Scorpionism: A hidden public health crisis

What is scorpionism?

‘Mum, dad, a scorpion stung me!’ Maybe it was one of the harmless ones. Maybe. Your child's heart is racing, their forehead grows hot. You hurry to the nearest medical centre, hoping that doctors may have the drugs required to stabilise your child’s heartbeat, or antivenom to neutralise the toxins spreading through their tiny body. With the right treatment and an ICU bed, maybe your child will survive. Maybe. 

This is a scenario that 2.5 billion people in tropical and subtropical regions are at risk of living, and yet most of us have never heard of it. 

Scorpionism is the development of life-threatening symptoms resulting from envenoming by medically significant species of scorpions. The most accurate and up-to-date estimates (from 18 years ago!) state that over 3,000 people, mainly children under the age of 15 years old, die from severe complications following a scorpion sting annually. Here are some of the fundamental aspects of this deadly, yet preventable, disease.  

A fat-tail scorpion (Genus Androctonus) from Morocco. Michel Dugon

Scorpionism is a child-health issue

Children are disproportionally impacted by the severe complications of scorpionism and are significantly more likely to die following a scorpion sting compared to adults. In Brazil, children under nine make up under 15% of all scorpionism cases, but account for over a third of all deaths. In North Africa the contrast is even starker: in Sudan and Morocco, 77% and 96.8% of all fatal cases involved children under 15. 

A variety of hypotheses attempt to explain the disparities in mortality between adults and children. The lack of clarity regarding the mechanisms involved clearly demonstrate that much more research is required to truly understand, and therefore prevent, juvenile morbidity caused by scorpion stings. 

Scorpionism is a timely issue, and an issue as old as time

Scorpion-human conflict in the form of accidental stinging events is a problem as old as humanity, and methods of ridding the house of scorpions are mentioned in the Ebers papyrus, a medical text produced in Egypt ~3500 years ago. Yet, because of our impact on the environment, our growing needs for natural resources, and other ongoing humanitarian and environmental crises, scorpionism seems to be on the increase.

In Brazil, evidence suggests the national incidence of scorpion stings has increased from 31.8 per 100,000 in 2012 to 142.82 per 100,000 in 2024, an increase of 349%. Improved reporting is likely contributing to these figures; however, it cannot account for the scale of the increase. It has been suggested that the double threat of climate change and the encroachment of human habitation into wild areas, combined with the ecological plasticity of medically significant species, could be driving this increase.

On the other side of the world, humanitarian crises resulting in sudden scorpion-human conflict and epidemics of scorpion stings, are only serving to underscore the urgency of the matter. In northern Sudan, populations living on the edges of the Nile have been swarmed with scorpions displaced by the rising water after the construction of the Merowe dam, with devastating consequences on their children. In the same region, disturbances caused by artisanal gold mining activities have created perfect habitats for scorpions to multiply in the vicinity of miners’ settlements, as highlighted by Dr Rania Mohamed Hassan Baleela.  

As humans encroach further into the natural environment, and with instability becoming the new normal, the root causes of scorpionism must be addressed in a holistic manner, to prevent further suffering from this ancient disease.

Scorpionism is a neglected disease 

In 2018, efforts to highlight scorpionism by granting it Neglected Tropical Disease (NTD) status, brought forward by Morocco and Benin, were rejected (11th NTD STAG report 2018). To paraphrase, this appeal was rejected because there is too little research into the scale of the scorpionism issue, and the control measures currently available are unlikely to be effective in improving the situation. Despite this, scorpionism meets many of the NTD specifications - it is absent from the global health agenda, it disproportionately affects populations impacted by economic and social injustice in the Global South, and it causes morbidity and / or mortality. This incident demonstrates that the burden of scorpion sting has passed largely unnoticed by funding bodies and political institutions with the clout to raise the profile of this disease globally. 

Ultimately, such institutions remain overwhelmingly located in Europe and North America and as such it is perhaps unsurprising that a disease impacting some of the most marginalised people in the Global South remains ignored. Only a concerted cross-disciplinary effort from the scientific community ranging from zoologists and field ecologists to immunologists, social scientists and epidemiologists and backed by political champions, will be able to bring this deadly, yet preventable disease under control. 

Recent publications in the British Medical Journal and Frontiers in Public Health have again called for action on scorpionism on a local, regional, and international level. Perhaps now is the time to make scorpionism our issue? 

About the Authors

Isabella Hubbard is a PhD candidate at the Liverpool School of Tropical Medicine, funded by a Medical Research Council Doctoral Training Partnership, investigating scorpion sting envenomation.

Dr Michel Dugon is a Lecturer in Zoology and the Principal Investigator of the Dugon Venom Lab at the University of Galway.