SNAKE ENVENOMATION: “GRAVE PREDICAMENT” IN NEGLECT
Why snake envenomation lacks its visibility from the priority list of health care policies in India? Why the country is still unequipped to face the problem with prime predilection? Despite its long history, why the medical system still follows century back protocols to treat envenomation? An amalgamation of factors has led to the above aforesaid crisis of snake envenomation. Problems related to production of snake antivenom, lack of research, efficacy problem with polyvalent antivenom, lack of diagnostic systems to predict envenomation status of victims, lack of doctors who has the expertise to heal snake bites and also the ignorance and myths related to snakes - all such multi-component factors contribute well to snake bite becoming one of the most abandoned, neglected, ignored, underestimated and fundamentally misunderstood medical dilemma.
The consequences of this negligence by medical and policy makers towards snake envenomation seriously affect the impoverished population around the globe. As estimated by WHO, India accounts for more than half of the global snake bite deaths. Though the exact number of snake bites in India is unspecified, there are 50,000 snakebite deaths per year against the global figure of 1, 25,000 deaths and more than 75,000 deaths happen in Asia annually. The estimated data figured that one snakebite death for two HIV deaths reported in the country.
Apart from envenomation contributes a sequence of suffering and disability to bite victims. The snake attacks are more commonly reported in males in the world, who are agricultural workers in the age of 15-29 in the rural areas of the country. Housewives and children are the second affected group. The socio-economic impact of snakebite is that it is not only affecting the victims but their whole family is also agonized. Thousands of victims are dying or becoming permanently maimed each year because of the lack of accessibility for proper treatment. The survivors experience tiredness and pain, either at the bite site or elsewhere in the body which greatly affects their agility, rendering them all the more incapacitated. Numbness, edema of face, hands and legs, liquid oozing from the bite site, blurred vision, eye watering, dizziness, palpitation, tremor, and nausea etc. are the other long term complications chronicled.
Snake bite is a public health problem that has lingered on with least interest to government officials, public health programs and the news media. This is because snake envenomation usually do not cause dramatic outbreaks that kill large numbers of people. Rather, it exact their toll over a longer period of time, leading to crippling deformities, severe disabilities and/or relatively slow deaths. In order to build a pressure on public health authorities and policy makers, WHO has included snake bites in the list of high priority Neglected tropical disease (NTDs) in 2017. This might encourage the attention from the Government and other relevant organizations in national and international level to frame a more relevant policy on this public health issue.
The non-availability of reliable epidemiological data on snake bites is the major crisis, which mask the depth of the deadly disease. The data collection is deeply flawed and there is no authorized system which can give an exact figure of snakebite casualties in India. The cases reported to health ministries by clinics and hospitals are often only a small proportion of the actual burden because many victims never reach primary care facilities, and are therefore unreported. This poor data on the number and type of snake bites have led to difficulty in guesstimating the distribution policies of antivenin by manufactures.
The ASV available in India is a polyvalent ASV that has efficacy against the venom of 4 snake species also known as the “big four” (Indian cobra, Common Krait, Saw-scaled viper and Russell’s viper). There is only one venom extraction centre in the country, The Irula Co-operative Society, which functions under the aegis of the Ministry of Commerce and Industry in Tamil Nadu.About 85% of venom extracted for antivenom production comes from this region. In our experience, we found the variability in the efficacy of ASV in India between species, within the same species and between different geographical regions. To deal with this, an upgradation of the existing ASV to become more effective pan India is demanded for the faster recovery of patients.
Despite improvements in purification, stability and efficacy, the basic method of production of ASV however, has not changed over the past 100 years. As a result polyvalent ASV continues to be associated with a very high rate of anaphylactic reaction. In order to switch to monoclonal antivenom, researches are needed to develop a bedside technique/ device to identify the species that have bitten the patient. This will minimize risk both to patient and wastage of antivenom thereby offering the best treatment to snake envenomation with a cocktail of antivenoms. The government should facilitate more funding to design new strategies and agendas to overcome the above said issues. To improve the life quality of snake bite victims, the manufacturers of antivenom, researchers, clinicians, community workers, national and regional health authorities, and international and community organizations should work hand in hand together and come up with sustainable developments in snake bite treatment.
