Who are the most affected by Bothrops snakebite envenoming in Brazil? A Clinical-epidemiological profile study among the regions of the country.

Snakebite envenoming represents an important Neglected Tropical Disease (NTD) that mainly affects tropical and subtropical developing countries according to the World Health Organization (WHO). As a priority issue in the tropics, it is estimated that accidental encounter between snakes and humans is the leading cause of morbidity and mortality among all NTDs in the world. In Brazil, an extremely diverse country with continental dimensions, snakebite envenoming is the second leading cause of reported human envenoming. Treating the disease has been an unprecedented challenge for Brazilian Health Systems for decades. Despite access to Antivenom therapy and distributing it free of charge across the country, Brazil faces numerous issues regarding the notification process and accurate treatment targeting for at-risk populations. Thus, this study aimed to identify the temporal epidemiological dynamics of accidents caused by Bothrops snakes in Brazil, the country's major group of venomous snakes, based on secondary information from the online database provided by The Brazilian Notifiable Diseases Information System (SINAN). For this purpose, reported Bothrops snakebites between 2012 and 2021 were counted, then the data were analyzed. We looked at the frequency, occurrence, mortality rates, case fatality rate (CFR), age and gender distribution, and the time lapse between the incident and the initiation of Antivenom therapy. The data were also organized considering regional variations of the country. Throughout the studied period, a total of 202,604 cases of envenoming caused by Bothrops spp. were notified, resulting in 766 fatalities. These accidents were found to occur in variable proportions across different regions in Brazil, with notable concentrations observed in the North, Northeast, and Southeast regions. The epidemiological profile of patients varied greatly between the regions, revealing that snake envenoming is much more a social, economic, and ecological problem than a medical one. In conclusion, our study provides an overview of the clinical and epidemiological profile of envenoming by Bothrops snakes in Brazil. Notably, this is the first study to present such information in a country as vast and diverse as Brazil, encompassing a comparative analysis of its regions using SINAN data, that proves to be a very useful national tool to improve the control and management of envenoming. Author summary: Snakebite envenoming it is a health challenge worldwide. In Brazil, the largest country in Latin America, Bothrops snakebites represents the main cause of envenoming by venomous snakes. Every year, at least 20,000 accidents with Bothrops snakes are notified by The Brazilian Information System for Notifiable Diseases (SINAN). However, it is well known that these numbers do not represent reality in many cases, since a significant portion of envenoming patients continue to dispense specialized medical care or are unable to arrive in time at the reference medical centers. Therefore, in our comprehensive study with secondary data made available online by SINAN, we decided to understand the temporal dynamics of Bothrops snakebites over a ten-year period across the five regions of Brazil. According to our results, which evaluated variables such as occurrence, incidence, mortality and lethality, envenoming by Bothrops snakes remains an important neglected public health problem in our country. Currently, the high rates of occurrence and incidence in certain regions are due to socioeconomic problems found in a vast and developing country such as Brazil. Despite this, lethality and mortality rates remain low at all regions of the country, a fact that can be associated with the effectiveness of the Antivenom therapy treatment provided free of charge by The Brazilian National Health System (SUS). [ABSTRACT FROM AUTHOR]