Renal failure and death after multiple stings in Papua New Guinea. Ecology, prevention and management of attacks by vespid wasps.

Although most species of wasps are solitary and no hazard to humans, attacks by colonies of large social wasps of the family Vespidae, which commonly are known as hornets, can result in envenomation with severe toxicity. The effects of such envenomation on six persons from Papua New Guinea are described and discussed in the light of other published reports from Melanesia, Asia, Europe and America. Four deaths and at least four cases of acute renal failure occurred. Vespa affinis (L.), 1764 was responsible for at least two deaths and Vespa tropica (L.), 1764 for one death. The ecology of vespids in Asia and the Pacific is reviewed and guide-lines for the prevention of wasp attacks are outlined, including appropriate clothing, and the recognition, avoidance and selective destruction of nests. A description is helpful in the identification of the species of insect that was responsible for clinical cases. Management includes hospitalization for victims of multiple stings, with careful monitoring for early and late damage to kidneys, blood, liver and muscle.