International Society on Toxinology - Global Snakebite Initiative

Global Snakebite Statistics - Epidemiology
Recent research by Kasturiaratne et al, published in PLoS, has redefined global estimates of snakebite epidemiology. However, this is, to some extent, a "work in progress". One of the authors, Prof. Janaka de Silva (Sri Lanka) has kindly made available some of the data tables on which the study conclusions were based, with a "challenge" to IST members (and others) to provide more definitive data for each listed country. These tables will be listed on a separate page structure for this website. All interested membewrs are urged to peruse this information and contact Prof. de Silva if they have additional data that might be used to update the tables. This work may be considered as one section of the Global Snakebite Initiative.

Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, Savioli L, Lalloo DG, de Silva HJ.. (2008) The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med.. 5:e218.
ABSTRACT: BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa.

Important venomous snakes, estimates of number of snake bite envenomings and deaths, and AVS required per year by country

Geographical Region

Medically important snakes

Country

Current population (2007

Number of cases (Low)

Number of cases (High)

Number of deaths (Low)

Number of deaths (High)

AVS (vials) required

Asia, Central

Armenia

   3002271

      74

      74

      0.0

      0.0

Asia, Central

Azerbaijan

   8467167

      17

     115

      0.9

     4.4

Asia, Central

Georgia

   4395420

       9

      63

      0.0

      0.0

Asia, Central

Kazakhstan

  15421861

      32

     186

      0.0

      0.0

Asia, Central

Kyrgyzstan

   5316543

      11

      91

     2.8

     2.8

Asia, Central

Mongolia

   2628840

       5

      32

      0.3

     1.4

Asia, Central

Tajikistan

   6735996

      14

     125

      0.7

     3.5

Asia, Central

Turkmenistan

   4965278

      10

      73

      0.5

     2.6

Asia, Central

Uzbekistan

  27372260

      56

     453

     3.0

    14.2

Asia, East

China

1336317116

    1136

  212118

   450.0

4081.0

Asia, East

DPR Korea

  23790245

      20

    2359

      0.0

      0.0

Asia, East

Republic of Korea

  48223853

     192

     621

     5.0

     5.0

Asia, East

Hong Kong

   7057000

     427

     427

     5.3

   176.4

Asia, East

Japan

 127966709

     509

    2529

     7.4

    13.3

Asia, East

Taiwan

  22858872

    2999

    3769

     7.2

   571.5

Asia, South

Afghanistan

  27145275

     687

  128738

   192.5

  1368.7

Asia, South

Bangladesh

 158664959

    4014

    8280

  1680.0

  8000.0

Asia, South

Bhutan

    658479

    2458

    2977

     4.7

    33.2

Asia, South

India

1169015509

   81399

  163051

 10835.0

 15000.0

Asia, South

Nepal

  28195994

   19991

  142727

   200.0

  1000.0

Asia, South

Pakistan

 163902405

   12784

   17578

  1200.0

  8264.1

Asia, South

Sri Lanka

  18963553

   32902

   32902

   132.7

   948.2

Asia, Southeast

Brunei Darussalam

    390056

       2

       6

      0.0

      0.0

Asia, Southeast

Cambodia

  14443679

     794

   21482

    80.0

   722.2

Asia, Southeast

Indonesia

 231626978

   12739

  214883

    20.0

 11581.3

Asia, Southeast

Laos

   5859393

     322

    8383

      0.5

   293.0

Asia, Southeast

Malaysia

  26571879

   11812

   23637

     8.0

    79.7

Asia, Southeast

Maldives

    305556

       0

       0

      0.0

      0.0

Asia, Southeast

Mauritius

   1261641

       0

       0

      0.0

      0.0

Asia, Southeast

Mayotte

         0

       0

       0

      0.0

      0.0

Asia, Southeast

Myanmar

  48798212

    8832

   14633

   336.7

   649.0

Asia, Southeast

Philippines

  87960117

    4838

   58989

   200.0

   300.0

Asia, Southeast

Seychelles

     86606

       0

       0

      0.0

      0.0

Asia, Southeast

Singapore

   4436281

       0

       0

      0.0

      0.0

Asia, Southeast

Thailand

  63883662

    8465

    9101

     5.0

    94.0

Asia, Southeast

Timor Leste

   1154775

      64

    1501

      0.1

    57.7

Asia, Southeast

Viet Nam

  87375196

   29970

  117583

     6.8

  4368.8

Australasia

Australia

  20743179

    1099

    1260

     1.8

     4.1

Australasia

New Zealand

   4178525

       0

       0

      0.0

      0.0

Oceania

American Samoa

     65000

       0

       0

      0.0

      0.0

Oceania

Cook Islands

     13325

       0

       0

      0.0

      0.0

Oceania

Fiji

    838698

       0

       0

      0.0

      0.0

Oceania

French Polynesia

    252000

       0

       0

      0.0

      0.0

Oceania

Guam

    168000

       0

       0

      0.0

      0.0

Oceania

Kiribati

     95067

       0

       0

      0.0

      0.0

Oceania

Marshall Islands

     59286

       0

       0

      0.0

      0.0

Oceania

Micronesia (Fed States)

    111117

       6

      60

     3.5

7.2

Oceania

Nauru

     10152

       0

       0

      0.0

      0.0

Oceania

New Caledonia

    237000

       0

       0

      0.0

      0.0

Oceania

Niue

      1565

       0

       1

      0.0

      0.1

Oceania

Northern Mariana Islands

     86000

       0

       0

      0.0

      0.0

Oceania

Palau

     20314

       1

       6

      0.6

     1.0

Oceania

Papua NG

   6331010

     313

    4051

   200.0

   455.7

Oceania

Pitcairn Islands

         0

       0

       0

      0.0

      0.0

Oceania

Samoa

    187023

       0

       0

      0.0

      0.0

Oceania

Solomon Islands

    495662

      25

     328

    15.7

    36.5

Oceania

Tokelau

      2000

       0

       0

      0.0

      0.0

Oceania

Tonga

    100336

       5

      54

      0.0

      0.0

Oceania

Tuvalu

     10530

       0

       0

      0.0

      0.0

Oceania

Vanuatu

    226180

      11

     135

     7.1

    15.6

Oceania

Wallis & Futuna islands

     15000

       0

       0

      0.0

      0.0

Europe, Central

Albania

   3190012

       1

      94

      0.0

      0.0

Europe, Central

Bosnia & Herzegovina

   3934816

      12

      67

      0.0

      0.0

Europe, Central

Bulgaria

   7638831

       2

     119

      0.0

      0.0

Europe, Central

Croatia

   4555398

      26

     108

     1.0

     1.0

Europe, Central

Czech Republic

  10186330

      31

     158

      0.2

     2.2

Europe, Central

Hungary

  10029683

       3

     174

      0.2

     2.2

Europe, Central

Montenegro

    597983

       0

       0

      0.0

      0.1

Europe, Central

Poland

  38081971

      11

     765

     2.6

     8.4

Europe, Central

Romania

  21437887

       6

     523

      0.0

      0.0

Europe, Central

Serbia

   9858424

       3

     262

     1.0

     2.2

Europe, Central

Slovakia

   5390035

       9

     124

      0.6

     1.2

Europe, Central

Slovenia

   2001506

       1

      51

      0.0

      0.0

Europe, Central

Macedonia

   2038464

       1

      44

      0.0

      0.0

Europe, Eastern

Belarus

   9688795

      37

      37

      0.0

      0.0

Europe, Eastern

Estonia

   1335333

       5

       5

      0.4

      0.6

Europe, Eastern

Latvia

   2277040

       9

       9

     1.0

     1.0

Europe, Eastern

Lithuania

   3389937

      13

      13

      0.2

     1.5

Europe, Eastern

Moldova

   3793604

      14

      14

      0.0

      0.0

Europe, Eastern

Russian Federation

 142498532

     541

     541

    35.0

    62.6

Europe, Eastern

Ukraine

  46205382

     176

     176

      0.0

      0.0

Europe, Western

Andorra

     74601

       0

       0

      0.0

      0.0

Europe, Western

Austria

   8360746

       8

     151

      0.0

      0.0

Europe, Western

Belgium

  10457343

       0

       0

      0.0

      0.0

Europe, Western

Channel Islands

    149000

       0

       0

      0.0

      0.0

Europe, Western

Cyprus

    854671

       1

      14

      0.0

      0.0

Europe, Western

Denmark

   5442098

       5

      45

     1.0

     1.0

Europe, Western

Faro Islands

     47000

       0

       0

      0.0

      0.0

Europe, Western

Finland

   5276892

     201

     229

     1.0

     1.0

Europe, Western

France

  61647375

    1541

    1880

     1.0

    11.7

Europe, Western

Germany

  82599471

      74

     561

      0.4

    15.7

Europe, Western

Gibraltar

     27000

       0

       0

      0.0

      0.0

Europe, Western

Greece

  11146918

      10

     228

      0.0

      0.0

Europe, Western

Greenland

     57000

       0

       0

      0.0

      0.0

Europe, Western

Holy See

      1000

       0

       0

      0.0

      0.0

Europe, Western

Iceland

    301006

       0

       0

      0.0

      0.0

Europe, Western

Ireland

   4300902

       0

       0

      0.0

      0.0

Europe, Western

Isle of Man

     78000

       0

       0

      0.0

      0.0

Europe, Western

Italy

  58876834

     465

    1290

      0.0

      0.0

Europe, Western

Liechtenstein

     34000

       0

       0

      0.0

      0.0

Europe, Western

Luxembourg

    466560

       0

       0

      0.0

      0.0

Europe, Western

Malta

    406582

       0

0

0.0

0.0

Europe, Western

Monaco

     32711

       0

       0

      0.0

      0.0

Europe, Western

Netherlands

  16418824

      15

     293

      0.0

      0.0

Europe, Western

Norway

   4698097

      40

      79

      0.0

      0.0

Europe, Western

Portugal

  10623031

      10

     240

      0.0

      0.0

Europe, Western

San Marino

      6000

       0

       0

      0.0

      0.0

Europe, Western

San Pierre et Miquelon

     30926

       0

       0

      0.0

      0.0

Europe, Western

Spain

  44279180

     112

     597

      0.0

      0.0

Europe, Western

Sweden

   9118955

     237

     276

      0.2

     1.7

Europe, Western

Switzerland

   7483973

      43

      93

      0.5

     1.4

Europe, Western

United Kingdom

  60768946

     200

     522

      0.4

    11.5

North America

Canada

  32876047

     260

     372

      0.0

      0.0

North America

USA

 305826246

    2422

    3487

     4.8

    7.0

Latin America, Central

Colombia

  46155958

    2340

    2696

    72.5

   345.1

Latin America, Central

Costa-Rica

   4467625

     572

     695

     3.8

     8.9

Latin America, Central

El Salvador

   6857328

      51

    2122

     3.1

    51.3

Latin America, Central

Guatemala

  13353911

     513

    5715

     6.0

    99.9

Latin America, Central

Honduras

   7106001

     510

    3294

     3.2

    53.1

Latin America, Central

Mexico

 106534880

   28 056

   41009

    47.6

   796.6

Latin America, Central

Nicaragua

   5603190

     507

     641

     2.5

    41.9

Latin America, Central

Panama

   3343374

    2542

    2542

    17.4

    25.0

Latin America, Central

Venezuela

  27656832

    6997

    8659

    37.0

    38.8

Latin America, Andean

Bolivia

   9524568

     856

    5500

   100.0

   100.0

Latin America, Andean

Ecuador

  13341197

    1199

    8189

    42.6

   140.1

Latin America, Andean

Peru

  27902760

    4492

   13963

   100.0

   293.0

Latin America, Southern

Argentina

  39531115

    1957

    1957

     3.8

     3.8

Latin America, Southern

Chile

  16634760

       1

     102

      0.2

     1.6

Latin America, Southern

Falkland Islands

      3000

       0

       0

      0.0

      0.0

Latin America, Southern

Uruguay

   3339700

     100

105

0.0

0.0

Latin America, Tropical

Brazil

 191790929

   29536

   31274

    93.5

   290.0

Latin America, Tropical

Paraguay

   6127077

     100

     621

     7.0

     9.3

Caribbean

Anguilla

     12000

       0

       0

      0.0

      0.0

Caribbean

Antigua & Barbuda

     85109

       0

       0

      0.0

      0.0

Caribbean

Aruba

    103000

      50

     364

      0.1

    55.1

Caribbean

Bahamas

    331278

       0

       0

      0.0

      0.0

Caribbean

Barbados

    293891

       0

       0

      0.0

      0.0

Caribbean

Belize

    287699

      51

     884

      0.4

   153.9

Caribbean

Bermuda

     83000

       0

       0

      0.0

      0.0

Caribbean

British Virgin Islands

     22000

       0

       0

      0.0

      0.0

Caribbean

Cayman Islands

     43000

       0

       0

      0.0

      0.0

Caribbean

Cuba

  11267883

       0

       0

      0.0

      0.0

Caribbean

Dominica

     67390

       0

       0

      0.0

      0.0

Caribbean

Dominican Republic

   9759664

       0

0

0.0

0.0

Caribbean

French Guiana

    187000

      84

     334

   100.0

   100.0

Caribbean

Grenada

    105672

       0

       0

      0.0

      0.0

Caribbean

Guadeloupe

    446000

       0

       0

      0.0

      0.0

Caribbean

Guyana

    737906

     528

    3017

     4.3

   394.6

Caribbean

Haiti

   9597849

       0

       0

      0.0

      0.0

Caribbean

Jamaica

   2713779

       0

       0

      0.0

      0.0

Caribbean

Martinique

    397000

      20

      21

      0.6

   212.3

Caribbean

Montserrat

      4000

       0

       0

      0.0

      0.0

Caribbean

Netherland Antilles

    224000

       0

       0

      0.0

      0.0

Caribbean

St. Kitts & Nevus

     50417

       0

       0

      0.0

      0.0

Caribbean

St. Lucia

    164924

       4

     640

      0.0

      0.0

Caribbean

St. Vincent & Grenadine

    120402

       0

       0

      0.0

      0.0

Caribbean

Suriname

    457964

     327

     868

     2.0

   244.9

Caribbean

Trinidad & Tobago

   1333272

      33

    1911

      0.0

      0.0

Caribbean

Turks & Caicos

     22000

       0

       0

      0.0

      0.0

North Africa/ Middle East

Algeria

  33857915

     100

    6470

     2.9

     6.3

North Africa/ Middle East

Bahrain

    752648

       2

      38

      0.0

      0.0

North Africa/ Middle East

Egypt

  75497913

     223

   21254

    14.0

    14.0

North Africa/ Middle East

Iran

  71208384

     210

   11079

     6.0

    13.2

North Africa/ Middle East

Iraq

  28993374

      86

    4366

     2.4

     5.4

North Africa/ Middle East

Israel

   6927677

     100

     119

      0.2

     1.3

North Africa/ Middle East

Jordan

   5924245

      17

     613

      0.5

     1.1

North Africa/ Middle East

Kuwait

   2851144

       8

      56

      0.0

      0.0

North Africa/ Middle East

Lebanon

   4099115

      12

     228

      0.3

      0.8

North Africa/ Middle East

Libya

   6160483

      18

     388

      0.5

     1.1

North Africa/ Middle East

Morocco

  31224137

      92

    6349

     2.6

     5.8

North Africa/ Middle East

Palestinian Territory

   3762000

      11

     513

      0.3

      0.7

North Africa/ Middle East

Oman

   2595133

     361

     583

      0.2

      0.5

North Africa/ Middle East

Qatar

    840635

       2

      26

      0.0

      0.0

North Africa/ Middle East

Saudi Arabia

  24734533

    1484

    1855

     2.1

     4.6

North Africa/ Middle East

Syria

  19928516

      59

    4651

     1.7

     3.7

North Africa/ Middle East

Tunisia

  10327285

      30

    1747

      0.9

     1.9

North Africa/ Middle East

Turkey

  74876695

     221

   11777

     6.3

    13.9

North Africa/ Middle East

United Arab Emirates

   4380439

      13

     239

      0.4

      0.8

North Africa/ Middle East

Western Sahara

    324000

       1

      10

      0.0

      0.1

North Africa/ Middle East

Yemen

  22389169

      66

    7949

     1.9

     4.2

Sub Saharan Africa, Cent.

Angola

  17024084

    1262

    8004

    19.6

   542.5

Sub Saharan Africa, Cent.

Central African Republic

   4342735

     322

    1935

     5.0

   130.1

Sub Saharan Africa, Cent.

Congo

   3768086

     435

     593

     4.3

   75.2

Sub Saharan Africa, Cent.

DR Congo

  62635723

   16021

   36814

   224.3

  2305.9

Sub Saharan Africa, Cent.

Equatorial Guinea

    507499

      38

     229

      0.6

    15.4

Sub Saharan Africa, Cent.

Gabon

   1330574

      99

     246

     2.3

    13.6

Sub Saharan Africa, East

Burundi

   8508232

    1174

    2230

    38.3

   322.7

Sub Saharan Africa, East

Comoros

    839187

       0

       0

      0.0

      0.0

Sub Saharan Africa, East

Djibouti

    833021

     115

     132

     3.7

8.4

Sub Saharan Africa, East

Eritrea

   4850763

     669

    1233

    21.8

173.7

Sub Saharan Africa, East

Ethiopia

  83099190

   11468

   21223

   373.9

  3002

Sub Saharan Africa, East

Kenya

  37537716

    5180

    8194

   168.9

  980.8

Sub Saharan Africa, East

Madagascar

  19683358

       0

       0

      0.0

      .0

Sub Saharan Africa, East

Malawi

  13925070

    1922

    3556

    62.7

   503.0

Sub Saharan Africa, East

Mozambique

  21396916

    2953

    4832

    96.3

   602.5

Sub Saharan Africa, East

Rwanda

   9724577

    1342

    2399

    43.8

   328.5

Sub Saharan Africa, East

Somalia

   8698534

    1200

    2289

    39.1

   332.4

Sub Saharan Africa, East

Sudan

  38560488

    5321

    8554

   173.5

  1044.4

Sub Saharan Africa, East

Uganda

  30883805

    4262

    8109

   139.0

  1175.5

Sub Saharan Africa, East

Tanzania

  40453513

    5583

    9341

   182.0

  1194.4

Sub Saharan Africa, East

Zambia

  11921999

    1645

    2731

    53.6

   346.2

Sub Saharan Africa, South

Botswana

   1881504

      21

      58

     2.7

    10.0

Sub Saharan Africa, South

Lesotho

   2007833

      23

      85

     2.9

    10.6

Sub Saharan Africa, South

Namibia

   2074146

      23

      82

     3.0

    11.0

Sub Saharan Africa, South

South Africa

  48576763

    1383

    1864

   257.5

   257.5

Sub Saharan Africa, South

Swaziland

   1141427

      13

      48

     1.6

     6.0

Sub Saharan Africa, South

Zimbabwe

  13349434

     150

     160

    19.0

    70.8

Sub Saharan Africa, West

Benin

   9032787

    5913

   11392

   650.0

   764.1

Sub Saharan Africa, West

Burkina Faso

  14784291

    1109

    8279

   200.0

441.9

Sub Saharan Africa, West

Cameroon

  18549176

    2255

    6206

    33.8

   265.9

Sub Saharan Africa, West

Cape Verde

    530437

       0

       0

      0.0

      0.0

Sub Saharan Africa, West

Chad

  10780571

      87

   14414

     3.5

1008.1

Sub Saharan Africa, West

Cote d’Ivoire

  19261821

    6380

   12366

   200.0

   300.0

Sub Saharan Africa, West

Gambia

   1708681

      14

    2344

      0.6

   163.9

Sub Saharan Africa, West

Ghana

  23478394

     190

   24515

     7.6

  1713.3

Sub Saharan Africa, West

Guinea-Bissau

   1695043

      14

    2170

      0.5

   151.8

Sub Saharan Africa, West

Guinea

   9370113

    1275

    6295

    28.1

   468.5

Sub Saharan Africa, West

Liberia

   3750261

      30

    4104

     1.2

   286.9

Sub Saharan Africa, West

Mali

  12336799

     100

   19516

     4.0

  1365.5

Sub Saharan Africa, West

Mauritania

   3123813

      25

    2325

     1.0

   162.3

Sub Saharan Africa, West

Niger

  14225521

    1337

   21527

    26.7

    76.5

Sub Saharan Africa, West

Nigeria

 148092542

    1200

  141710

    48.0

 9900.9

Sub Saharan Africa, West

Saint Helena

      5000

       0

       6

      0.0

      0.4

Sub Saharan Africa, West

Sao Tome & Principe

    157638

       1

     217

      0.1

    15.2

Sub Saharan Africa, West

Senegal

  12378532

    1238

    1946

   185.7

  867.0

Sub Saharan Africa, West

Sierra Leone

   5865872

      48

    6724

     1.9

   470.1

Sub Saharan Africa, West

Togo

   6585147

    6783

    8644

   197.6

   232.0