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Snakebites notified to the poison control center of Morocco between 2009 and 2013

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      Abstract

      Background

      Snakebites cause considerable death and injury throughout the globe, particularly in tropical regions, and pose an important yet neglected threat to public health. In 2008, the Centre Anti Poison et de Parmacovigilance du Maroc (CAPM) started to set up a specific strategy for the control of snakebites that was formalized in 2012. The aim of the present study is to describe and update the epidemiological characteristics of snakebites notified to CAPM between 2009 and 2013.

      Methods

      This retrospective five-year study included all cases of snakebites notified to CAPM by mail or phone.

      Results

      During the study period, 873 snakebite cases were reported to CAPM, an average incidence of 2.65 cases per 100,000 inhabitants with 218 cases each year. The highest incidence was found in Tangier-Tetouan region with 357 cases (40.9 %) followed by Souss Massa Draa region with 128 cases (14.6 %). The average age of patients was 26.8 ± 17.2 years. The male to female sex ratio was 1.67:1 and 77 % of cases occurred in rural areas. The bites occurred mainly in spring (44 %) followed by summer (42 %). Snake species was identified in 54 cases (6.2 %): colubrids represented 31 % ( n = 18) and vipers 67 % ( n = 36), mainly Daboia mauritanica, Bitis arietans and Cerastes cerastes. In 311 cases (35.6 %), the patients showed viper syndrome. Thrombocytopenia was observed in 23.5 % of viper syndrome cases, whereas, compartment syndrome was observed in 7.6 % patients. FAV-Afrique® was administered in 41 patients (5 %). In patients treated with antivenom, 38 patients recovered and three died. Twenty-seven deaths were reported (3.9 %).

      Conclusion

      Despite specific efforts to better understand the epidemiology of snakebites in Morocco (incidence, severity, snake species involved), it remains underestimated. Therefore, further work is still necessary to ensure accessibility of appropriate antivenom against venomous species and to improve the management of envenomation in Morocco.

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      Most cited references 50

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      Estimate of the burden of snakebites in sub-Saharan Africa: a meta-analytic approach.

      Snakebites represent an important neglected public health problem in many developing countries. There is a lack of epidemiological data, which would be very useful for the organisation of snakebite management and provision of antivenom. An extensive literature search for the years 1970-2010 was performed. Data were analysed using meta-analysis to take into account the heterogeneity between the studies and their respective weight. Incidence, mortality and population at risk were estimated after stratification according to the environment (urban or rural) and survey methodologies (national, hospital or community studies). The incidence of snakebite was inversely correlated with population density. The number of envenomings was estimated at 314,078 [CI95% = 251,513-377,462], of which 95% occurred in rural areas. The remainder occurred in cities. The annual mortality was estimated at 7,331 [5,148-9,568], of which 97% occurred in a rural environment. The annual number of amputations ranged from 5,908 to 14,614. The population most at risk was young men engaged in agricultural or pastoral labours. Household surveys indicated that actual incidence and mortality were likely 3-5 times higher. The difference maybe explained by treatment seeking behaviour. However, incidences and mortalities reported here reflect the number of patients who attend modern health facilities, giving underestimated figures of the burden of snakebites in sub-Saharan Africa but realistic current requirements for antivenoms. Copyright © 2011 Elsevier Ltd. All rights reserved.
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        Venoms, antivenoms and immunotherapy.

         J Chippaux,  M Goyffon (1998)
        A century after the discovery of antivenom and despite real progress undertaken in its manufacture, its use remains largely empirical. Recent studies of pharmacokinetics of envenoming permitted improved understanding of immunotherapy. Improved purification of the antivenom by using immunoglobulin fragments has lead to increased tolerance and efficiency of antivenom. The respective advantages and disadvantages of F(ab')2 and F(ab) are discussed in relation to neutralising efficacy and clearance from the circulation. Although the time during which the action of antivenom remains beneficial after the bite is unknown, the superiority of intravenous administration has now been proved. Although immunisation procedures and purification and use of IgG fragments can be improved using modern technology, the future of immunotherapy seems promising. It is vital that therapeutic protocols should be rigidly adhered to in order to optimise immunotherapy. The use of vaccination has yet to be explored.
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          Biogeography and conservation of viperids from North-West Africa: An application of ecological niche-based models and GIS

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            Author and article information

            Affiliations
            [ ]Centre Anti Poison et de Pharmacovigilance du Maroc, Rabat, Maroc
            [ ]Laboratoire de Génétique et Biométrie Faculté des Sciences, Université Ibn Tofail, Kénitra, Maroc
            [ ]UMR 216, Mère et enfant face aux infections tropicales, Institut de Recherche pour le Développement, Cotonou, Bénin, and Université Paris Descartes, Sorbonne Paris Cité, Faculté de Pharmacie, Paris, France
            [ ]Faculté de Médecine et de Pharmacie, Université Mohammed V, Rabat, Maroc
            Contributors
            chafiqfouad@yahoo.fr
            elhattimy@gmail.com
            nrhalemcap@gmail.com
            jean-philippe.chippaux@ird.fr
            asoulaymani@yahoo.fr
            mokhtari@univ-ibntofail.ac.ma
            rsoulaymani@gmail.com
            Journal
            J Venom Anim Toxins Incl Trop Dis
            J Venom Anim Toxins Incl Trop Dis
            The Journal of Venomous Animals and Toxins Including Tropical Diseases
            BioMed Central (London )
            1678-9199
            16 March 2016
            16 March 2016
            2016
            : 22
            26985186 4793752 65 10.1186/s40409-016-0065-8
            © Chafiq et al. 2016

            Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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            Research
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            © The Author(s) 2016

            snakebite, envenomation, viper, morocco, epidemiology

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