03606nas a2200325   4500000000100000008004100001260004600042653001700088653001500105653000900120653001100129653003600140653002500176653002500201653002300226100002200249700001900271700002400290700002200314700001500336700001900351700002500370700001900395245014600414856009900560300001100659490000700670520258900677022001403266       2026                            d  c09/2026bPublic Library of Science (PLoS)10aEpidemiology10aSnake bite10aPeru10aSnakes10aSocioeconomic aspects of health10aDisease surveillance10aSpatial epidemiology10asedentary behavior1 aGrados Vásquez M1 aGuerra Blas JC1 aSalcedo-Prudencio A1 aSantos Siqueira T1 aMonteiro W1 aAmaya Parra JA1 aMartinez-Espinosa FE1 ade Almeida JRR00aPersistent spatial hotspots and socioeconomic inequalities of snakebite envenoming in Peru: A nationwide spatiotemporal analysis, 2010–2025  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014747&type=printable  a1 - 260 v203 a<p><strong>Background</strong></p>

<p>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.</p>

<p><strong>Methodology</strong></p>

<p>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.</p>

<p><strong>Findings</strong></p>

<p>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  &lt; 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  &lt; 0.001), indicating higher burden in socioeconomically vulnerable districts.</p>

<p><strong>Conclusions</strong></p>

<p>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.</p>
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