How many venemous snakebites are estimated to occur annually, globally and in the United States?

Answer

The World Health Organization (WHO) estimates there are up to 1.8 million bites from venomous snakes annually worldwide, causing 20,000-90,000 deaths.^[1]The vast majority of venomous snake species are viperids (eg, rattlesnakes, Gaboon vipers) or elapids (eg, cobras, taipans). Although most snakes in the Colubridae family are nonvenomous, some (eg, boomslang) are venomous and responsible for significant morbidity and mortality.

In the United States, several thousand snakebites occur every year, resulting in fewer than 10 deaths.^{[2, 3, 4, 5]}There are four types of venomous snakes native to the United States: copperheads, cottonmouths (water moccasins), rattlesnakes, and coral snakes. The first three are crotalids in the family Viperidae, subfamily Crotalinae. There are approximately 25 species of rattlesnakes in the genera Crotalus and Sistrurus. The genus Agkistrodon has both copperheads (Agkistrodoncontortrix, Agkistrodonlaticinctus) and cottonmouths (Agkistrodonpiscivorus, Agkistrodonconanti). Collectively, these crotalids, also known as pit vipers, account for greater than 95% of all native snake envenomations.

Coral snakes are the only elapids that are native to the Western hemisphere, and the three species of US coral snakes account for less than 5% of all native envenomations.

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Media Gallery

Eastern copperhead, Agkistrodon contortrix. Courtesy of Spencer Greene, MD.
Broad-banded copperhead, Agkistrodon laticinctus. Courtesy of Kimberly Wyatt.
Western cottonmouth, Agkistrodon piscivorus leucostoma. Courtesy of Kimberly Wyatt.
Western diamondback rattlesnake, Crotalus atrox.
Texas coral snake, Micrurus tener. Courtesy of Chip St. John.
Comparison of the harmless Mexican milksnake, Lampropeltis triangulum annulata (top) with the Texas coral snake, Micrurus tener (bottom). Courtesy of Charles Alfaro.
Aberrant Texas coral snake, Micrurus tener. Courtesy of Reece Hammock.
Juvenile southern Pacific rattlesnake, Crotalus oreganus helleri. Courtesy of Sean Bush, MD.
Copperhead bite day 3; initial wounds were to finger.
Moderate rattlesnake envenomation in a toddler after treatment with antivenom. Courtesy of Sean Bush, MD.
Hemorrhagic bleb following Eastern copperhead (Agkistrodon contortrix) envenomation. Courtesy of Spencer Greene, MD.
Proper elevation of upper extremity bite. Courtesy of Spencer Greene, MD.
Swelling and bruising after crotalid envenomation. Courtesy of Spencer Greene, MD.
Copperhead bite day 3; initial wounds were to finger.
Copperhead bite day 3; initial wounds were to finger.
Superficial necrosis following copperhead envenomation. Courtesy of Spencer Greene, MD.
Petechiae 1 week after being treated for black-tailed rattlesnake (Crotalus molossus) envenomation; platelet count = 2,000 (reference range 150,000-450,000). Courtesy of Daniel Jarvis.

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Author

Spencer Greene, MD, MS, FACEP, FACMT, FAAEM President, Bayou City Medical Toxicology and Emergency Medicine Consultants, PLLC

Spencer Greene, MD, MS, FACEP, FACMT, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, East Texas Herpetological Society, Texas College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Sean P Bush, MD, FACEP Professor of Emergency Medicine, The Brody School of Medicine at East Carolina University

Sean P Bush, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Society on Toxicology, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Daniel R Ouellette, MD, FCCP Associate Professor of Medicine, Wayne State University School of Medicine; Medical Director, Pulmonary Medicine General Practice Unit (F2), Senior Staff and Attending Physician, Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital

Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Brian J Daley, MD, MBA, FACS, FCCP, CNSC Professor and Program Director, Department of Surgery, Chief, Division of Trauma and Critical Care, University of Tennessee Health Science Center College of Medicine

Brian J Daley, MD, MBA, FACS, FCCP, CNSC is a member of the following medical societies: American Association for the Surgery of Trauma, Eastern Association for the Surgery of Trauma, Southern Surgical Association, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, Tennessee Medical Association

Disclosure: Nothing to disclose.

Lisa Kirkland, MD, FACP, FCCM, MSHA Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; Chair, Department of Critical Care, ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, FCCM, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Chandler Long, MD Resident Physician, Department of Surgery, University of Tennessee Medical Center-Knoxville

Disclosure: Nothing to disclose.

A Mariah Alexander, MD Resident Physician, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville

A Mariah Alexander, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Sneha Bhat, MD Resident Physician, Department of Surgery, University of Tennessee Health Science Center College of Medicine

Disclosure: Nothing to disclose.

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