Epidemiological characterization of lonomism in South America

Lonomism is the envenomation caused by accidental contact with Lonomia caterpillars, and this is a public health priority in South America since it is relatively common but remains underestimated. This study presents an updated and integrative analysis of reliable global data from 1960 to 2020 on the epidemiology of this envenomation in the whole continent. A total of 13,186 notifications were recorded for South America: 13,056 (99.01%) in Brazil, 49 (0.37%) in Argentina, 43 (0.33%) in Colombia, 29 (0.22%) in Venezuela, 6 (0.05%) in Peru and 3 (0.02%) in French Guiana. The number of new locations reporting accidents has increased since the first formally notifications at the middle of the last century. Most of these locations are situated in Brazil, the pioneer in deeply researching the Lonomia genus and its impacts in public health. Most victims were males, in the economically productive age group, and accidental contact occurred more frequently in the upper limbs while doing activities outdoors in urban/rural areas. Regarding the determinants of clinical outcome, countries where patients received delayed medical care were associated with a higher number of moderate and/or severe cases, as well as a higher chance of progressing to death. Additionally, the longer the delay for accessing medical care, the higher the risk of developing systemic complications, thereby increasing the need for specific treatment. Our study also shows that accidents globally occurred more frequently in the summer months and in the beginning of autumn. Although having identified several shortcomings in the documents selected and verified that notifications are strongly biased by public policies adopted by each South American country, this study provides the first comprehensive assessment of lonomism in South America, demonstrating the increase in the number of accidents, and their expansion to other areas of the continent over time. Our findings will undoubtedly help guide the appropriate allocation of resources and implementation of prevention strategies and define priority criteria for epidemiological surveillance of this neglected tropical disease.