Strengthening public health programmes and the antivenom ecosystem: strategic policy priorities to combat envenomation by animal bites and stings in Latin America and the Caribbean.

BACKGROUND: Envenomation by snakes, scorpions, spiders, and caterpillars remains a major but unevenly addressed public health challenge in Latin America and the Caribbean (LAC). Environmental change, urbanisation, and ecological disruption are changing the distribution of medically important species, while persistent gaps in surveillance, clinical management, and antivenom availability limit prevention and care. In this study, we analysed epidemiological trends, health system capacity, and the regional antivenom ecosystem to inform strategic public health priorities.

METHODS: We analysed secondary data from regional surveys coordinated by Pan American Health Organization networks for the period 2019-2024. We used negative binomial regression models to assess temporal trends in total cases and deaths from four major envenomations and to generate projections up to 2030. We used spatial analyses to examine heterogeneity in incidence, mortality, and case-fatality rates, and evaluated antivenom production, procurement, and use with indicators standardised to epidemiological burden. We complemented the quantitative findings with qualitative content analysis of regional and meeting reports.

RESULTS: The incidence of all envenomations showed an increasing trend over time, with particularly marked increases in spider bites and caterpillar contacts. We observed spatial heterogeneity across countries. Overall mortality remained low for most envenomations, while the case-fatality rate for spider envenomation was projected to increase by 2030 if the observed trends continued. We identified weaknesses in surveillance quality, risk mapping, clinical preparedness, and follow-up of sequelae. We also identified mismatches between antivenom production, procurement, and therapeutic use, varying by envenomation type. Regional initiatives have strengthened coordination but have not fully resolved inequities in access and preparedness.

CONCLUSIONS: Envenomation in LAC remains an expanding and evolving public health challenge requiring coordinated, forward-looking responses. While acknowledging limitations in data quality and the need for longer-term evidence, our findings provide a system-level analysis and generate scientifically and policy-relevant evidence, supporting a targeted action framework to advance progress toward the World Health Organization 2030 targets for reducing envenomation-related morbidity and mortality.