This study re-evaluates the global burden of snake envenoming (SE) using an updated literature review and geostatistical modelling. The review included publications in any language up to March 31, 2025. Country- and region-level aggregated data, hospital records and community-based surveys were used to estimate incidence and mortality. Low and high burden scenarios were generated, accounting for potential underreporting where relevant.
The authors report conservative estimates of at least 2.1 million envenomings and 274,000 deaths annually worldwide. Upper-bound estimates indicate up to 7 million envenomings and 513,000 deaths per year. Low-income countries carry the highest incidence and mortality; sub-Saharan Africa accounts for 45% of global envenomings and deaths. The study highlights substantial data gaps and heterogeneity of observations, which increase uncertainty in many country estimates.
The authors updated global snakebite estimates because existing figures were based on limited, often dated data and likely underestimated the burden. They systematically reviewed literature up to March 2025 and applied geostatistical methods to produce spatially explicit estimates for countries with snakes, including those with sparse or no direct data. Key findings were the multi-million annual envenomings and hundreds of thousands of deaths, with the greatest burden in low-income countries, particularly sub-Saharan Africa, South Asia, and Southeast Asia. The summary stresses the need for improved surveillance, access to antivenom, and strengthened clinical care.
Snake envenoming predominantly affects resource-poor, rural agricultural communities in tropical and subtropical regions and imposes substantial medical and economic burdens. Survivors often experience disability and long-term health consequences that reduce quality of life. Recognition of the problem led WHO to list snake envenoming among Neglected Tropical Diseases in 2017. Despite that recognition, reliable incidence and mortality data from the rural areas where bites are most common remain scarce.
Most prior estimates derive from hospital returns or incomplete databases and therefore undercount bites and deaths because many victims do not present to formal health facilities and may seek traditional treatment. Incidence varies geographically and seasonally; regional heterogeneity has been documented both between and within countries. These limitations motivated a comprehensive update using all available published data and spatial modelling to better characterise global and regional burdens.
The authors performed a new literature search for reports of snakebites, envenomings and mortality through March 31, 2025, with no language restriction. They collated country- and region-level aggregated data and extracted information from hospital-based and community-based surveys. Explanatory covariates reflecting social and natural environmental conditions were selected to inform the spatial models.
Geostatistical models produced individual-country estimates under low and high scenarios. The modelling framework accounted for potential underreporting in settings where healthcare-seeking and data collection are limited. The study made the data and code available via a public repository, and all relevant data are included within the manuscript and supporting information.
Using the assembled evidence and geostatistical methods, the authors estimate a conservative global burden of at least 2.1 million snake envenomings and 274,000 deaths annually. High-bound model outputs suggest the burden could be as high as 7 million envenomings and 513,000 deaths per year.
Burden is disproportionately concentrated in low-income countries. Sub-Saharan Africa accounts for 45% of global envenomings and deaths, with incidence nearly three times that estimated for South Asia. South Asia and Southeast Asia are also identified as severely affected regions. These updated estimates imply that previous global burden figures may substantially underestimate the true scale of snakebite-related disease and mortality.
Implications
The findings indicate that snake envenoming remains an important cause of morbidity and mortality worldwide and may affect far more people than earlier estimates indicated. This has implications for resource allocation: improved prevention strategies, enhanced surveillance, wider access to effective antivenom, and stronger clinical capacity are required, particularly in the most affected regions.
Limitations
The principal limitations are the scarcity and heterogeneity of empirical data across many countries, and the consequent reliance on modelling assumptions in settings with limited or no observations. Countries with little or no direct information have greater uncertainty in their estimates. The authors acknowledge that these constraints reduce precision and necessitate caution when interpreting country-level figures.
Recommendations
The authors call for improved quality and coverage of epidemiological data, particularly in sub-Saharan Africa where the burden and uncertainty are greatest. Enhanced surveillance systems, more representative community surveys, transparent reporting of hospital data, and investment in antivenom availability and clinical training are identified as priorities to reduce morbidity and mortality and to enable more accurate future estimates.
All relevant data are provided in the manuscript and supporting information, and the code used for analyses is publicly accessible in a GitHub repository referenced by the authors. The research was funded by the Medical Research Council (grant MR/P024513/1). The funders did not influence study design, data collection and analysis, decision to publish, or manuscript preparation. One author reports membership of WHO committees on snakebite and the Global Snakebite Taskforce; other authors declared no competing interests.