Why do so many people still die of snake bites?

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Tens of thousands of people die every year from snakebites around the world. Lack of treatment and even the wrong drug mean that many of these deaths can be prevented.

Snake bites may not seem like a major public health problem.

But in some parts of the world, they are a daily risk and can be deadly or life changing.

Victims often do not get the treatment they need, if at all.

In other cases, they receive medication to treat an injury caused by a different snake.

It is thought that about 11,000 people a month die as a result of a venomous snake bite, a number similar to one that perished during all of the Ebola crises in West Africa 2014. -2016.

An estimated 450,000 more people a year suffer from injuries such as amputation and permanent disability.

The magnitude of the problem means that snake bites are now clbadified as priority neglected tropical diseases.

Who gets bitten?

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In developed regions – such as Europe, Australia, and North America – snake bites kill only a handful of people each year, despite the large number of snakes. Venomous species.

This compares with 32,000 deaths in sub-Saharan Africa and twice as many in South Asia.

Many rural communities in the tropics have an almost constant risk of snake bites, whether they work in the field, travel at dusk, or even sleep at home at night.

Young farmers are the most at risk group, followed by children.

If a large rural population is a factor, health systems in some parts of Africa and Asia are often ill prepared to deal with snake bites.

Clinical training, emergency transportation and affordable medicines are often lacking, with tragic consequences.

Expensive medicine

Venomous snake bites are generally responsible for three main types of life-threatening symptoms: uncontrollable bleeding, paralysis, and irreversible tissue destruction.

It is essential that snake bite victims get the right medication as soon as possible after a snake bite.

Antivenin is the drug of choice for treating snake bites.

It is made using the venom of the snake, it is designed to treat.

This means that many versions are needed because there are many venomous snakes around the world – cobras, mambas, kraits, vipers and vipers, to name a few.

The toxins present in their venom differ from one group of snakes to another, or even between the same groups of snakes from another region.

This means that the correct antivenom is often difficult to identify and can be very expensive.

How antivenoms are made

• A small, non-harmful amount of snake venom is injected into an animal – usually a horse or sheep
• This boosts the immune system of the animal to create venom neutralizing antibodies
• These antibodies are extracted from the blood of the animal, purified and transformed into antivenom serum.
• Antivenins must be used in the hospital because of the high rate of adverse drug reactions in patients.

In Latin America, antivenom is often produced in the country and subsidized by the government.

Mortality rates are significantly higher in sub-Saharan Africa, where the best antivenom costs between $ 140 and $ 300 per vial, with 3 to 10 vials usually needed to save the life of the victim.

As the typical Swaziland farmer earns $ 600 a year, most of this medicine is out of reach.

The bad antivenom

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This situation has allowed weak or inappropriate drugs to flood the market over the past decade, particularly in Africa.

These antivenoms often cost about $ 30 per bottle – a fraction of the cost of proven products.

Some African ministries of health naturally understood that it was a win-win situation, with more drugs available and cheaper.

These products began to be used in hospitals across most of the continent.

However, several reports now indicate that some of these drugs may be dangerously ineffective.

Small-scale case studies in Ghanaian and Central African hospitals have shown that when cheaper drugs were used, mortality rates increased from 2% or less to more than 10%.

Often these antivenoms are made from snake venoms from a different region than the one where the product is sold – for example, an antivenom made from Indian snake venom used in Africa.

Others are made with the proper venoms, but with a low concentration of antibodies per dose, which gives very low drugs.

This means that the number of vials needed to successfully treat the patient goes from three to ten, up to 20 or 30.

Ironically, this situation has pushed some established manufacturers to reduce the supply of their indispensable products by the time they have become overpriced.

Lack of tests

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These problems have been aggravated by the lack of antivenom tests.

Most drugs must undergo independent and extensive testing, and clinical trials must prove their effectiveness.

But this is often not the case with the antivenom. National drug agencies sometimes approve products without strong evidence of efficacy or comparison with existing treatments.

To remedy this, the World Health Organization has launched a pre-market testing program, the results of which are expected to be released later this year.

This should allow ministries of health, pharmacists and clinicians to better understand which antivenoms are appropriate for their region, while identifying the manufacturers responsible for affordable antivenoms.

However, manufacturers are not obliged to participate in the system and countries are not obliged to withdraw products from the market based on the results.

Nevertheless, it is hoped that this seal of approval from the World Health Organization will have a significant influence on the decisions of the purchase of antivenoms throughout Africa.

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Looking to the future

An effective antivenom is part of solving the problem of snake bites, but many other problems remain.

Much remains to be done to identify the communities most at risk and to ensure the flow of a sustainable flow of affordable medicines.

Meanwhile, training more clinicians and health workers on how to effectively treat snakebite victims would reduce the number of deaths.

Finally, educating local communities about snake bites would help reduce the risk of biting and would mean that appropriate measures would be taken more after a bite.

About this piece

This badytical document was commissioned by the BBC to experts working for an outside organization.

Dr. Nicholas Casewell is a keynote speaker and academic researcher at the Snakebite Center for Research and Response (CSRI). You can follow him on Twitter right here.

Dr. Stuart Ainsworth is a postdoctoral research badistant and lecturer on snake bites at CSRI. You can follow him on Twitter right here.

Published by Eleanor Lawrie