{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:01:29Z","timestamp":1790704889406,"version":"4.1.0"},"update-to":[{"DOI":"10.1371\/journal.pntd.0014747","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000}}],"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["EDITAL No. 038\/2022 \u2013 PDPG\/CAPES"],"award-info":[{"award-number":["EDITAL No. 038\/2022 \u2013 PDPG\/CAPES"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["EDITAL No. 038\/2022 \u2013 PDPG\/CAPES"],"award-info":[{"award-number":["EDITAL No. 038\/2022 \u2013 PDPG\/CAPES"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004916","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Amazonas","doi-asserted-by":"publisher","award":["EDITAL FAPEAM No. 017\/2023 \u2013 PRONEM"],"award-info":[{"award-number":["EDITAL FAPEAM No. 017\/2023 \u2013 PRONEM"]}],"id":[{"id":"10.13039\/501100004916","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methodology<\/jats:title>\n 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\u2019s I and Local Indicators of Spatial Association (LISA), while associations between Human Development Index (HDI) and snakebite envenoming incidence were evaluated across Peruvian macroregions.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n \n 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 Mart\u00edn, and Ucayali. Snakebite incidence exhibited significant spatial autocorrelation throughout the study period (Moran\u2019s I\u2009=\u20090.53\u20130.61;\n p<\/jats:italic>\n \u2009<\u20090.05), 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\n Bothrops atrox<\/jats:italic>\n , 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\u2019s\n \n \n \n \n \n \u03c1<\/mml:mi>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n =\n \n \n \n \n \n \u2212<\/mml:mo>\n 0.42<\/mml:mn>\n <\/mml:mrow>\n <\/mml:math>\n <\/jats:alternatives>\n <\/jats:inline-formula>\n ;\n p<\/jats:italic>\n \u2009<\u20090.001), indicating higher burden in socioeconomically vulnerable districts.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pntd.0014747","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T17:45:16Z","timestamp":1790271916000},"page":"e0014747","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent spatial hotspots and socioeconomic inequalities of snakebite envenoming in Peru: A nationwide spatiotemporal analysis, 2010\u20132025"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0002-6377","authenticated-orcid":true,"given":"Malena","family":"Grados V\u00e1squez","sequence":"first","affiliation":[{"name":"Institute of Biological Sciences, Federal University of Minas Gerais (UFMG)","place":["Belo Horizonte, Minas Gerais, Brazil"],"department":["Department of Biochemistry and Immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Guerra Blas","sequence":"additional","affiliation":[{"name":"Adaptation and Vulnerabilities (DIIAV), National Institute for Space Research (INPE), S\u00e3o Jos\u00e9 dos Campos","place":["S\u00e3o Paulo, Brazil"],"department":["Division of Impacts"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Salcedo-Prudencio","sequence":"additional","affiliation":[{"name":"Institute of Biological Sciences, Federal University of Minas Gerais (UFMG)","place":["Belo Horizonte, Minas Gerais, Brazil"],"department":["Department of Biochemistry and Immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thayane","family":"Santos Siqueira","sequence":"additional","affiliation":[{"name":"Health Sciences Graduate Program, Federal University of Sergipe","place":["Aracaju, Sergipe, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuelton","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Universidade do Estado do Amazonas (UEA)","place":["Manaus, Amazonas, Brazil"]},{"name":"Funda\u00e7\u00e3o de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD)","place":["Manaus, Amazonas, Brazil"]},{"name":"Duke Global Health Institute, Duke University","place":["Durham, North Carolina, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Alexanders","family":"Amaya Parra","sequence":"additional","affiliation":[{"name":"Institute of Biological Sciences, Federal University of Minas Gerais (UFMG)","place":["Belo Horizonte, Minas Gerais, Brazil"],"department":["Department of Biochemistry and Immunology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flor Ernestina","family":"Martinez-Espinosa","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o de Medicina 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