Wasp sting mortality in Australia
Forbes McGain, James Harrison and Kenneth D Winkel
Wasp sting fatalities have rarely been reported in Australia. We used
data from the Australian Bureau of Statistics and State coronial
authorities to investigate deaths from wasp stings in Australia from
1979 through 1998. Seven cases were identified, all involving men in
rural settings. Five of the seven victims had prior histories of wasp
or bee venom allergy, or both, but none carried injectable adrenalin.
All patients with a history of systemic Hymenoptera sting allergy
should undergo assessment for immunotherapy and carry adrenalin.
MJA 2000; 173: 198-200
Clinical records -
More articles on Insects, bites and stings
Australia has a diverse range of venomous creatures capable of
causing lethal injuries. While most attention has been focused on
deaths from snake and spider bite, arthropods such as jumper ants
honey bees (Apis
mellifera)2 and European wasps
(Vespula germanica)3 can also inflict dangerous
stings. Indeed, the widespread distribution of the hymenopterans
(bees and wasps) means that their stings are a leading cause of
mortality from bites and stings globally.4,5 The vast majority of
deaths from Hymenoptera stings are caused by immediate
hypersensitivity reactions to venom.4,5|
Despite the importance of fatalities from Hymenoptera stings
internationally, little has been published on the circumstances and
incidence of such deaths in Australia. For example, an analysis of
Australian bee sting fatalities during 1960-1981 was unable to
obtain adequate clinical information about most of the fatalities
during that period, and coronial records were examined for only one of
the 27 fatalities identified in that study.2 Despite the increasing
abundance of the introduced and aggressive European wasp (V.
germanica),6 and consequent concerns
about the increasing health risks posed by this vespid,3 even less
information is available about fatalities from wasp stings in
Australia than for those from bee stings. Indeed, only two minimally
documented reports of fatal wasp stings exist in the Australian
medical literature. In 1913, Cleland noted "oedema of the larynx and
subsequent death occurred from a man being stung by a wasp. He had been
drinking out of the spout of a waterbag in which the wasp was
hiding".7 Lee also made reference to a
fatal wasp sting in a 47-year-old man in southern Queensland in
Analysis of fatalities can provide important information on the
determinants of severe morbidity, which may be useful in injury
prevention. Thus, we investigated, in detail, wasp sting related
fatalities that occurred in Australia over the past two decades. This
period was coincident with the arrival and dispersal of V.
germanica on the Australian mainland.6 In the absence of national
coronial data for this period, we used State-based coronial
information systems. In particular, we aimed to identify the
contribution of allergy versus venom toxicity (envenomation), and
the likely contribution of V. germanica to the mortality
We identified seven wasp sting fatalities, which occurred between 1
January 1979 and 31 December 1998, from the following data sources:
the Australian Bureau of Statistics mortality dataset;
- State and Territory Registrars of Births, Deaths and Marriages;
- State and Territory coronial authorities; and
- in one instance, from the family physician of the deceased.
These data allowed us to analyse the circumstances of the wasp stings,
the likely wasp species involved, and any history of Hymenoptera
sting allergy and its management.
This project was approved by the University of Melbourne Health
Sciences human ethics subcommittee.
The seven fatalities identified during the 20-year period
correspond to a mean annual incidence rate of 0.02 deaths per million
population per year. The deceased were all men living in northern New
South Wales, or in Queensland (from the southeast to the far north
coast). They were aged between 39 and 73 years (mean age, 54 years).
Five of the seven deaths occurred during December and February, and
the remaining two deaths occurred in April and May. In no year was there
more than one death from wasp sting. All stings occurred in rural areas
and four of the deceased were described as farmers in the coronial
reports. The details of each case are summarised in Box 1.
More than one thousand species of wasp have been recognised in
Australia,9 but most are solitary, and
rarely come into contact with humans. The most medically significant
wasps belong to the family Vespidae.9 The genera Vespula,
Polistes and Ropalidia, illustrated in Box 2,
comprise the most important subfamily of vespids, the Vespinae.
These social wasps cooperate in the construction and provisioning of
their nests and have a propensity for interaction with humans. For
example, European wasps are great scavengers and are usually found
around areas of human habitation and activity,
thus posing a particular hazard.
In Europe4,10 and the United
States,11 relative proportions of
deaths from wasp and bee stings are different from those in Australia.
In Sweden, these proportions are 90% for wasps and 10% for
bees;4 corresponding figures for
Denmark are 63% for wasps and 37% for bees,10 while, in the US, wasp and
bee sting fatalities occur with approximately equal
frequency.11 By contrast, our finding
of a wasp sting fatality rate of 0.02 per million population per year is
only a quarter of the reported Australian bee sting fatality rate of
0.086 per million population per year.2 This may reflect the
relatively recent arrival in Australia of the European
compared with the European honey bee.
Although our study was precipitated by concern about the health
impact of European wasps, and we looked at a period that coincided with
their arrival and spread on the mainland, we identified no fatalities
attributable to this wasp. All of the wasp-sting deaths occurred
outside the known range of V. germanica.6 This may change
as increasing numbers of people become sensitised to its venom.
Further research is required to ascertain whether the arrival of
V. germanica has altered sting-related morbidity patterns
As in previous studies,2,4,10 in the deaths we
examined we found that the reponsible wasp was rarely formally
identified. Nonetheless, it seems likely that at least one case was
attributable to a Polistes species. This is consistent with
reports of severe allergic reactions to stings by Polistes
and Ropalidia species in Queensland.12 Moreover, given the
distribution of the various vespid wasps,9 it seems likely that all
seven fatalities were caused by Polistes and
Ropalidia species. This adds impetus to the call for purified
Ropalidia venom to become available for
immunotherapy,12 as, currently, only
imported Polistes and Vespula venoms are available.
The absence of wasp sting mortality outside Queensland and NSW
contrasts with the nationwide occurrence of deaths from bee
stings.2 It is possible that the wasp
species found in Queensland and NSW possess greater allergenic
potential than those found elsewhere in Australia. No systematic
research has yet been undertaken on this question. The formal
identification of the wasp species implicated in future fatalities
would facilitate such research.
Consistent with previous analyses of bee and wasp sting mortality
internationally,2,4,5 we found a low number of
stings, rapid onset of symptoms, no child fatalities and
over-representation of middle-aged men among those who died. It has
been proposed that pre-existing heart disease might explain the
increased risk for men aged over 40 years;2,4 certainly, this may have
contributed to death in two of our cases. However, our findings differ
from these other reports in the high frequency of autopsy
examinations and low rates of underlying cardiorespiratory
Venom toxicity is rarely reported in Hymenoptera-related
fatalities,2,4,10,11 and we found no
fatal massive envenomations. In all cases death was attributable to
anaphylaxis (although ideally mast cell tryptase and IgE level
measurements should be made to confirm this diagnosis). In contrast
with previous international reports, most of the victims in our study
had either previously diagnosed allergy to wasp stings or a clear
history of systemic reactions indicating severe allergy. Thus, most
of these deaths might have been prevented by specific immunotherapy,
early treatment with adrenalin or both. However, patients and their
families should be aware that vulnerability to venom-induced
anaphylaxis persists at least until maintenance doses of
immunotherapy are attained.
As with Australian bee sting fatalities,2 most deaths occurred in the
summer months when human-wasp interaction is most likely. The rural
setting of these fatalities highlights concerns about the acute
shortage of specialist allergists and clinical immunologists in
rural areas,13 although it is unclear
whether such shortages contributed to the fatal outcomes.
Nevertheless, this underservicing, combined with the lack of
Ropalidia,12Myrmecia1 and other venoms for
immunotherapy, increases the importance of anaphylaxis emergency
kits and education14 for those with
life-threatening allergy to insect stings and their families.
The fact that most of the deceased were reported to be farmers is
consistent with the fact that rates of work-related deaths in
agriculture are among the highest in Australia.15 Information
on bites and stings should therefore be incorporated within injury
prevention programs such as those developed by Farmsafe
As noted in previous investigations of bee sting
mortality,2 dependence on a single data
set is likely to lead to an underestimation of the total injury burden.
It is possible that additional wasp sting deaths occurred during the
study period but were not recorded because of miscertification,
misattribution as bee sting, or other inadequate or inaccurate
recording. We found that the wasp sting diagnosis was almost wholly
dependent on the presence of a witness and absence of retained bee
sting on autopsy. Clearly, unwitnessed wasp sting deaths could be
attributed to other causes, and our findings should be considered an
underestimate of wasp sting mortality.
This study was supported by grants from the Victorian Department of
Human Services, Snowy Nominees, the BHP Community Trust and Bayer
Healthcare Australia. We acknowledge the assistance of Ms Malinda
Steenkamp, Mr Stan Bordeaux, of the Research Centre for Injury
Studies, Flinders University; Mr Peter Burke and Mr David Jayne, of
the Australian Bureau of Statistics, Brisbane, as well as the various
state and regional coronial authorities, hospitals and individual
clinicians involved. We also thank Assistant Professor Nadine
Levick, of Johns Hopkins Medical Institutions, and Associate
Professor Gordon Smith, of the School of Public Health, Baltimore,
Maryland, USA, for helpful advice. Dr Gabrielle Hawdon and Associate
Professor James Tibballs, Australian Venom Research Unit, as well as
Dr Jo Douglass, Department of Allergy, Asthma and Clinical
Immunology, The Alfred Hospital, critically reviewed the
manuscript. Dr Ken Walker, of Museum Victoria, and Dr Justin Schmidt,
of the Carl Hayden Bee Research Center, Tucson, Arizona, USA,
provided photographs and entomological advice.
- Clarke PS. The natural history of sensitivity to jack jumper ants
(Hymenoptera formicidae Myrmecia pilosula) in Tasmania.
Med J Aust 1986; 145: 564-566.
Harvey P, Sperber S, Kette F, et al. Bee sting mortality in
Australia. Med J Aust 1984; 140: 209-211.
Levick NR, Winkel KD, Smith GS. European wasps: an emerging hazard
in Australia. Med J Aust 1997; 167: 650-651.
Johansson B, Eriksson A, Ornehult L. Human fatalities caused by bee
and wasp stings in Sweden. Int J Legal Medicine 1991; 104:
Langley R, Morrow W. Deaths resulting from animal attacks in the
United States. Wild Environ Med 1997; 8: 8-16.
Spradbery JP, Maywald GF. The distribution of the European or
German wasp in Australia, past, present and future. Aust J
Zool 1992; 40: 495-510.
Cleland JB. Insects and their relationship to disease in man in
Australia. Trans 9th Aust Med Congress Sydney 1911; 1:
Lee DJ. Arthropod bites and stings and other injurious effects.
Sydney: School of Public Health and Tropical Medicine. The
University of Sydney, 1975.
Naumann ID. Hymenoptera. Chapter 42. In: CSIRO. The insects of
Australia. 2nd ed. Melbourne: Melbourne University Press, 1991:
Mosbech H. Death caused by wasp and bee stings in Denmark
1960-1980. Allergy 1983; 38: 195-200.
Barnard J. Studies of 400 Hymenoptera sting deaths in the United
States. J Allergy Clin Immunol 1973; 52: 259-264.
Solley G. Allergy to stinging and biting insects in Queensland.
Med J Aust 1990; 153: 650-654.
O'Hehir RE, Douglass JA. Stinging insect allergy. Med J Aust
1999; 171: 649-650.
Douglass JA, O'Hehir RE. Peanut allergy. Education, avoidance
and adrenaline are the mainstays of management. Med J Aust
1997; 166: 63-64.
Fragar L. Agricultural health and safety in Australia. Aust J
Rural Health 1996; 4: 200-206.
(Received 6 Mar, accepted 21 Jun, 2000)
Australian Venom Research Unit, Department of Pharmacology,
University of Melbourne, VIC.
Forbes McGain, MB BS, Honorary Fellow;
Winkel, MB BS, FACTM, Director.
Research Centre for Injury Studies, Mark Oliphant Building,
Flinders University, Bedford Park, SA.
James Harrison, MB BS, MPH, Director.
Reprints will not be available from the authors.
Correspondence: Dr K
D Winkel, AVRU, Department of Pharmacology, University of
Melbourne, VIC 3010.
|1: Summary of the circumstances and features
of wasp sting fatalities in Australia from 1 January 1979 to 31 December
||Previously well. No significant reactions to
previous bee or wasp stings.
||Witnessed sting to the neck after disturbing
a wasp nest while working outdoors. Collapsed with convulsions and died
||Two puncture marks to the neck, severe laryngeal
oedema, no coronary atherosclerosis.
||Identified by a professional entomologist as
"paper wasps" (genus Polistes).
||Previously well. Allergic to both bees and
wasps (degree uncertain).
||Witnessed sting to the scalp while outdoors,
followed by rapid collapse, cyanosis and death.
||Single puncture to the occipital scalp, gross
laryngeal oedema, no coronary atherosclerosis.
||Not formally identified.
|| Previously well. No known history of bee or
wasp sting allergy.
||Single witnessed sting to the hand while gardening;
initial marked local reaction only, followed by collapse, cyanosis and death
within an hour.
||Erythematous left hand, glottic oedema and
moderately severe coronary atherosclerosis.
||Not formally identified.
||Previously well, but with a history of systemic
reactions to wasp stings.
||Single witnessed sting to the thigh after disturbing
a wasp nest while working outdoors; dyspnoea, cyanosis, collapse and death
within 30 minutes.
||Single puncture to the thigh, epiglottic oedema
and no coronary atherosclerosis.
|| Not formally identified.
|| Severe wasp sting allergy and a prosthetic
mitral valve; otherwise well.
||Unspecified allergy treatment by family doctor
and "specialist". Victim did not carry adrenalin.
||Single witnessed sting to the ear while gardening,
followed by collapse, convulsions and death within minutes.
|| Aryepiglottic oedema; moderate coronary atherosclerosis.
||Not formally identified.
||Previous anaphylactic reaction to either a
bee or wasp sting.
||Single witnessed sting while gardening; developed
urticaria, cyanosis and cardiac arrest within 15 minutes.
|| No autopsy; death not reported to the coroner.
||Not formally identified.
||Previous life threatening allergic reactions
to "paper wasp" stings.
||Multiple witnessed stings, while walking in
a national park; collapsed with convulsions and died.
|| Angioneurotic truncal oedema, laryngeal and
tracheal oedema, no coronary atherosclerosis.
||Described as "paper wasps" by victim's son,
who witnessed the stings.
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