{ "abstract": "Background: Snakebite envenoming remains a major neglected tropical disease worldwide, disproportionately affecting rural and socioeconomically vulnerable populations in tropical and subtropical regions. In Peru, snakebite burden is strongly concentrated in Amazonian territories, yet nationwide evidence on its long-term spatial dynamics and socioeconomic determinants remains limited. Methodology: This study provides the first multiscale spatiotemporal assessment of snakebite envenoming incidence in Peru between 2010 and 2025. National surveillance data were analyzed at departmental and district levels to evaluate temporal trends, spatial clustering, hotspot persistence, ecological suitability, and socioeconomic associations. Spatial autocorrelation was assessed using Global Moran’s I and Local Indicators of Spatial Association (LISA), while associations between Human Development Index (HDI) and snakebite envenoming incidence were evaluated across Peruvian macroregions. Findings: A total of 32,942 snakebite envenoming cases were reported during the study period, with more than 60% concentrated in Amazonian departments, particularly Loreto, San Martín, and Ucayali. Snakebite incidence exhibited significant spatial autocorrelation throughout the study period (Moran’s I = 0.53–0.61; p < 0.05), revealing a non-random and spatially structured distribution of risk. LISA analyses identified persistent hotspot districts concentrated mainly in the northern and central Peruvian Amazon, forming a stable corridor of elevated incidence over time. Persistent hotspots spatially overlapped with areas of high environmental suitability for medically important venomous snakes, particularly Bothrops atrox, and elevated potential species richness. Socioeconomic analyses revealed marked regional heterogeneity, with a significant moderate negative correlation between HDI and snakebite incidence in the Northern Amazon (Spearman’s ρ = −0.42; p < 0.001), indicating higher burden in socioeconomically vulnerable districts. Conclusions: These findings demonstrate that snakebite envenoming in Peru is spatially persistent, ecologically structured, and closely associated with socioeconomic inequalities in Amazonian regions. Identifying persistent high-risk areas may support geographically targeted surveillance, optimized antivenom allocation, and territorially adapted public health interventions. Author summary: Snakebite envenoming is a major public health problem that mainly affects poor rural populations living in tropical regions. In Peru, most snakebite cases occur in the Amazon, where many communities depend on agriculture, fishing, forestry, and river transport, often with limited access to healthcare and antivenom treatment. Despite this, little was known about how snakebite risk has changed across Peru over time or whether the same high-risk areas persist year after year. In this study, we analyzed national snakebite surveillance data from 2010 to 2025 to identify long-term spatial patterns of snakebite envenoming in Peru. We found that snakebite risk is not randomly distributed but concentrated in persistent hotspot districts located mainly in the northern and central Amazon. These hotspots also overlapped with areas environmentally suitable for medically important venomous snakes and with districts presenting lower levels of human development. Our findings show that snakebite envenoming in Peru is strongly linked to both environmental conditions and social inequalities. Identifying persistent high-risk areas may help improve epidemiological surveillance, prevention campaigns, and antivenom distribution in vulnerable Amazonian populations.", "abstract_shown": true, "affiliations": [ "Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil", "Division of Impacts, Adaptation and Vulnerabilities (DIIAV), National Institute for Space Research (INPE), São José dos Campos, São Paulo, Brazil", "Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil", "Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil", "Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus, Amazonas, Brazil", "Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America", "Instituto Leônidas e Maria Deane (ILMD/Fiocruz Amazônia), Manaus, Amazonas, Brazil" ], "article_type": "Research Article", "arxiv": null, "author_total": 7, "authors": [ { "affs": [ 0 ], "name": "Malena Grados Vásquez" }, { "affs": [ 1 ], "name": "Juan Carlos Guerra Blas" }, { "affs": [ 2 ], "name": "Anthony Salcedo-Prudencio" }, { "affs": [ 3 ], "name": "Thayane Santos Siqueira" }, { "affs": [ 4 ], "name": "Wuelton Monteiro" }, { "affs": [ 5 ], "name": "John Alexanders Amaya Parra" }, { "affs": [ 6 ], "name": "Flor Ernestina Martinez-Espinosa" } ], "bibtex": "https://research.draconitic.com/paper/9fvj77t8xzawf.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014747", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014747", "id": "9fvj77t8xzawf", "issns": [ "1935-2735" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014747", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "1311|Venomous Animal Envenomation and Studies" ], [ "plos", "/Biology and life sciences/Organisms/Eukaryota/Animals/Vertebrates/Amniotes/Reptiles/Squamates/Snakes" ], [ "plos", "/Biology and life sciences/Psychology/Behavior/Sedentary behavior" ], [ "plos", "/Biology and life sciences/Zoology/Animals/Vertebrates/Amniotes/Reptiles/Squamates/Snakes" ], [ "plos", "/Medicine and health sciences/Epidemiology" ], [ "plos", "/Medicine and health sciences/Epidemiology/Disease surveillance" ], [ "plos", "/Medicine and health sciences/Epidemiology/Spatial epidemiology" ], [ "plos", "/Medicine and health sciences/Health care/Socioeconomic aspects of health" ], [ "plos", "/Medicine and health sciences/Medical conditions/Tropical diseases/Neglected tropical diseases/Snakebite" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Socioeconomic aspects of health" ], [ "plos", "/People and places/Geographical locations/South America/Peru" ], [ "plos", "/Social sciences/Psychology/Behavior/Sedentary behavior" ] ], "openalex": "W7214152822", "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014747&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-24", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/9fvj77t8xzawf.ris", "sources": [ { "first_seen": "2026-10-30T12:17:43Z", "native_id": "10.1371/journal.pntd.0014747", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014747" } ], "subjects": [ { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" } ], "title": "Persistent spatial hotspots and socioeconomic inequalities of snakebite envenoming in Peru: A nationwide spatiotemporal analysis, 2010–2025", "title_text": "Persistent spatial hotspots and socioeconomic inequalities of snakebite envenoming in Peru: A nationwide spatiotemporal analysis, 2010–2025", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:43Z", "url": "https://research.draconitic.com/paper/9fvj77t8xzawf", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }