The global snakebite crisis-a public health issue misunderstood, not neglected

Wilderness and Environmental Medicine

Volumn 20, Issue 1, 2009, Pages 43-56

  Simpson, Ian D ^a,c   Norris, Robert L ^b  

^a Pakistan Medical Research Council   (Pakistan)

^b STANFORD UNIVERSITY MEDICAL CENTER   (United States)

^c Kooran House   (India)

Author keywords

An tivenom; Anaphylaxis; Anti snake venom; Economics; Envenoming; Snakebite; World health organization

Indexed keywords

VENOM ANTISERUM;

ANAPHYLAXIS; ARTICLE; DEVELOPING COUNTRY; DRUG COST; DRUG MARKETING; DRUG QUALITY; ENVENOMATION; MEDICAL EDUCATION; SNAKEBITE; TRAINING; WORLD HEALTH ORGANIZATION;

EID: 63649101548     PISSN: 10806032     EISSN: None     Source Type: Journal    
DOI: 10.1580/08-WEME-CON-263.1     Document Type: Article

References (102)

1. World Health Organization. Rabies and Envenomings: A Neglected Public Health Issue. Geneva, Switzerland: World Health Organisation; 2007.
2. World Health Organization. Progress in the characterization of venoms and standardization of antivenoms. WHO Offset Publ. 1981;58:1-44.
3. Wood DJ, Padilla A, Griffiths E. W.H.O. Expert Committee on Biological Standardization: highlights of the 50th meeting, October 1999. Biologicals. 2000;28:199-206.
4. Theakston RDG, Warrell DA, Griffiths E. Report of a W.H.O. workshop on the standardization and control of antivenoms. Toxicon. 2003;41:541-557.
5. Warrell DA. Tropical health: venomous bites and stings in the tropical world. Med J Aust. 1993;159:773-779.
6. Warrell DA. Clinical toxicology of snakebite in Asia/Africa and the Middle East/Arabian Peninsula. In: White J, Meier J, eds. Handbook of Clinical Toxicology of Animal Venoms and Poisons. Boca Raton, FL: CRC Press; 1995: 433-593.
7. Laing GD, Renjifo JM, Ruiz F, et al. A new pan African polyspecific antivenom developed in response to the an-tivenom crisis in Africa. Toxicon. 2003;42:35-41.
8. Muguti G, Maramba A, Washaya CT. Snake bites in Zimbabwe: a clinical study with emphasis on the need for antivenom. Cent Afr J Med. 1994;40:83-88.
9. wilde H, Thipkong P, Sitprija V, Chaiyabutr N. Heterologous antisera and antivenins are essential biologicals: perspectives on a worldwide crisis. Ann Intern Med. 1996;125:233-236.
10. Warrell DA. W.H.O./SEARO Guidelines for the clinical management of snakebite in the Southeast Asian Region. SE Asian J Trop Med Public Health. 1999;1:1-85.
11. heng AC, Winkel KD. Snakebite and antivenoms in sia-Pacific: wokabaut wantaim raka hebou ("Walking ogether"). Med J Aust. 2001;175:648-651.
12. Cheng AC, Currie BJ. Venomous snakebites worldwide with a focus on the Australia-Pacific region: current management and controversies. J Intensive Care Med. 2004; 19:259-269.
13. Currie BJ. Snakebites in Australia: moving from anecdotes to prospective studies. Emerg Med. 2003;15:406-408.
14. art RC, Stark Y, Fulton B, Koziol-McLain J, Lowen-stein SR. Insufficient stocking of poisoning antidotes in ospital pharmacies. JAMA. 1996;276:1508-1510.
15. white J, Warrell DA, Eddleston M, Currie BJ, Whyte IM, Isbister GK. Clinical toxinology-where are we now? J Toxicol Clin Toxicol. 2003;41:263-276.
16. Chippaux JP. Snake Venoms and Envenomations. Malabar, FL: Krieger Publishing Company; 2006:211-246.
17. Gutierrez JM, Theakston RDG, Warrell DA. Confronting the neglected problem of snakebite envenoming: the need for a global partnership. PLoS Med. 2006;6:el50.DOI: 10:1371/journal.pmed.0030150.
18. Stock RR Massougbodji A, Alagon A, Chippaux JP. Bringing antivenoms to sub-Saharan Africa. Nature. 2007;25:173-177.
19. Fry BG, Winkel KD, Wickramaratna JC, Hodgson WC, Wuster W. Effectiveness of snake antivenom: species and regional venom variation and its clinical impact. J Toxicol. 2003;22:23-34.
20. McCarthy EJ. Basic Marketing: A Managerial Approach.Homewood, IL: Irwin; 1960.
21. Gutiérrez JM, Rojas E, Quesada L, et al. Pan-African polyspecific antivenom produced by caprylic acid purification of horse IgG: an alternative to the antivenom crisis in Africa. Trans R Soc Trop Med Hyg. 2005;99: 468-475.
22. South African Vaccine Producers. Snake products: equine antivenoms. Available at: http://www.savp.co.za/Products.htm. Accessed July 14, 2008.
23. Blaylock RSM. The identification and syndromic management of snakebite in South Africa. S Afr Fam Pract. 2005;47:48-53.
24. Simpson ID, Norris RL. Snake antivenom product guidelines in India: the devil is in the details. Wilderness Environ Med. 2007;18:163-168.
25. Warrell DA. Unscrupulous marketing of snake bite antivenoms in Africa and Papua New Guinea: choosing the right product-'what's in a name?' Trans R Soc Trop Med Hyg. 2008;102:397-399.
26. Serum Institute of India, Ltd. Sii Polyvalent Anti-Snake Venom Serum (Lyophilised) Central Africa [package insert, 2006]. Pune, India: Serum Institute of India Ltd.
27. Simpson ID. The "worldwide shortage" of anti snake venom: is the only right answer "produce more" or is it also "use it smarter"? Wilderness Environ Med. 2008; 19:99-107.
28. Visser LE, Kyei-Faried S, Belcher DW, Geelhoed DW, van Leeuwen JS, van Roosmalen J. Failure of a new antivenom to treat Echis ocellatus snake bite in rural Ghana: the importance of quality surveillance. Trans R Soc Trop Med Hyg. 2008;102:445-450.
29. Chippaux JP. Snakebites: appraisal of the global situation. Bull WHO. 1998;76:515-524.
30. Swaroop S, Grabb B. Snakebite mortality in the world. Bull WHO. 1954;10:35-76.
31. Gaitonde BB, Bhattacharya S. An epidemiological survey of snakebite cases in India. Snake. 1980;12:129-133.
32. Lallooo D, Trevett AJ, Saweri A, Naraqi S, Theakston RDG, Warrell DA. The epidemiology of snake bite in Central Province and National Capital District, Papua New Guinea. Trans R Soc Trop Med Hyg. 1995;89:178-182.
33. McGain F, Limbo A, Williams D, Didei G, Winkel K. Snakebite mortality at Port Moresby General Hospital, Papua New Guinea, 1992-2001. Med J Aust. 2004:181: 687-691.
34. Ali Z, Begum M. Snake bite-a medical and public health problem in Pakistan. In: Gopalakrishnakone R Chou P, eds. Snakes of Medical Importance. Singapore. China: Singapore University Press; 1990:419-445.
35. Fox S, Rathuwithana AC, Kasturiratne A, Lalloo DG, de Silva HJ. Underestimation of snakebite mortality by hospital statistics in the Monaragala District of Sri Lanka.Trans R Soc Trop Med Hyg. 2006;100:693-695.
36. Sharma SK, Chappuis F, Jha N, Bovier PA, Loutan L, Koirala S. Impact of snakebites and determinants of fatal outcomes in Southeastern Nepal. Am J Trop Med Hyg. 2004;71:234-238.
37. Hati AK, Mandal M, Mukherjee H, Hati RN. Epidemiology of snake bite in the district of Burdwan, West Bengal. J Indian Med Assoc. 1992;90:145-147.
38. Sharma SK, Khanal B, Pokhrel P, Khan A, Koirala S. Snakebite-reappraisal of the situation in Eastern Nepal.Toxicon. 2003;41:285-289.
39. Bawaskar HS, Bawaskar PH, Punde DP, Inamdar MK,Dongare RB, Bhoite RR. Profile of snakebite envenoming in rural Maharashtra, India. J Assoc Physicians India. 2008;56:88-95.
40. Auerbach PS, Norris RL. Disorders caused by reptile bites and marine animal exposures. In: Kasper DL, Braunwald E, Hauser SL, Longo DL, Jameson JL, Fauci AS, eds. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005:2593-2600.
41. Ghosh S, Maisnam I, Murmu BK, Mitra PK, Roy A, Simpson ID. A locally developed snakebite management protocol significantly reduces overall anti snake venom utilization in West Bengal, India. Wilderness Environ Med. 2008;19:267-274.
42. Snow RW, Bronzan R, Roques T, Nyamawi C, Murphy S, Marsh K. The prevalence and morbidity of snake bite and treatment-seeking behaviour among a rural Kenyan population. Ann Trop Med Parasitol. 1994;88:665-671.
43. Odio W, Musama E, Engo Biongo G, Malukisa J, Bie-zakala E. Epidemiology of snakebites in sugar cane plantations of Kwilu Ngongo in Democratic Republic of Congo. Bull Soc Pathol Exot. 2005;98:312-315.
44. McNamee D. Tackling venomous snakebites worldwide.Lancet. 2001;357:1680-1681.
45. Chippaux JP, Goyffon M. Round table and synthesis of the meeting. Bull Soc Pathol Exot. 2002;95:217-219.
46. Morais V, Massaldi H. Economic evaluation of snake antivenom production in the public system. J Venom Anim Toxins Incl Trop Dis. 2006;12:497-511.
47. Simpson ID. Time for an alternative perspective: the eternal problem of supply and quality of anti snake venom in the developing world-"it's the economy stupid." Wilderness Environ Med. 2008;19:186-194.
48. Gutierrez JM, Lomonte B, Leon G, Rucavado A, Chaves F, Angulo Y. Trends in snakebite envenomation therapy: scientific, technological and public health considerations. Curr Pharm Des. 2007;13:2935-2950.
49. Otero-Patiflo R, Cardoso JL, Higashi HG, et al. A randomized, blinded, comparative trial of one pepsin-digested and two whole IgG antivenoms for Bothrops snake bites in Uraba, Colombia. Am J Trop Med Hyg. 1998;58:183-189.
50. Otero R, Gutierrez JM, Rojas G. et al. A randomized blinded clinical trial of two antivenoms, prepared by caprylic acid or ammonium sulphate fractionation of IgG, in Bothrops and Porthidium snake bites in Colombia: correlation between safety and biochemical characteristics of antivenoms. Toxicon. 1999;37:895-908.
51. Otero R, Leon G, Gutierrez JM, et al. Efficacy and safety of two whole IgG polyvalent antivenoms, refined by caprylic acid fractionation with or without beta-propiolac-tone, in the treatment of Bothrops asper bites in Colombia. Trans R Soc Trop Med Hyg. 2006;100:1173-1182.
52. 2 anti snake venom by caprylic acid: a fast method for obtaining IgG fragments with high neutralisation activity, purity and yield. Toxicon. 1989;27:297-303.
53. Rojas G, Jimenez JM, Gutierrez JM. Caprylic acid fractionation of hyperimmune horse plasma: description of a simple procedure for antivenom production. Toxicon.1994;2:351-363.
54. Government of Sindh. Anti Snake Venom Laboratory: (Pre Feasibility Report). Karachi, Pakistan: Health Department, Government of Sindh; 2005.
55. Theakston RD, Warrell DA. Crisis in snake antivenom supply for Africa. Lancet. 2000;356:2104.
56. Ariaratnam CA, Sjostrom L, Raziek Z, et al. An open randomised comparative trial of two antivenoms for the treatment of envenoming by Sri Lankan Russell's viper (Daboia russelii russelii). Trans R Soc Trop Med Hyg. 2001;95:74-80.
57. Isbister GK, Brown SG, McDonald E, White J, Currie BJ. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med J Aust. 2008;188:473-476.
58. Simpson ID. A study of the current knowledge base in treating snakebite amongst doctors in the high risk countries of India and Pakistan-does snakebite treatment training reflect the local requirement? Trans R Soc Trop Med Hyg. 2008; doi:10.1016/j.trstmh.2008.04.013.
59. De Silva HJ, Fonseka MMD, Gunatilake SB, KularatneSAM, Sellahewa KH. Anti-venom for snakebite inSri Lanka. Ceylon Med J. 2002;2:43-45.
60. 60.Malasit P, Warrell DA, Chanthavanich P, et al. Prediction, prevention and mechanism of early (anaphylactic) antivenom reactions in victims of snake bites. BMJ. 1986; 292:17-20.
61. Sampson HA, Mendelson L, Rosen JP. Fatal and near-fatal anaphylactic reactions to food in children and adolescents. N Engl J Med. 1992;327:380-384.
62. McLean-Tooke APC, Bethune CA, Fay AC, Spickett GP. Adrenaline in the treatment of anaphylaxis: what is the evidence? BMJ. 2003;327:1332-1335.
63. Phillips RE, Theakston RD, Warrell DA. Paralysis, rhab-domyolysis and haemolysis caused by bites of Russell's viper (Vipera russelli pulchella) in Sri Lanka: failure of Indian (Haffkine) antivenom. Q J Med. 1988;8:691-715.
64. Warrell DA. Animal toxins. In: Cook GC, Zumla A, eds. Manson's Tropical Diseases. London, UK: WB Saunders; 2003:581-618.
65. Burnouf T, Griffiths E, Padilla A, Seddik S, Stephano MA, Gutiérrez JM. Assessment of the viral safety of an-tivenoms fractionated from equine plasma. Biologicals. 2004;32:115-128.
66. rifi MN, El Ayeb M, Dellagi K. The improvement and standardization of antivenom production in developing countries: comparing antivenom quality, therapeutical efficiency and cost. J Venom Anim Toxins. 1999;5:128-141.
67. Isbister GK, Tankel AS, White J, et al. High rate of immediate systemic hypersensitivity reactions to tiger snake antivenom. Med J Aust. 2006;184:419-420.
68. Rawlins M, Vale JA. Drug therapy and poisoning. In: Kumar P, Clark M, eds. Clinical Medicine. 6th ed. Philadelphia, PA: Elsevier Ltd; 2005:991-1024.
69. Zafar J, Aziz S, Hamid B, Qayyum A, Alam MT, Qazi RA. Snake bite experience at Pakistan Institute of Medical Sciences. J Pak Med Assoc. 1998;48:308-310.
70. Mishra SK. Now serpent doctors to hold sway. The Statesman. March 1, 2007, Kolkata Plus I.
71. Modi NS. Modi's Textbook of Medical Jurisprudence and Toxicology. Bombay, India: NM Tripathi Private Ltd; 1988.
72. 72.Hung DZ, Wu TC, Deng JF. The painful experience of inappropriate therapy of snake bites: a report of two cases. Chin Med J (Taipei). 1997;60:326-330.
73. Kulkarni ML, Anees S. Snake venom poisoning: experience with 633 cases. Indian Pediatr. 1998;31:1239-1243.
74. Khan R. Snakebite management in India [Letter]. J Indian Med Assoc. 2007;105:655.
75. Girish Kumar NV. Snakebite management in India [Letter]. J Indian Med Assoc. 2007; 105:655.
76. Visser LE, Kyei-Faried S, Belcher DW. Protocols and monitoring to improve snakebite in rural Ghana. Trans R Soc Trop Med Hyg. 2004;98:278-283.
77. Suleman MM, Shahab S, Rab MA. Snake bite in the Thar Desert. J Pak Med Assoc. 1998;48:306-308.
78. Bharati K, Hati K. Snakebite management in the tropics. Sci Culture. 2000;66:302-304.
79. Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J. 2006;22:118-120.
80. Raweerith R, Ratanabanangkoon K. Fractionation of equine antivenom using caprylic acid precipitation in combination with cationic ion-exchange chromatography. J Immunol Methods. 2003;282:63-72.
81. Government of India. National Snakebite Protocol. New Delhi, India: Health & Family Welfare Department; 2007.
82. 82.Simpson ID, Quraishi NA, Qureshi HI. Snakebite Management in Pakistan-A Guide to the Latest Methods of Treatment. Islamabad, Pakistan: Pakistan Medical Research Council; 2008.
83. Anker RL, Staffon WG, Loiselle DS, Anker KM. Retarding the uptake of mock venom in humans. Comparison of three first aid treatments. Med J Aust. 1982;1: 212-214.
84. Anker RL, Straffon WG, Loiselle DS, Anker KM. Comparison of three methods designed to delay the uptake of mock venom. Aust Fam Physician. 1983;12:365-368.
85. Blaylock RSM. Pressure immobilisation for snakebite in southern Africa remains speculative. S Afr Med J. 1994; 12:826-827.
86. Chauhan S, Faruqui S, Bhalla A, Sharma N, Varma S, Bali J. Pre hospital treatment of snake envenomation in patients presented at a tertiary hospital in North Western India. J Venom Anim Toxins Incl Trop Dis. 2005; 11:275 - 282.
87. Duncan AW, Tibballs J, Sutherland SK. Comment on retarding the uptake of mock venom in humans. Med J Aust. 1982;1:214.
88. Dutta TK, Mukta V. Snakebite. J Indian Med Assoc. 2006:104:250, 252-254.
89. Kochar DK, Tanwar PD, Norris RL, et al. Rediscovery of severe saw scaled viper (Echis sochureki) envenoming in the Thar Desert region of Rajasthan, India. Wilderness Environ Med. 2007;18:75-85.
90. Norris RL, Ngo J, Nolan K, Hooker G. Physicians and lay people are unable to apply pressure immobilisation properly in a simulated snakebite scenario. Wilderness Environ Med. 2005;16:16-21.
91. Simpson ID. Snakebite management in India, the first few hours: a guide for primary care physicians. J Indian Med Assoc. 2007;105:324-335.
92. Sutherland, Coulter AR, Harris RD. Rationalisation of first aid methods for elapid snakebite. Lancet. 1979;i: 183-186.
93. Sutherland SK. Mock venom in humans. Aust Fam Physician. 1983; 12:368.
94. Sutherland SK. Reply to pressure immobilisation for snakebite in Southern Africa remains speculative. S Afr Med J. 1995;10:1039-1040.
95. Warrell DA. Injuries, envenoming, poisoning, and allergic reactions caused by animals. In: Warrell DA, Cox TM, Firth JD, eds. Oxford Textbook of Medicine. Oxford, Oxfordshire: Oxford University Press; 2003:923-947.
96. Warrell DA. 2005. Antivenoms: clinical efficacy and safety-the need for trials data. Available at: http://jmt. pennpress.org/strands/jmt/pdfHandler. pdf;jsessionid=D57C86CEEEE5B71DBD7B68153FE47 AB6?issue=20060201&file= 20060201-029-045.pdf. Accessed May 26, 2007.
97. Gawarammana IB, Kularatne M, Abeysinga S, et al. Parallel infusion of hydrocortisone ± chlorpheniramine bolus injection to prevent acute adverse reactions to antivenom for snakebites. Med J Aust. 2004;180:20-23.
98. Lieberman P. Use of epinephrine in the treatment of anaphylaxis. Curr Opin Allergy Clin Immunol. 2003;3:313-318.
99. Premawardenha A, de Silva CE, Fonseka MMD, Guna-tilakee SB, de Silva HJ. Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom se-rum in people bitten by snakes: randomised, placebo controlled trial. BMJ. 1999;318:1041-1043.
100. Wen Fan H, Marcopito LF, Cardoso JLC, et al. Sequential randomised and double blind trial of promethazine prophylaxis against early anaphylactic reactions to antivenom for Bothrops snake bites. BMJ. 1999;318:1451-1453.
101. Dixon RW, Harris JB. Nerve terminal damage by beta-Bungaratoxin: its clinical significance. Am J Pathol.1999;154:447-455.
102. Watt G, Theakston RD, Hayes CG, et al. Positive response to edrophonium in patients with neurotoxic envenoming by cobras (Naja naja Philippinensis). N Engl J Med. 1986;23:1444-1448.