The Pan American Health Organization
Promoting Health in the Americas

 Safe Hospitals

Health Surveillance & Disease Prevention & Control   —   Veterinary Public Health:   Anthrax - Avian Influenza - Food Safety - Foot-and-Mouth Disease - Rabies - RIMSA - West Nile Virus - Zoonoses/Animal Health - Virtual Library in Veterinary Public Health (VHL) -
Pan American Center for Foot-and-Mouth Disease PANAFTOSA (avian influenza, rabies, other zoonoses) - News: Veterinary Public Health -
Communicable Diseases - Health Analysis & Statistics - Chronic Diseases


Health Surveillance and Disease Prevention and Control / Veterinary Public Health / Zoonoses

Technical Consultation on Accidents Involving Venomous Animals in Latin America

(São Paulo, SP, Brazil, 27–29 November 2007)

Report (in Spanish, 54 pp, PDF, 514 Kb; key sections translation to right, with headings of others translated below for user orientation)

 
Argentina
Bolivia
Colombia
Costa Rica
Ecuador
Mexico

Country Reports
Mozambique
Panama
Paraguay
Peru
Venezuela

Working Groups
1. Global initiative to deal with the problem of poisoning through bites and stings of venomous animals
2. Epidemiological surveillance
3. Interventions

Regional Center for Zoonoses: PANAFTOSA

PANAFTOSA

Information Systems

Statistical Database

Bibliographical Database

SIEPI

SIEPI: Epidemiological Information System

VHL-VPH

VHL: Virtual Library in Veterinary Public Health

RIMSA

RIMSA: Inter-American Meetings, at Ministerial Level, on Health and Agriculture

PAHO Links
- Zoonoses / Animal Health
- Veterinary Public Health

healthy people

- Introduction
- Objectives
- Participants

- Prologue
- Conclusions
- Determinants
- Future Actions

Introduction

Every year nearly 5 million accidents involving poisonous animals are reported globally, of which between 50 and 75% require treatment in order to prevent death, amputations, or permanent sequelae. Particularly in the tropical countries, their magnitude is not well known because they often occur predominantly in rural areas far from health services. The impact of sequelae and deaths represents a great health, social, and economic burden for the countries of the Americas. The greatest number of these cases is reported in Brazil, a country that has had over 20 years of development in terms of its surveillance system, emergency care, and production of biologicals.

The decision made by PAHO/WHO and the countries of the Americas to promote strategies to diminish the health burden of accidents involving poisonous animals in the countries of Latin America has been aided by the experience and capacity developed by the some of the countries of the Region, which will enable them to contribute to countries where national production is insufficient or where it does not have manufacturing laboratories. The formation of a PAHO-coordinated network among the countries of Latin America constitutes an initiative that can, in the short run, meet the needs for antivenoms and, at the same time, structure a surveillance system for accidents involving venomous animals over the entire continent.

Objectives

  • Analyze the current situation and formulate recommendations for surveillance, prevention, and treatment of accidents involving venomous animals.
  • Establish technical cooperation networks.

Participants: Those responsible for epidemiology in the ministries of health, as well as representatives of venom and antivenom producers and regulatory agencies in Latin America and Mozambique.

Prologue by Dr. Albino Belotto, Senior Advisor for Veterinary Public Health in PAHO and Director of PANAFTOSA

Accidents involving poisonous animals and their sequelae bear a relation to health determinants remaining outside the control of the ministries of health: environmental changes, opportunities taken up in the natural environment by major undertakings (hydroelectric plants, mining), or agriculture that alters animals' habitat and increases the probability of accidental hazards. This makes it necessary, at all decision-making levels (federal, regional, and local) to approach this problem both multisectorally and multidisciplinary.

Despite the important burden presented by accidents involving poisonous animals in terms of deaths and severe sequelae, the attention paid to this issue by research has been inadequate; and the resources allocated to producing venoms and antivenoms, insufficient. Recognizing this, PAHO has convened this expert meeting to analyze the situation and identify the need to prioritize surveillance, prevention, and care for accidents involving venomous animals.

Attempts have been made to optimize available public-sector resources in the countries and to generate conditions that will enable them to face the challenges of curtailing an inequitable situation. Based on the recommendations made at this technical consultation, PAHO/WHO is calling for action to be taken as soon as possible at the national, subregional, regional, and international that are necessary to implement the recommendations, mobilizing for this centers of excellence, reference laboratories, collaborating centers, scientific and professional associations, religious institutions, nongovernmental organizations involved in health, the private/corporate sector with its social responsibility, communities and their leaders, and general public.

Conclusions

  • Care for Those Who Have Been Attacked
    • We call attention to the minimum conditions that healthcare centers should have to treat these attacks and the absolute necessity of having personnel and medical equipment available to treat acute cases and adverse reactions to serum. A recommendation was made to assess, on a case-by-case basis, situations that may constitute exceptions to the rule (for example, using serum in precarious conditions).
  • Epidemiology
    • It should be taken into account that, in all cases analyzed, both the registries and the estimations of the number of people attacked have significantly increased in recent years, making this an emerging problem in the process of expanding.
    • The majority of cases are reported in children and rural workers of reproductive age. Death or disability among the latter endangers families' livelihood. As a result, the occupational nature of the problem and the need for interaction between the occupational and agricultural sectors should be emphasized.
    • Since registries of accidents and deaths in remote areas are improbable, morbidity and mortality estimates based on rates in areas with adequate information and on the rural population at risk should be used for resource planning and for estimating burden.
    • In several countries of South America, there has been an explosive increase in reported cases of bites by poisonous scorpions in urban areas. Surveillance should be strengthened; mechanisms to care for those attacked, enlisted; and the possible determinants of the problem, investigated.
  • Logistics and Capacity for Care
    • Health centers are in many cases insufficient (inaccessible to reach on time) or underutilized (they do not have the means to serve the patients who do reach them). The same thing occurs with logistics and the cold chain with the distribution and storage of biologicals. Programs should be developed to mobilize resources to maximize the capacity to care for the injured.
  • Venoms and Antivenoms
    • In all the participating countries, the regulatory and inspection role of the administration is clear, as is the need to use effective antivenoms against the poisons prevalent in the locality where the accident occurred, as well as the need to collect and monitor venomous animals and their poisons on an ongoing basis. However, several cases of marketing and use of antivenoms were reported as being outside the control of regulatory activities—a situation that can result in fatalities due to deficiencies in the efficacy or safety of these products.
    • Agreement following the discussions on the need to strengthen control mechanisms and to avoid the use of antivenoms that are not duly authorized by the responsible authorities.
  • Strengthening National Programs
    • It is necessary to strengthen monitoring, care, attack reporting, venom and antivenom production, quality control, and policing of marketing and product use.
    • Public investment and resource mobilization is seen as subject to hindrance due to the lack of estimates of burden, morbidity, and mortality resulting from accidents involving poisonous animals. As a result, cooperative actions are recommended to begin estimating the burden.

Determinants Identified (Summary)

  • Care for Those Who Have Been Attacked
    • Minimum conditions at health centers treating such attacked were discussed. Noteworthy points were the absolute need for having personnel and medical equipment available for treating acute cases and adverse reactions to serum. It is also recommended. Assessment on a case-by-case basis was also recommended for situations that constitute exceptions to the rule (e.g. applying serum in precarious conditions).
  • Epidemiology
    • In all the countries, the number of those attacked has increased significantly in recent years.
    • The majority of cases is recorded among children and rural workers, where death or disability of the latter endangers their family's livelihood. The occupational nature of the problem and the need for interaction among the occupational and agricultural sectors is emphasized.
    • Registries of accidents and deaths from animal venoms in remote areas are deficient, which means that estimations of morbidity and mortality based on rates from areas with adequate information on the rural population at risk should be used when planning resources and estimating burden.
    • In several countries of South America, an explosive increase of the number of reported poisoning cases from scorpion bites has been observed in urban areas.
  • Logistics and Capacity for Care
    • In many cases, health centers in are insufficient, impossible to reach on time, and underutilized in that they do not have the means to care for the patients who do manage to reach them. The same thing occurs with the logistics and the cold chain when distributing and storing biologicals.
  • Venoms and Antivenoms
    • In all the countries, the regulatory and inspection role of the administration is clear, as is the need to use effective antivenoms against venoms prevalent in the locality where the accident occurred. This generates the need to collect and monitor venomous animals and their poisons on an ongoing and continual basis.
    • Cases involving the marketing and use of antivenoms are recorded outside the control of regulatory activities—a situation that can result in fatalities due to deficiencies in the efficacy or safety of these products.
  • Strengthening National Programs
    • To strengthen national programs, it is necessary to strengthen monitoring, care, attack reporting, production of venoms and antivenoms, quality control, and police the marketing and use of products.
    • Public investment and resource mobilization encounter difficulties due to the lack of estimations of the burden of disease, morbidity, and mortality caused by accidents involving poisonous animals.

Future Actions

  • Before January 2008, prepare a list with all the producers in the Region that will be invited to review the WHO guidelines and to share in an ad hoc questionnaire to generate knowledge of productive capacity in the countries of the Region.
  • Before January 2008, prepare a list of all available products in the Region.
  • In cooperation with BIREME (Latin American Center for Health Sciences Information), form an Online Community for follow-up on the recommendations made at the meeting and for facilitating communication among network members works.

Regional Office for the Americas of the World Health Organization
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America
Tel.: +1 (202) 974-3000 Fax: +1 (202) 974-3663

© Pan American Health Organization. All rights reserved.