Reference Work Entry

Clinical Toxinology in Asia Pacific and Africa

Volume 2 of the series Toxinology pp 3-22


Epidemiology of Snake Envenomation in Taiwan

  • Yan-Chiao MaoAffiliated withDivision of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General HospitalDivision of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General HospitalInstitute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University Email author 
  • , Dong-Zong HungAffiliated withDivision of Toxicology, Trauma and Emergency Center, China Medical University HospitalGraduate Institute of Clinical Medical Science, China Medical University


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.