Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006

ORIGINAL PAPER
The Journal of Venomous Animals and Toxins including Tropical Diseases
ISSN 1678-9199 | 2012 | volume 18 | issue 2 | pages 217-224

EpidemiologicalprofileofsnakebitesinRiodeJaneiro,Brazil,2001-2006

Machado C (1), Bochner R (2), Fiszon JT (3)

(1) Vital Brazil Institute (IVB), Niterói, Rio de Janeiro State, Brazil; (2) Institute for Communication and Scientific and
Technological Information on Health (ICICT), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro State,
Brazil; (3) Sergio Arouca National School of Public Health (ENSP), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio
de Janeiro State, Brazil.

Abstract: All snakebites registered in Rio de Janeiro state, Brazil, between 2001 and 2006 were analyzed.
Of these, the snake species involved was identified in 2,431 cases, most of which were caused by Bothrops
(2,347). Most victims were male (78.4%) and the age group most frequently attacked was between 20 and
39 years (38.4%). As for severity, 1,118 (45.9%) were classified as minor, 748 (30.7%) as moderate, and 209
(8.6%) as severe. Progression towards complete cure occurred in 1,567 patients; 39 had sequelae; three
died; and clinical outcomes were not monitored in 822 cases. The time between bite and first medical
attention was less than three hours in 74.6% of cases. Most occurred in municipalities with vast areas of
preserved Atlantic Forest: Angra dos Reis (208), Rio de Janeiro (197), Parati (186), Teresópolis (134), and
Petrópolis (110).Accidentfrequencywashighest between November and April,in whichthe daily average
is practically twice that observed in other months. Although results show that Rio de Janeiro state has a
good level of medical care, it could be improved by creating multidisciplinary teams that include doctors,
biologists, and nurses. The Vital Network for Brazil helps to promote a stimulating environment for this
type of training, with both traditional courses and distance learning. Training hours must be increased to
improve the skills of professionals responsible for victim care.

Key words: snakebites, envenomation, snake bite epidemiology, information systems.
INTRODUCTION

Accidents caused by venomous snakes are a
serious public health issue in tropical countries,
especially in Latin America. It is estimated that
2,500,000 accidents with venomous snakes occur
annually in the world; approximately 125,000 are
lethal (1-9).
The Brazilian Health Department (10)
estimates that approximately 26,000 snakebites
occur each year in Brazil. According to Lira-da-
Silva et al. (11), this is an underestimate because
of inadequacies in data collection, and a large
insufficiency in the number of notifications.
Although the majority of snakebites occur in
northern Brazil, most records come from the
south and southeast regions, where most of the
populationisconcentrated,andwherethequality
of health care and information systems are much
better (12, 13).
Rural areas are more affected by snakebites,
presenting high morbidity and mortality rates.
This is due to higher exposure of the population
toriskareas,andtodifficultiesinaccessinghealth
centersthatcanprovidesnakeantivenom,theonly
specific treatment for these accidents. Numerous
victims suffer permanent consequences due to
the necrotic action of venoms. And there are
also psychological consequences. The economic
impact of these accidents is considerable, because
most victims are young (14).
The information on number of accidents

Machado C, et al. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006
per region, types of venom, deaths and the
consequences of accidents are essential for
evaluating the problem and developing public
policies aimed at reducing the number of
accidents,andimprovingmedicalhelpforvictims.
The importance of recording snakebites has been
a concern since Vital Brazil’s time (1865-1950)
(15). The first epidemiological study on ophidism
in Brazil was made in 1901 by Vital Brazil: he
collected the number of deaths from venomous
snakebites in São Paulo state (SP). Since then,
little progress has been made on the knowledge
of ophidism in Brazil, because information
on accidents was scarce and recording not
mandatory.
Beforethe1980s,studiespresentingsignificant
information and detailed epidemiological data
were published by Penteado (16), Amaral (17),
Barroso (18) and Fonseca (19). Due to shortages
in serum production in 1985, the Brazilian
Ministry of Health stated that notification of
snakebites were mandatory from 1986 onward.
Later, itsinclusion in ahealthinformationsystem
for episodic accidents became mandatory as
well. Since then, it became possible to follow
the evolution of these accidents. More and more
epidemiological studies on snakebites have been
conducted in Brazil, especially at a regional level
(13, 20-40).
The small amount of research on snakebite
epidemiology in Rio de Janeiro state, Brazil,
justifies the analysis of the available information,
and comparison of subsequent results with
existing studies from the rest of the country.

MATERIALS AND METHODS

On November 28, 2010, information held
by the Notifiable Diseases Information System
(SINAN) on snakebites that occurred in Rio de
Janeirostatebetween2001and2006wascollected.
The study period is explained by the following:
2001 was the first year in which information was
available online, and 2006 was the most recent
year in which information appears consolidated,
without the need for further revision. Only
accidents involving aggressive venomous snakes
were recognized and taken into account. Cases in
which the snake was identified as non-venomous
were ignored.
In order to analyze the monthly distribution
of accidents in each period, independent of the

JVenom AnimToxins inclTrop Dis | 2012 | volume 18 | issue 2
number of days in the month, a daily average
for accidents was established using the following
formula: number of accidents recorded during a
month divided by number of days in that month.
Even though only secondary data provided by
SINAN was analyzed without identifying any of
the victims, the present study was submitted to
andapprovedbytheEthicsCommitteeonHuman
Research,of Joaquim Venancio Polytechnic
Health School, Oswaldo Cruz Foundation
(Fiocruz) (protocol number 2011/0128).

RESULTS

According to SINAN, 2,431 snakebites were
registered in Rio de Janeiro state between 2001
and 2006. Table 1 shows the distribution of
these accidents by snake genera and age group,
gender, and education level of victims. It also
indicates elapsed time between the accident
and first medical attention, and clinical data on
the severity and evolution of the envenomation.
Figure 1 shows the municipalities with higher
number of notifications. In the period, more than
one hundred accidents occurred in the following
cities: Angra dos Reis (208 cases), the capital Rio
de Janeiro (197), Parati (186), Teresópolis (134),
and Petrópolis (110). Municipalities where the
incidence of snakebites was higher were: Trajano
de Moraes (115.7 per 100,000 inhabitants), Parati
(97.5), Varre-sai (71.6), and Duas Barras (71.3).
The 20 to 39 years age group had the highest
number of victims, 934 cases; 760 males (81.3%),
173 females (18.5%); in only one case the victim
gender was not specified (Figure 2).
Accidents were more frequent between
November and April (Figure 3). In the figure, it is
possible to observe that increase in daily average
of accidents follows a seasonal rhythm, with
values doubling between 2002 and 2006.

DISCUSSION

The predominance of Bothrops snakebites
(96.5%) recorded in Rio de Janeiro state reflects
the national situation (10). This pattern has
also been described for several states including
Amazonas, Amapá, Roraima, Ceará, Sergipe,
Bahia, Paraíba, and Goiás (13, 22, 31-33, 35, 37-
39).
Nearly 35% of all cases in Rio de Janeiro
state were concentrated in five regions: Angra

218

219
Machado C, et al. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006

Table 1. Distribution of snakebites by snake genera; age group, gender, and education level of victims;
elapsed time between accident and first medical attention; and case classification and evolution (Rio de
Janeiro state, 2001 to 2006)
 
Genus of the snake
Total
Variable
Bothrops
Crotalus
Micrurus
Lachesis
Victim’s age group
<1 year
1-4
5-9
10-14
15-19
20-39
40-59
60-64
65-69
70-79
80 and over
Unknown
20
30
95
174
181
896
682
104
86
68
10
1
–
2
–
1
3
32
21
2
2
2
1
–
–
–
2
–
3
4
2
2
–
–
–
–
–
–
–
–
1
2
2
–
–
–
–
–
20
32
97
175
188
934
707
108
88
70
11
1
Victim’s gender
Male
Female
Unknown
1844
498
5
47
19
–
10
3
–
4
1
–
1905
521
5
Education level of the victim
None
1-3 years
4-7 years
8-11 years
12 or more years
Does not apply
Unknown
140
323
485
126
35
115
1123
4
5
11
7
–
2
37
1
–
3
1
1
2
5
–
–
3
–
–
–
2
145
328
502
134
36
119
1167
Elapsed time between the bite and first medical care
0-1 hours
1-3 hours
3-6 hours
6-12 hours
12 or more hours
Unknown
885
871
194
62
51
284
19
24
8
2
3
10
8
2
1
–
1
1
2
2
1
–
–
–
914
899
204
64
55
295
Classification of the case
Minor
Moderate
Severe
Unknown
1083
726
193
345
27
20
14
5
6
1
2
4
2
1
–
2
1118
748
209
356
Evolution of the case
Cure
Cure with sequelae
Death
Unknown
Total
1514
39
2
792
2347
41
–
1
24
66
9
–
–
4
13
3
–
–
2
5
1567
39
3
822
2431
Source: MS/SVS/SINAN

JVenom AnimToxins inclTrop Dis | 2012 | volume 18 | issue 2

Machado C, et al. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006
JVenom AnimToxins inclTrop Dis | 2012 | volume 18 | issue 2
220
Figure1.SpatialdistributionofsnakebitesinRiodeJaneirostatebetween2001and2006(source:MS/SVS/
SINAN).
Figure2.FrequencyofsnakebitesbyagegroupandgenderinRiodeJaneirostatebetween2001and2006
(source: MS/SVS/SINAN).

Machado C, et al. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006
dos Reis, Rio de Janeiro, Parati, Teresópolis,
and Petrópolis. This can be explained by the
concentration of population living in the capital,
and by the concentrated area of natural forest
in the other four municipalities. Municipalities
withmorethan50accidentscontainedimportant
conservation units (national and state parks), the
natural habitat of most venomous snakes.
In the 20-59 year age group, the higher
frequency of accidents in males (81.3%) can
be explained by occupation, as most accidents
happened in rural areas where men work (2).
Similar results for affected males were found in
different states from different regions of Brazil,
varying from 82.1% in the river Purus riverine
community of Amazonas to 53.1% in the north
of Minas Gerais state (27, 19). Albuquerque et al.
(13) found that in Paraíba state 73.2% of victims
were male. Another study on Bothrops snakebites
in Paraíba state by Oliveira et al. (38) showed a
75.1% predominance of male victims in that
region, following the national average.
The seasonal snakebite pattern in Rio de
Janeiro state can be explained by the fact that
snakes are ectothermic animals that need a high
temperature for thermoregulation, which is

JVenom AnimToxins inclTrop Dis | 2012 | volume 18 | issue 2
fundamental for satisfactory metabolism. This
same characteristic has been observed in the
states of Goiás and São Paulo, and in the regions
of northern Minas Gerais and city of Juiz de Fora
(27, 30, 32, 36). In the Campina Grande region,
Paraíba state, and the state of Ceará,the periods
in which most accidents happened were from
July to November and April to September, which
is substantially different from the rest of the
country (28, 31). Seasonal accident distribution
has already been mentioned in several articles on
ophidism in Brazil, mainly in the Amazon area
(22, 23, 29).
According to Lemos et al. (28), as far as the
northeastisconcerned,especiallythecountryside,
there may be a direct relationship between the
increasing number of accidents and harvest
time, as well as the higher rainfalls in the area,
characterizing them as work-related accidents. In
fact, this increase coincides with the migration of
rural workers to the fields. Knowledge on snake
seasonality highlights the months in which there
are higher risks of accidents. This is extremely
important as it alerts healthcare providers, helps
establish distribution strategies and control
of antivenom stocks in health centers, and

221
Figure3.MonthlydistributionofsnakebiteaveragesinRiodeJaneirostatebetween2001and2006(source:
MS/SVS/SINAN).

Machado C, et al. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006
stimulates preventive education campaigns. In
RiodeJaneirostate,45.9%oftheaccidentscaused
by snakes during the study period were classified
as minor. In the consulted literature, snakebite
seriousness in Brazil is generally considered
moderate, as in the states of Bahia and Goiás and
the regions of Juiz de Fora (Minas Gerais state)
and Rio Branco (Acre state), or minor, as in the
regions of northern Minas Gerais, northwest São
Paulo and Campina Grande (Paraíba state) (25,
27, 28, 30, 32, 34, 39).
Concerning snakebites, the time between bite
and first aid is known to be crucial for optimal
treatment outcome. Studies have shown that
the average time between accident and first aid
in Rio de Janeiro state is better than the time
recommendedbytheHealthMinistrytoguarantee
efficient treatment, below six hours (10). In this
study, only 4.8% of the cases were actually treated
six hours or later after the accident and almost all
cases evolved to full cure.
In most Brazilian states, the average time
betweenaccidentandfirstaidwasbelowsixhours.
Only northern regions exceeded this Health
Department recommended time, including
Amapá, the riverine communities of the river
Purus and other cities of Amazonas state, and
some areas of Araguaia (Tocantins state) (22,
24, 29, 35). This delay in commencing first aid is
probably due to the geographic configuration of
these regions, and by the lack of transportation,
oftenbyboatoralongdifficulttracks.Thesituation
for victims in Amazonas is more serious, since
patientsarriveatthehospitalmorethansixhours
after accidents and health professionals do not
offer serotherapy. This practice has no scientific
basis (22).
Ofthe2,431accidentsinRiodeJaneiro,14.6%
were not classified regarding severity and the
evolutionwasunknownornotrecordedin33.8%.
Thesedata,andthefactthat83.0%ofvictimswere
medically treated in less than six hours, suggest
adequate distribution of health centers providing
serotherapy, and a possible substandard level of
data recording.
It is important to highlight the problems
found in recording snakebiteinformationall over
Brazil. Reports showing a lack of information
about the identity of the snake causing the
accident are common: for example, in the state
of Paraíba, this information was missing in more

JVenom AnimToxins inclTrop Dis | 2012 | volume 18 | issue 2
than 29% of cases (13). Failures in recording
antivenom administration were also observed as
well as inappropriate application of anti-Crotalus
antivenom in a case of Bothrops envenomation
and antivenom application in non-venomous
accidents (25, 30, 34,35, 39). Data available
by SINAN do not allow us to evaluate similar
parameters in this study.
Although our results show that the state of
Rio de Janeiro has a good level of medical care, it
could be improved by creating multidisciplinary
teams with doctors, biologists, and nurses. The
Vital Network for Brazil creates a stimulating
environment for conducting this training, with
both traditional and distance learning courses
(41). The number of training hours must be
increased to improve the skills of the professional
teams responsible for victim care.

ACKNOWLEDGEMENTS
TheauthorsthankDr.AntonioJoaquimWerneck
de Castro and Luis Eduardo Ribeiro da Cunha of
Vital Brazil Institute for providing the necessary
facilities, and are also grateful to post-graduation
program in Information and Communication in
Health (PPGICS) of Fiocruz.

COPYRIGHT
© CEVAP 2012

SUBMISSION STATUS
Received: December 15, 2011.
Accepted: March 5, 2012.
Abstract published online: March 6, 2012.
Full paper published online: May 31, 2012.

CONFLICTS OF INTEREST
The authors declare no conflicts of interest.

ETHICS COMMITTEE APPROVAL
ThisstudywasapprovedbytheEthicsCommittee
on Human Research, Joaquim Venancio
Polytechnic Health School, Fiocruz (protocol
number 2011/0128).

CORRESPONDENCETO
Claudio Machado, Instituto Vital Brasil, Rua
Maestro José Botelho, 64, Niterói, RJ, 24230-410,
Brazil. Phone: +55 21 2711 9223 or +55 21 2711
9254. Email: herpetologia@ivb.rj.gov.br.

222

Machado C, et al. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006
REFERENCES

1. Fan HW, Cardoso JLC. Clinical toxicology of snake
bites in South America. In: Meier J, White J, editors.
Handbook of clinical toxicology of animal venoms
and poisons. Florida: CRC Press; 1995. 667-88 p.
2. Gutierrez JM. Clinical toxicology of snake bites
in Central America. In: Meier J, White J, editors.
Handbook of clinical toxicology of animal venoms
and poisons. Florida: CRC Press; 1995. 645-65 p.
3. Chippaux JP. Snake-bites: appraisal of the global
situation. Bull World Health Organ. 1998;76(5):515-
24.
4. Warrell DA. Epidemiology, clinical features and
management of snake bites in Central and South
America. In: Campbell J, Lamar WW, editors.
VenomousreptilesoftheWesternHemisphere.Ithaca:
Cornell University Press; 2004. 709-61 p.
5. Arfaoui A, Hmimou R, Ouammi L, Soulaymani A,
Mokhtari A, Chafiq F, et al. Epidemiological profile
of snakebites in Morocco. J Venom Anim Toxins incl
Trop Dis. 2009;15(4):653-66.
6. Cesaretli Y, Ozkan O. Snakebites in Turkey:
epidemiological and clinical aspects between the years
1995 and 2004. J Venom Anim Toxins incl Trop Dis.
2010;16(4): 579-86.
7. Chippaux JP. Control of ophidism in Brazil: a model
for Africa. J Venom Anim Toxins incl Trop Dis.
2010;16(2):188-90.
8. Snake bite: time to stop the neglect. Lancet.
2010;375(9708):2.
9. WarrellAD.Snakebite.Lancet.2010;375(9708):77-88.
10. Brasil.MinistériodaSaúde.SecretariadeVigilânciaem
Saúde. Departamento de Vigilância Epidemiológica.
Doenças infecciosas e parasitárias: guia de bolso. 8th
ed. Brasília: Ministério da Saúde; 2010. 444 p.
11. Lira-da-Silva RM, Mise YF, Brasil TK, Casais-e-Silva,
LL, Carvalho FM. Morbimortalidade por ofidismo
no Nordeste do Brasil (1999 – 2003). Gaz Méd Bahia.
2009;79(Supl 1):21-5.
12. Araújo FAA, Santalúcia M, Cabral R. Epidemiologia
dos acidentes por animais peçonhentos. In: Cardoso
JLC, França FOS, Fan HW, Malaque CMS, Haddad V
Jr, editors. Animais peçonhentos no Brasil: biologia,
clínica e terapêutica dos acidentes. 1st ed. São Paulo:
Sarvier; 2003. 6-12 p.
13. Albuquerque HN, Fernandes A, Albuquerque ICS.
Snakebites in Paraíba, Brazil. J Venom Anim Toxins
incl Trop Dis. 2005;11(3):242-51.
14. Kasturiratne A, Wickremasinghe AR, Silva N,
Gunawardena NK, Pathmeswaran A, Premaratna
R, et al. The Global Burden of snakebite: a literature
analysis and modelling based on regional estimates of
envenoming and deaths. PLoS Med. 2008;5(11):e218.
15. BochnerR,StruchinerCJ.Epidemiologiadosacidentes
ofídicos nos últimos 100 anos no Brasil: uma revisão.
Cad Saúde Pública. 2003;19(1):7-16.
16. Penteado DC. Accidentes ophidicos: effeitos do
tratamento específicos sobre a mortalidade ophídica.
In: Coletânea de trabalhos do Instituto Butantan

JVenom AnimToxins inclTrop Dis | 2012 | volume 18 | issue 2
17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28

29.

30.
(1901-1917). São Paulo: Instituto Butantan; 1918. p.
325-31.
Amaral A. Campanhas anti-ophidicas. Mem Inst
Butantan. 1930;5(1):195-232.
Barroso RD. Ofidismo no Brasil: considerações em
torno de 2.238 acidentes ofídicos tratados com soro.
Bol Inst Vital Brazil. 1944;26(1):35-47.
Fonseca F. Animais peçonhentos. São Paulo: Empresa
Gráfica da Revista dos Tribunais/Instituto Butantan;
1949. 376 p.
Martinez EG, Vilanova MCT, Jorge MT, Ribeiro LA.
Aspectos epidemiológicos do acidente ofídico no Vale
doRibeiro,SãoPaulo,1985a1989.CadSaúdePública.
1995;11(3):511-5.
Da Silva ERO, Lofego AC. Acidentes ofídicos na
região de São José do Rio Preto (SP). Revista UNORP.
2005;4(12):128-33.
Borges CC, Sadahiro M, Santos MC. Aspectos
epidemiológicos e clínicos dos acidentes ofídicos
ocorridos nos municípios do Estado do Amazonas.
Rev Soc Bras Med Trop. 1999;32(6):637-46.
Pardal PPO, Monteiro MRCC, Arnaund RN, Lopes
FOB, Asano ME. Aspectos epidemiológicos de 465
acidentes ofídicos atendidos no HUJBB – Belém – Pará
no período de 1993 a 1994. Rev Soc Bras Med Trop.
1995;28(Supl 1):170.
PaulaNetoJB,RibeiroRSP,LuzJA,GalvãoM,Carvalho
SMD, Haddad V Jr. Clinical and epidemiological
characteristics of injuries caused by venomous snakes
observed at the hospital for tropical diseases of
Araguaína, Tocantins State, Brazil, from 1995 to 2000.
J Venom Anim Toxins incl Trop Dis. 2005;11(4):422-
32.
Rojas CA, Gonçalves MR, Almeida Santos, SM.
Epidemiologia dos acidentes ofídicos na região
noroeste do Estado de São Paulo, Brasil. Rev Bras
Saúde Prod An. 2007;8(3):193-204.
Hote PS, Silva DJS, Roberti HM, Povoa HCC. Estudo
epidemiológico dos acidentes por serpentes do gênero
Bothrops na região de Muriaé. In: III Encontro de
Iniciação Científica da FAMINAS zona da mata, 2006,
Muriaé. Anais do III Encontro de Iniciação Científica
da FAMINAS zona da mata. Muriaé: Editora
FAMINAS; 2006. 207 p. 3 vol.
Lima JS, Martelli Junior H, Martelli DRB, Silva MS,
Carvalho SFG, Canela JR, et al. Perfil dos acidentes
ofídicos no norte do Estado de Minas Gerais, Brasil.
Rev Soc Bras Med Trop. 2009;42(5):561-4.
Lemos JC, Almeida TD, Fook SM, Paiva AA, Simões,
MOS.Epidemiologiadosacidentesofídicosnotificados
pelo Centro de Assistência e Informação Toxicológica
de Campina Grande (Ceatox-CG), Paraíba. Rev Bras
Epidemiol. 2009;12(1):50-9.
Waldez F, Vogt RC. Aspectos ecológicos e
epidemiológicosdeacidentesofídicosemcomunidades
ribeirinhasdobaixorioPurus,Amazonas,Brasil.Acta
Amaz. 2009;39(3):681-92.
Barreto BB, Santos PLC, Martins FJ, Barbosa NR,
Ribeiro LC, Leite ICG, et al. Perfil epidemiológico dos
acidentes ofídicos no município de Juiz de Fora – MG
no período de 2002-2007. Rev APS. 2010;13(2):190-5.

223

Machado C, et al. Epidemiological profile of snakebites in Rio de Janeiro, Brazil, 2001-2006
31. Feitosa RF, Melo IM, Monteiro HS. Epidemiologia dos
acidentes por serpentes peçonhentas no Estado do
Ceará-Brasil.RevSocBrasMedTrop.1997;30(4):295-
301.
32. PinhoFMO,OliveiraES,FaleirosF.Acidenteofídicono
Estado de Goiás. Rev Assoc Med Bras. 2004;50(1):93-
6.
33. Vilar JC, Carvalho CM, Furtado MFD. Epidemiologia
dos acidentes ofídicos em Sergipe (1999-2002). Biol
Geral Exper. 2004;4(2):3-13.
34. Moreno E, Queiroz-Andrade M, Lira-da-Silva RM,
Tavares-Neto J. Características clínicoepidemiológicas
dos acidentes ofídicos em Rio Branco, Acre. Rev Soc
Bras Med Trop. 2005;38(1):15-21.
35. Lima ACSF, Campos CEC, Ribeiro JR. Perfil
epidemiológico de acidentes ofídicos do Estado do
Amapá. Rev Soc Bras Med Trop. 2009;42(3):329-35.
36. Ribeiro LA, Albuquerque MJ, Pires de Campos
VAF, Katz G, Takaoka NY, Lebrão ML, et al. Óbitos
por serpentes peçonhentas no Estado de São Paulo:
avaliação de 43 casos, 1988/93. Rev Ass Med Brasil.
1998;44(4):312-8.
37. Nascimento SP. Aspectos epidemiológicos dos
acidentes ofídicos ocorridos no Estado de Roraima,
Brasil, entre 1992 e 1998. Cad Saúde Pública.
2000;16(1):271-6.

JVenom AnimToxins inclTrop Dis | 2012 | volume 18 | issue 2
38. Oliveira FN, Brito MT, Morais ICO, Fook SML,
Albuquerque HN. Accidents caused by Bothrops and
Bothropoides in the State of Paraíba: epidemiological
and clinical aspects. Rev Soc Bras Med Trop.
2010;43(6):662-7.
39. Mise YF, Lira-da-Silva RM, Carvalho FM.
Envenenamento por serpentes do gênero Bothrops no
Estado da Bahia: aspectos epidemiológicos e clínicos.
Rev Soc Bras Med Trop. 2007;40(5):569-73.
40. Rodrigues CK, Koch MC, Sgrott I, Mello FM, Grando
M, Zannin M. Aspectos clínicos epidemiológicos
dos acidentes por Micrurus registrados no CIT/SC.
In:Reunião Anual da SBPC, 58ª, 2006, Florianópolis
Santa Catarina: Universidade Federal de Santa
Catarina; 2006.
41. Brazil TK, Melgarejo AR, Werneck de Castro AJ,
BarravieraB,SouzaCM,BrazilEV,etal.Vitalnetwork
forBrazil:nationalnetworkofinformation,discussion
and cooperation concerning venomous animals. J
Venom Anim Toxins incl Trop Dis. 2011;17(3):235-6.

224