Puff adders are the snakes responsible for most snake bite deaths in Africa.
As antivenom is not as accessible in Africa as in America and Asia, and a lot of people live far away from hospitals in Africa, the number of fatalities from puff adders can be greatly reduced if and when the infrastructure is improved in parts of Africa.
Despite all of this, fatalities from the puff adder are relatively rare, and definitely less than approximately 5% of all bites, as most surveys indicate that the overall death rate of snake bites in Africa is well below 2%. Amputations and other surgeries are common to mitigate the effect of bites though.
The puff adder is not the most difficult snake to identify, as it is very large and heavy bodied.
Several studies indicate that people hospitalized due to a venomous snake bite knew when it was a puff adder. In the United States, puff adder bites only occur from puff adders held in captivity by reptile enthusiasts and zoo employees.
In a South African study (Blaylock, 2003) the consequences of a number of snake bites were reported. Among the venomous snake bites, five bites were proven puff adder bites.
One patient of the five bitten by the puff adder died. The patient, an 11-year–old boy, did not receive antivenom, as it was not considered appropriate in his particular case.
The boy had abnormally high blood pressure at the time of admission to the hospital and died four days after the bite despite several blood transfusions.
The puff adder is a large and strong snake, but despite its size, it is capable of striking with lightning speed. A study by Bruce A. Young from 2009 showed that the puff adder is much faster than smaller snakes.
The puff adder is a typical ambusher.
It sits and waits until a prey animal is close enough and then strikes. Like all other snakes, the puff adder cannot hear, but its jaw can feel vibrations, and it's Jacobsen’s organ can analyze inputs from its tongue. When a prey gets too close, the puff adder has to be fast. When it bites, it releases the prey immediately and lets the prey escape. This way it won't get hurt itself. It then tracks the prey down that is gradually weakened because of the venom.
In fact, the aforementioned study indicates that the puff adder is approximately twice as fast as the diamondback rattlesnake, another large venomous snake;although not living in the same places as puff adders.
Blaylock, R. "Epidemiology of snakebite in Eshowe, KwaZulu-Natal, South Africa" Toxicon 43 pp. 159-166 (2004) YOUNG, B. A. "How a heavy-bodied snake strikes quickly: high-power axial musculature in the puff adder (Bitis arietans)" J Exp Zool A Ecol Genet Physiol. 313(2) pp. 114-121 (2010).