Scorpion stings: increasing the importance as a public health problem in Brazil.

Santalucia, M., Fan, H.W. and Oliveira, R.C.

Secretary of Health Surveillance, Brazilian Ministry of Health. 

The National Program for Control of Poisonous Animals Accidents was implemented in 1986, initially for snakebites and, in 1988, it was extended to scorpion stings and spider bites. The health surveillance system lacks to detect all cases, since most patients do not received antivenom thus leading to sub-registration. Nevertheless, in 2002, 21,420 cases were reported, most in the Northeastern region, with ascending rates, at least, in the last 10 years. A total of 7,572 ampoules of scorpion/arachnid antivenom have been used in 28.3% of patients. Only 2.5% of cases were considered severe while 12.5% were moderate and 71.3% were mild (information was not available in 13.7%). Most of the 570 severe cases occurred in patients that arrived at the hospital one hour after sting thus indicating the rapid onset of systemic envenoming. Case-fatality rate was low (0.27%) but most of the 57 deaths occurred in children under 14 years. Exponential increase in the risk of deaths occurred in patients that arrived to treatment from 6 to 12 hours after sting (0.89%). In the first years of the National Program, the number of accidents caused by scorpions was evidently under dimensioned. However nowadays figures indicate that, in some parts of Brazil, scorpion stings are much more frequent than snakebites. Although several Tityus species are implicated in scorpion stings, the national surveillance system is not able to detect which species have been responsible for the accidents. Severity of envenoming is evidently closed related to group age and rapid evolution to death indicates the necessity of early intervention strategies.

Finantial support: Unesco 914BRA1015

Correspondence to: fan.hui@funasa.gov.br