Skip to main content
SpringerLink
Log in

Epidemiology of Snake Envenomation in Taiwan

  • Reference work entry
  • First Online:
Clinical Toxinology in Asia Pacific and Africa

Part of the book series: Toxinology ((TOXI,volume 2))

Abstract

There are six major venomous snakes in Taiwan including 3 crotalids, Trimeresurus (Viridovipera) stejnegeri, Protobothrops mucrosquamatus, and Deinagkistrodon acutus; 1 viperid, Daboia russelli siamensis; and 2 elapids, Naja atra and Bungarus multicinctus. The annual incidence of these venomous snakebites has increased from 361.3 to 965.5 cases in the past 70 years, while the incidence rate declines from 8.8 to 4.3 cases per 100,000 person-years. Overall, the highest frequency of bites is observed for, in descending order, T. stejnegeri, P. mucrosquamatus, B. multicinctus, N. atra, D. acutus, and D. r. siamensis. However, the distribution of snakebites varies throughout the country and between hospitals and has changed with time. In northern and southern Taiwan, T. stejnegeri and P. mucrosquamatus snakebites account for the majority of cases; in central Taiwan, cases of N. atra bites predominate, whereas cases of D. r. siamensis bites only scattered in the southern and eastern areas. In Sawai’s studies during 1960s–1970s, the case fatality rate for T. stejnegeri, P. mucrosquamatus, N. atra, and B. multicinctus bites was 0 %, 1.4 %, 1.6 %, and 7.1 %, respectively. In a recent study, three deaths were reported among 3,862 snakebite cases during 2002–2005. Snakebite is an occupational and environmental disease in Taiwan, generally involving middle-aged males, with a ratio of male to female victims of 2–3:1. Snakebites usually occur in the warm season (April–October) on farmlands, in homes, or on roads. Knowledge of the habitats and habits of venomous snakes could be helpful in the identification of offending snakes and the prevention of snakebites.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake bite in South Asia: a review. PLoS Negl Trop Dis. 2010;4:e603.

    Article  PubMed Central  PubMed  Google Scholar 

  • Chang KP, Lai CS, Lin SD. Management of poisonous snake bites in southern Taiwan. Kaohsiung J Med Sci. 2007;23:511–18.

    Article  PubMed  Google Scholar 

  • Chen JC, Liaw SJ, Bullard MJ, Chiu TF. Treatment of poisonous snakebites in northern Taiwan. J Formos Med Assoc. 2000;99:135–9.

    CAS  PubMed  Google Scholar 

  • Chen CF, Lin TJ, Hsu WC, Yang HW. Appropriate antivenom doses for six types of envenomations caused by snakes in Taiwan. J Venom Anim Toxins Incl Trop Dis. 2009a;15:479–90.

    Google Scholar 

  • Chen YW, Chen MH, Chen YC, Hung DZ, Chen CK, Yen DH, Huang CI, Lee CH, Wang LM, Yang CC. Differences in clinical profiles of patients with Protobothrops mucrosquamatus and Viridovipera stejnegeri envenoming in Taiwan. Am J Trop Med Hyg. 2009b;80:28–32.

    PubMed  Google Scholar 

  • Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Health Organ. 1998;76:515–24.

    CAS  PubMed Central  PubMed  Google Scholar 

  • Hsiang GS, Li PX, Yang YJ. Illustrated handbook of Taiwan amphibia and reptiles. Taipei: Owl Publishing Co.; 2009.

    Google Scholar 

  • Hu SC, Kao WF, Tsai J, Chern CH, Yen D, Lo HC, Lee CH. Analysis of prehospital ALS cases in a rural community. Zhonghua Yi Xue Za Zhi (Taipei). 1996;58:171–6.

    CAS  Google Scholar 

  • Huang RJ, Chen SW, Chen TK, Liau MY. The detoxification of Naja naja atra venom and preparation of potent antivenin. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi. 1985;18:177–83.

    CAS  PubMed  Google Scholar 

  • Huang RJ, Liau MY, Chen SW, Chen TK. Preparation of highly potent hemorrhagic antivenin. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi. 1986;37:410–15.

    Google Scholar 

  • Hung DZ. Taiwan’s venomous snakebite: epidemiological, evolution and geographic differences. Trans R Soc Trop Med Hyg. 2004;98:96–101.

    Article  PubMed  Google Scholar 

  • Hung DZ, Lin-Shiau SY. Studies on the diagnosis, treatment and toxic mechanism of Taiwan venomous snakebites [Doctoral dissertation]. Taipei: Graduate Institute of Toxicology, College of Medicine, National Taiwan University; 2001.

    Google Scholar 

  • Hung DZ, Liau MY, Lin-Shiau SY. The clinical significance of venom detection in patients of cobra snakebite. Toxicon. 2003;41:409–15.

    Article  CAS  PubMed  Google Scholar 

  • Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, Savioli L, Lalloo DG, de Silva HJ. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:e218.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kuo TP, Wu CS. Clinico-pathological studies on snakebites in Taiwan. Taiwan Yi Xue Hui Za Zhi. 1972;71:447–66.

    CAS  PubMed  Google Scholar 

  • Liang WJ, Tung YM, Wang HJ. Treatment of snakebite in Taiwan – analysis of 100 cases. J Med Sci. 1992;13:51–6.

    Google Scholar 

  • Liao WB, Lee CW, Tsai YS, Liu BM, Chung KJ. Influential factors affecting prognosis of snakebite patients management: Kaohsiung Chang Gung Memorial Hospital experience. Chang Gung Med J. 2000;23:577–83.

    CAS  PubMed  Google Scholar 

  • Liau MY. The development of vaccine on Taiwan. Sci Mon. 1999;30:541–643.

    Google Scholar 

  • Liau MY, Huang RJ. Toxoids and antivenoms of venomous snakes in Taiwan. Toxin Rev. 1997;16:163–75.

    Article  CAS  Google Scholar 

  • Liau MY, Huang RJ, Chen SW. Enhancement of Naja naja atra antivenin production in horses. Zhonghua Min Guo Wei Sheng Wu Ji Mian Yi Xue Za Zhi. 1982;15:294–9.

    CAS  PubMed  Google Scholar 

  • Liau MY, Fuh TH. Studies on the toxoids and antivenins of Formosan venomous snakes [Doctoral dissertation]. Taipei: School of Veterinary Medicine, National Taiwan University; 1991.

    Google Scholar 

  • Lin HC. Current conservation of land snakes in Taiwan. Sci Mon. 2001;32:398–405.

    Google Scholar 

  • Lin CS, Chang H, Shyu KG, Liu CY, Lin CC, Hung CR, Chen PH. A method to reduce response times in prehospital care: the motorcycle experience. Am J Emerg Med. 1998;16:711–13.

    Article  CAS  PubMed  Google Scholar 

  • Liu ZM. The animal study on Taiwan during Japanese colonial period. In: Proceedings of the 2005 Conference on the History of Science. Taipei: International Union of the History and Philosophy of Science, Division of History of Science, National Committee of the Republic of China; 2005. p. 182–187.

    Google Scholar 

  • Liu JX, Jiang DX, Lian WC, Liu DP. The epidemiological study of antivenin prescription during 2002–2005 on Taiwan. Yi Qing Bao Dao. 2009;25:466–78.

    CAS  Google Scholar 

  • Mao SS. Common terristrial venomous snakes of Taiwan. National Museum of Natural Science. Special publication 5; 1993. p. 1–116.

    Google Scholar 

  • Miao BL, Huang RJ, Hu MS, Liau MY. Venomous snake bites in Taiwan (1988–1991). Chin J Public Health. 1995;14:455–560.

    Google Scholar 

  • Oshima M. Notes on the venomous snakes from the islands of Formosa and Riu Kiu. Annual report of the Institute of Science, Government of Formosa, Taiwan; 1920;8:10.

    Google Scholar 

  • Research and manufacture of serums and vaccines. Construction books series 64. Taiwan: Department of Information, Taiwan Provincial Government; 1971.

    Google Scholar 

  • Sawai Y, Tseng CS. Snakebites on Taiwan. The Snake. 1969;1:9–18.

    Google Scholar 

  • Sawai Y, Tseng CS, Kuo TP, Wu CS. Snakebites in Kaohsiung Prefecture, Taiwan. The Snake. 1970;2:13–7.

    Google Scholar 

  • Sawai Y, Koba K, Okonogi T, Mishima S, Kawamura Y. An epidemiological study of snakebites in the Southeast Asia. Jpn J Exp Med. 1972;42:283–307.

    CAS  PubMed  Google Scholar 

  • Shen CS. A study of the history of immunology in Taiwan during the period of Japanese administration: a study from the development of the Central Research Institutions. Res Taiwan Stud. 2012;13:161–84.

    Google Scholar 

  • Shih YC, Ma H, Yeh FL, Lin JT, Hwang CH, Wang MS, Perng CK, Shen BH, Chen CH. Risk factors of surgical intervention in the management of venomous snakebite in Taiwan. J Plast Surg Assoc ROC. 2006;15:367–76.

    Google Scholar 

  • To S. Statistical studies of poisonous snakebites in Formosan. J Formos Med Assoc. 1941;40:1477–502; 1795–824.

    Google Scholar 

  • Tu MC. Amazing snakes. Yuang-Liou Publishing; 2008.

    Google Scholar 

  • Warrell DA. WHO SEARO Guidelines for the clinical management of snake-bites. 2nd edition. India: WHO Regional Office for South-East Asia. 2010a.

    Google Scholar 

  • Warrell DA. Snake bite. Lancet. 2010b;375:77–88.

    Google Scholar 

  • Wu ML, Tsai WJ, Ger G, Hung DZ, Deng JF. Snake bites-the cases analysis of National Poison Control Center. In: Conference of occupational disease and management of snakebites, Taipei; 1999.

    Google Scholar 

  • Xu YL, Wu JR, Zhou ZZ, Xie WQ, Zheng YF, Jiang ZR. The production of snake antivenom in Taiwan: the retrospects and prospects. Yi Qing Bao Dao. 2013;29:64–9.

    Google Scholar 

  • Yang CC, Wu ML, Ong HC, Hung SC, Kuo YP, Sa CH, Chen SS, Deng JF. Taiwan National Poison Center: epidemiologic data 1985–1993. J Toxicol Clin Toxicol. 1996;34:651–63.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, 40705, Taichung, Taiwan

    Yan-Chiao Mao

  2. Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Yan-Chiao Mao

  3. Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Yan-Chiao Mao

  4. Division of Toxicology, Trauma and Emergency Center, China Medical University Hospital, 2 Yude Road, 40447, Taichung, Taiwan

    Dong-Zong Hung

  5. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan

    Dong-Zong Hung

Authors
  1. Yan-Chiao Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dong-Zong Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yan-Chiao Mao .

Editor information

Editors and Affiliations

  1. Venom and Toxin Research Programme Department of Anatomy, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore

    P. Gopalakrishnakone

  2. Professor of Medicine (Rtd), Sir Salimullah Medical College, Dhaka, Bangladesh

    Abul Faiz

  3. Department of Forensic Medicine and Toxicology, University of Colombo, Colombo, Sri Lanka

    Ravindra Fernando

  4. Department of Clinical Medicine Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Christeine Ariaranee Gnanathasan

  5. Infectious and Tropical Diseases Unit Department of Medicine, Bayero University Kano Aminu Kano Teaching Hospital, Kano, Nigeria

    Abdulrazaq Garba Habib

  6. Department of Medicine, School of Medicine National Yang-Ming University, Taipei, Taiwan

    Chen-Chang Yang

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media Dordrecht

About this entry

Cite this entry

Mao, YC., Hung, DZ. (2015). Epidemiology of Snake Envenomation in Taiwan. In: Gopalakrishnakone, P., Faiz, A., Fernando, R., Gnanathasan, C., Habib, A., Yang, CC. (eds) Clinical Toxinology in Asia Pacific and Africa. Toxinology, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6386-9_45

Download citation

Publish with us

Policies and ethics

Search

Navigation