Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002-2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database

Jen-Yu Hsu; Shu-O Chiang; Chen-Chang Yang; Tan-Wen Hsieh; Chi-Jung Chung; Yan-Chiao Mao

doi:10.1371/journal.pntd.0011376

Nationwide and long-term epidemiological research of snakebite envenomation in Taiwan during 2002-2014 based on the use of snake antivenoms: A study utilizing National Health Insurance Database

PLoS Negl Trop Dis. 2023 Jun 8;17(6):e0011376. doi: 10.1371/journal.pntd.0011376. eCollection 2023 Jun.

Authors

Jen-Yu Hsu^{1

2

3}, Shu-O Chiang⁴, Chen-Chang Yang^{1

5}, Tan-Wen Hsieh⁶, Chi-Jung Chung^{7

8}, Yan-Chiao Mao^{9

10

11

12}

Affiliations

¹ Department of Occupational Medicine and Clinical Toxicology, Taipei Veterans General Hospital, Taipei, Taiwan.
² Office of Preventive Medicine, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
³ School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ ESTAT Statistical Consulting Co., Ltd., Taipei, Taiwan.
⁵ Institute of Environmental and Occupational Health Sciences, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁶ Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁷ Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
⁸ Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
⁹ PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
¹⁰ School of Medicine, National Defense Medical Center, Taipei, Taiwan.
¹¹ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
¹² Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

Abstract

Introduction: In Taiwan, six venomous snake species with medical importance have been found; however, long-term epidemiological data of snakebite envenomation (SBE) is lacking. This study aimed to explore the epidemiology of SBE based on the distribution and use of different antivenoms in different parts of Taiwan to facilitate the development of prevention strategies and resource allocation.

Methods and results: This retrospective study was conducted using the Taiwan National Health Insurance Research Database from 2002 to 2014. A total of 12,542 patients were treated with antivenoms. The directly standardized cumulative incidence was 3.6 cases per 100,000 individuals based on the 2000 World Standard Population. The incidence of SBEs peaked in the summer (35.9%). The relative risk (RR) of male patients versus female patients was 2.5 (p < 0.0001). The RRs of patients aged 18-64 and ≥65 years versus those aged <18 years were 6.0 (p < 0.0001) and 14.3 (p < 0.0001), respectively. Furthermore, the RR of eastern Taiwan versus northern Taiwan was 6.8 (p < 0.0001). The RR of agricultural workers versus laborers was 5.5 (p < 0.0001). Compared with patients envenomed by Trimeresurus stejnegeri stejnegeri or Protobothrops mucrosquamatus, those envenomed by Naja atra or Bungarus multicinctus multicinctus were more likely to occur in central (adjusted odds ratio [aOR] = 2.6, p < 0.0001) or southern (aOR = 3.2, p < 0.0001) Taiwan, but less frequently among agricultural workers (aOR = 0.6, p < 0.0001). The overall case-fatality rate was 0.11%.

Conclusions: Among Asian countries, Taiwan had low incidence and case-fatality rates of SBE. Risk factors included male gender, old age, summer season, being in eastern Taiwan, and being an agricultural worker. Differences of the epidemiological findings between snake species should be focused on when developing strategies for snakebite prevention.

Copyright: © 2023 Hsu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Animals
Antivenins / therapeutic use
Female
Male
Retrospective Studies
Snake Bites* / epidemiology
Snake Bites* / therapy
Snakes
Taiwan / epidemiology

Substances

Antivenins

Grants and funding

This study was partly supported by National Science and Technology Council (MOST 109-2320-B-075A-001) and Taichung Veterans General Hospital Research Fundings (TCVGH-1067205C; TCVGH-1127201B). Y.C.M. received the fundings. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.