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Venomous copperhead, exotic snakebites on the rise among children
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Venomous snakebites, including from copperheads and exotic snakes, and antivenom therapy use increased significantly in children and adolescents during a 13-year period, according to findings published in Pediatrics.
“One often-cited study assessing snakebites among U.S. children was published in 1965 and used data from individual hospitals in 10 states,” Joann Schulte, DO, MPH, from the North Texas Poison Control Center at Parkland Health & Hospital System in Dallas, Texas, and colleagues wrote. “Since that date, increasing urbanization, population shifts to the southern and western states, development of new antivenom treatments and the emergence of exotic snakes as an industry have altered the population and the circumstances in which snakebites may occur.”
To characterize snakebites reported to U.S. poison control centers in children and adolescents aged 18 years and younger, Schulte and colleagues investigated the trends and epidemiology of pediatric snakebites and consequent hospitalizations and antivenom treatment.
The researchers pooled data from the National Poison Data System reported by phone call between 2000 and 2013 and based their analysis from generic codes for snakebite characteristics, antivenom therapy and definition of treatable envenomation. The researchers described the newer antivenom as Fab antivenom (Wyeth, Pfizer).
During the study, callers reported 18,721 pediatric snakebites. Victims were mostly boys (n = 12,688) with an average age of 10.7 years. Children aged 3 to 9 years were at highest risk for being bitten (n = 6,717). Four children died because of snakebite and 20% of children required admission to ICU.
Callers reported snakebites in all 50 states, Washington, D.C. and Puerto Rico; they reported venomous snakebites in 48 states, Washington, D.C. and Puerto Rico. One-quarter of bites occurred in Texas and Florida. Highest incidences of venomous and nonvenomous bites occurred in West Virginia (n = 762.3), Louisiana (n = 625.5) and Oklahoma (n = 557.5).
Among 15,422 children who acquired bites that could be treated, rattlesnake victims were 3.8 times more likely to be admitted to a health care facility than children bitten by copperheads, cottonmouths or nonvenomous or exotic snakes (OR = 3.8; 95% CI, 3.48-4.13). Approximately half of snakebites were caused by venomous snakes, and 2% were caused by exotic snakes. In addition, the researchers discovered there were limited data on 28% of reported bites.
“We found that the use of antivenom for rattlesnake, copperhead and unknown crotalid bites increased during the study period, especially after 2006,” the researchers wrote. “This finding is similar to those of earlier studies examining the use of antivenom for briefer time periods.
“Much of the augmented use is driven by copperhead bites, which increased 107% during the study period; use of Fab antivenom for those bites increased 775%.” – by Kate Sherrer
Disclosure: Kleinschmidt reports funding for the North American Snakebite Registry that is supported by the American College of Medical Toxicology through an unrestricted grant from BTG Pharmaceuticals. The other researchers report no relevant financial disclosures.
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