Snakebite Envenomations In The Brazilian Amazon: A Little Less Neglected.

Snakebite envenomations have a disproportionate burden in the Brazilian Amazon compared to other regions of Brazil. Studies conducted in the state of Amazonas show that Bothrops atrox snakebites are the most common, occurring in every municipality of the state. All the 62 municipalities in the state have at least one urban health unit that offers antivenom treatment. The most affected populations in terms of incidence and fatality rate are riverine communities and indigenous people, who have limited access to antivenom treatment. A significant proportion of cases are not reported to the official surveillance system, and many deaths occur due to lack of medical care. In the last decade, important advances have been made in research into snakebites in the state of Amazonas, in a collaborative network led by the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, a referral institution for patient care, teaching and research in tropical medicine. Findings on the burden of disease in vulnerable populations; clinical, therapeutic and pathophysiological aspects; long-term disabilities; barriers to antivenom treatment; and cultural aspects of snakebites, are presented in this paper. We highlight the findings of the SAVING Program, which aimed to implement a culturally tailored antivenom decentralization program in indigenous community-health centers. We conclude by presenting a priority research agenda for snakebites for the coming years in the Amazon region.