Factors involved in the resilience of incidence and decrease of mortality from scorpion stings in Mexico

In Mexico, scorpion sting envenomation (SSE) is a significant public health issue that has engaged the attention of health authorities for more than a century. Rigorously characterized today, scorpion sting incidence is stable around 230 stings per 100,000 population, i.e. 300,000 annual stings treated in Mexican health centers and hospitals. Higher incidence is observed mainly in central and Pacific Mexico. Scorpion populations thrive in populated places, particularly in impoverished areas. Scorpion stings occur in houses. This could explain similar incidence according to gender and age. The number of scorpion stings has remained stable since the mid-2000s. In contrast, mortality, which was over 1500 deaths per year before the 1960s, underwent a dramatic drop after the 1970s, from 500 deaths per year to fewer than 50 annual deaths today. Case fatality rates have shown similar trend. We noted a significantly higher specific mortality in males than in females (0.199 and 0.168 per 100,000 respectively; P < 1.9·10⁻⁶). Three causes explained the drop in mortality and case fatality rate, a) ongoing improvement in hospital care, particularly in terms of supportive standardized treatments, b) the use of highly purified immunoglobulin F(ab')₂ fragments after 1995 and, c) increasing access to health services for most of the Mexican population. The authors retrace the history of the management of SSE, including the development of antivenoms, in Mexico between 1905 and today.