。
