POTENTIAL FATALITY? MORBIDITY AND MORTALITY RATES.

In India, the annual mortality incidence is 5.6-12.6 per 100,000 population. At one time, Burma listed snakebite as its fifth leading cause of death. More recently, the annual mortality incidence was 3.3 per 100,000 population. Data from Thailand and Malaysia in the 1980s demonstrate an annual mortality incidence of 0.1 per 100,000 population.
• Determining the exact contribution of cobras to overall snakebite morbidity and mortality is difficult. In most cases, bitten individuals are unable to identify the snake. In India, the tendency is to ascribe all fatal or serious bites to cobras. Physicians are also likely to attribute all bites with neurotoxic symptoms to cobras.
• In a Thai survey, cobras made up 17% of the 1145 snakes identified in bites and were responsible for 25% of the fatalities associated with those bites. In northern Malaysia, cobras accounted for 23 of 854 bites in which the snake was identified. In a survey in Taiwan, cobras were blamed for 100 of 851 bites in which the snake was identified; none was fatal. Cobras accounted for 2 of 95 bites on a Liberian rubber plantation. The ringhals was responsible for 18 of 314 envenomations in Natal. Based on patients' symptoms alone, 18 other bites in this series were ascribed to cobras.
• King cobra bites are considered more serious than bites from other cobra species because of the greater volumes of injected venom and the more rapid onset of neurotoxic symptoms. Mortality is also higher. In a series of 35 cases, 10 deaths occurred. Ringhals bites are similar to other cobra bites but are less serious both locally and systemically. Deaths are rare. A medical report of 4 bites by the desert black snake described relatively mild symptoms and reported recovery without specific treatment. Anecdotal reports of fatal bites exist. No medical accounts of bites by water cobras or tree cobras exist. Anecdotal evidence suggests both are dangerous.