The disease that bites - an assessment of demographics, clinical characteristics, and treatment practices of patients with snakebite envenoming across Vietnam.

Background: Snakebite envenoming presents a significant burden to the health care system in Vietnam. However, data on snakebite-related hospital visits and the availability of antivenom across the country remain scarce. Furthermore, details on clinical presentation, responsible snakes, and treatment practices are lacking. Methods: In this retrospective, cross-sectional study, we collected data on snakebite-related visits and antivenom availability in major hospitals across 40 provinces from 2018 to 2022 and analysed a subset of patients' files. We displayed the geographical distribution of snakebite-related visits, available antivenoms, and responsible snake species across Vietnam, described the clinical presentations of envenoming, and assessed the appropriateness of treatment practices. Results: We recorded 23 877 snakebite-related visits from 2018 to 2022. Antivenom was available in 29 of 62 (46.8%) hospitals, more commonly in the southern provinces. In 2024 patient files, signs of haemotoxic envenoming and neurotoxic envenoming were recorded in 445 (22.0%) and 59 (2.9%) patients, respectively. The most frequently recorded snake genera were Trimeresurus and Naja. Antivenom was administered to 434 (33.9%) of the 1280 patients from antivenom-equipped hospitals. Ancillary treatments were commonly used: 1076 (53.1%) patients received antibiotics, and 940 (46.4%) received corticosteroids. In-hospital mortality was low at 0.3% and was mainly due to neurotoxic envenoming. Conclusions: We recorded a considerable number of snakebite-related visits in participating hospitals; however, antivenom availability was limited, and treatment practices were often inappropriate. Improving access to antivenom and updating national guidelines are essential to further reduce morbidity and mortality of snakebite in Vietnam.