What We Know about Sting-Related Deaths? Human Fatalities Caused by Hornet, Wasp and Bee Stings in Europe (1994-2016)

Simple Summary Information about fatalities due to stinging insects is scarce. Hymenopteran-related deaths (n = 1691) in 32 European countries based on official registers over a 23-year period (1994-2016) are described. Male adults (25-64 years) were the most common group to be fatally injured and almost half of the fatalities were recorded at "unspecified places". Fatalities per million inhabitants per year ranged from 0 to 2.24 with an average of 0.26. Geographic, environmental, and ecological factors influence the frequency of stings, and its subsequent reaction. It is necessary to produce and interpret knowledge using diverse sources and in an interdisciplinary way. As part of the One Health philosophy, people and hornets, wasps and bees, as well as the environment that they share are closely connected. Epidemiology of Hymenopteran-related deaths in Europe, based on official registers from WHO Mortality Database (Cause Code of Death: X23), are presented. Over a 23-year period (1994-2016), a total of 1691 fatalities were recorded, mostly occurring in Western (42.8%) and Eastern (31.9%) Europe. The victims tended to concentrate in: Germany (n = 327; 1998-2015), France (n = 211; 2000-2014) and Romania (n = 149; 1999-2016). The majority of deaths occurred in males (78.1%) between 25-64 years (66.7%), and in an "unspecified place" (44.2%). The highest X23MR (mortality rate) were recorded in countries from Eastern Europe (0.35) followed by Western (0.28), Northern (0.23) and Southern Europe (0.2). The countries with the highest and lowest mean X23MR were Estonia (0.61), Austria (0.6) and Slovenia (0.55); and Ireland (0.05), United Kingdom (0.06) and the Netherlands (0.06), respectively. The X23 gender ratio (X23GR; male/female) of mortality varied from a minimum of 1.4 for Norway to a maximum of 20 for Slovenia. Country-by-country data show that the incidence of insect-sting mortality is low and more epidemiological data at the regional level is needed to improve our understanding of this incidence. With the expansion of non-native Hymenopteran species across Europe, allergists should be aware that their community's exposures are continually changing