Snake Bite Problem in India: An Overview (original) (raw)
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Venom, antivenom production and the medically important snakes of India
Snakebite is a medically and socially significant issue in India, but the quality of treatment and reporting protocols need to be upgraded to international standards. There are currently seven pharmaceutical laboratories in India which produce antivenom against four medically important Indian snake species (cobra (Naja sp.), krait (Bungarus sp.), Russell's viper (Daboia russelii) and saw-scaled viper (Echis carinatus sp.), the 'big four'. Most venom for antivenom production is sourced from Chennai, South India. While the 'big four' are responsible for a majority of serious and fatal bites, the situation is actually much more complex. In this article, we review the production of venom and antivenom in India and suggest areas of improvement. We show that several factors complicate the treatment of snakebite in India. The first is geographic, intra-species variation in venoms of cobras and Russell's vipers. Secondly, there are four species of cobra, eight species of kraits, two distinct sub-species of saw-scaled viper. In view of these observations, it is felt that identifying , evaluating and implementing changes to venom and antivenom production protocols, public education, snakebite treatment and policy in India should be an immediate priority.
Snake, snakebite and its management - The Indian scenario
Feature Article, 2018
Snakes are ubiquitous in India. There are many varieties of snakes with hundreds of species spanning across the country. It follows that snakebite is also a major problem in India. Snakebite deaths in India contribute to almost half of all global snakebite deaths annually. Those who survive are often left maimed and disfigured, accompanied by lifelong disabilities. Snakebites are managed at the field-level by providing psychological boost to the patient and by administering first aid. At the hospital-level, envenomed patients are treated by antivenom therapy, which is the only definitive treatment for venomous snakebites. These aspects have been discussed in detail in this review.
Review Snake Bite in South Asia: A Review
2013
Abstract: Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world’s most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms ’ composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data genera...
Snake Bite in South Asia: A Review
PLOS Neglected Tropical Diseases, 2010
Snake bite is one of the most neglected public health issues in poor rural communities living in the tropics. Because of serious misreporting, the true worldwide burden of snake bite is not known. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Despite increasing knowledge of snake venoms' composition and mode of action, good understanding of clinical features of envenoming and sufficient production of antivenom by Indian manufacturers, snake bite management remains unsatisfactory in this region. Field diagnostic tests for snake species identification do not exist and treatment mainly relies on the administration of antivenoms that do not cover all of the important venomous snakes of the region. Care-givers need better training and supervision, and national guidelines should be fed by evidence-based data generated by well-designed research studies. Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle.
PLOS ONE
Background Snakebite is possibly the most neglected of the NTDs (Neglected Tropical Diseases). Half of the global deaths due to venomous snakebites, estimated at 100,000 per year, occur in India. The only representative data on snakebite available from India is the mortality data from the RGI-MDS study (Registrar General of India- 1 Million Death Study) and another study on mortality from the state of Bihar. Incidence data on snakebite is available for 2 districts of the state of West Bengal only. Hospital-based data on snakebite admissions and use of ASV are gross underestimates as most snakebite victims in rural India depend more on alternate treatment methods which do not get represented in National registries. The proposed study is a multi-centric study to determine the incidence, morbidity, mortality and economic burden of snakebites in India covering all 5 geographical zones of the country. Protocol A community level surveillance for snakebite covering 31 districts in 13 state...
Clinical Profile and outcome of envenomous snake-bite at tertiary care centre in western Maharashtra
International Journal of Medicine and Public Health, 2011
cause of morbidity and mortality in tropical countries. In India, there are 216 species of snakes, of which only four are venomous snakes (cobra, krait, Russell's viper and saw scaled viper). Snake venoms are rich in protein and peptide toxins that have specifi city for a wide range of tissue receptors, making them clinically challenging and scientifi cally fascinating, especially for drug design 2. Although the full burden of human suffering attributable to snake bite remains obscure, hundreds of thousands of people are known to be envenomed and tens of thousands are killed or maimed by snakes every year. South Asia is the world's most heavily affected region, due to its high population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs. Poorly informed rural populations often apply inappropriate fi rst-aid measures and vital time is lost before the victim is transported to a treatment centre, where cost of treatment can constitute an additional hurdle 3 , 4. The defi ciency of snake bite
Incidence and treatment of snakebites in West Bengal, India
Toxicology Reports, 2019
Snake envenomation is a major cause of death and disability in the developing countries. In India and neighboring countries, the four venomous snakes of concern include-Indian cobra(Naja naja), Common Krait (Bungarus caeruleus); Russell's Viper (Daboia russelli); Saw Scaled Viper (Echis carinatus). We describe the management protocol for snakebite treatment in a tertiary care hospital of Paschim Medinipur district, West Bengal based on case reports of subjects admitted and treated in Ghatal Subdivisional Hospital(GSH) during 2013-2016. Methods &materials: We developed a structured data collection form to record demographic and clinical details of patients hospitalized at GSH between 1 January 2013 through 31 December 2016. Results: Snake bite cases in Ghatal Subdivisional hospital(GSH) were assessed during the period 2013-2016. A total 18 deaths due to snakebite has been reported from this tertiary care hospital during the period. Total patients admitted in this hospital with snakebite is 1160 during the period 2013-2016. In 80% of the cases the lower extremities were affected. Preliminary first aid was provided in 45% cases. About 65% of the affected victims suffered snakebite in the morning hours. Some of the recommended drugs that were prescribed by the physicians of GSH were neostigmine, atropine, adrenaline, hydrocortisone, Amoxicillin. WBCT 20 and Urea, Creatinine level were routinely performed. Conclusion: Hospital studies are a key source of information about snake bites. The ready availability and appropriate use of AVS, close monitoring of patients, the institution of ventilator support and if required, early referral to a larger hospital all help to reduce the mortality. Thus knowledge of the varied clinical manifestations of snake bite is important for effective management in hospitals by a complete health care team.
Toxicon, 2013
Sri Lanka is a tropical developing island nation that endures significant economic and medical burden as a result of snakebite envenomation, having not only a high prevalence of envenomations, but also one of the highest incidence rates (200 snakebites/ 100,000 people/year) of venomous snakebite in the world (Kasturiratne et al., 2005). Ironically, the very snakes responsible for this human morbidity and mortality are a valuable biomedical and ecological national resource, despite the medical and economic consequences of envenomation. Currently, no snake antivenom is produced using venoms from native Sri Lankan snakes as immunogens, and there is a true need for an efficacious Sri Lanka, poly-specific snake antivenom. An approach to fulfilling this need via combining the scientific, technological and economical resources from Costa Rica and the United States with the knowledge and talent of Sri Lankan official governmental agencies, legal counsels, environmental, medical and veterinary academic institutions, and religious and cultural leaders has been initiated, coordinated and funded by Animal Venom Research International (AVRI), a nonprofit charity. This bridging of nations and the cooperative pooling of their resources represents a potential avenue for antivenom development in a developing country that suffers the consequences of few specific resources for the medical management of venomous snakebite. The desired final outcome of such an endeavor for Sri Lanka is, most importantly, improved medical outcomes for snakebite patients, with enhanced and expanded science and technology relating to snake venoms and antivenoms, and the collateral benefits of reduced economic cost for the country.
Management of snake bite cases in RIMS Ranchi, Jharkhand, India
Instant hospital-based study has been done to assess the outcome of snake bite cases brought to tertiary care hospital in Jharkhand state capital at RIMS Ranchi. In view of large number of deaths due to snake bite cases in India especially in rural part and also in many other countries, the necessity of having a study at Ranchi, being state capital of Jharkhand which is a state of tribal dominated population is evidently felt. Accordingly RIMS Ranchi being only medical college in state capital of Jharkhand has been chosen as tertiary care hospital for the relevant study. The present study describes 01-year prospective study of snake bite patients from January 2018 to December 2018 at RIMS Ranchi. It is been observed that, the estimated death due to snake bites are around 40,000-50,000 annually in India. As per national data more than 95% bites occur in rural areas. The Studies was done on snake bite cases from Jharkhand area, where it is shown to be very few and non-conclusive. Over the period o one year total 375 cases of snake bite were brought to RIMS Ranchi who was managed by different protocol as per need and available resources. Out of this 375 snake bite cases, brought to RIMS Ranchi, 45 could not survive which means mortality is 12 percent. Out of total snake bite cases 61.33% was found male whereas 38.67% was found female. 93.33% cases had come from rural area and rest only 6.7 % were from urban area. More than 88% of the cases were successfully treated with low dose of ASV at this tertiary care hospital.
Management and Outcome Study of Snake Bite Cases in Central India
2014
Snake-bite is a life-threatening medical emergency & major public health problem throughout the World, especially in tropical countries like India. The annual death rate due to snake bite in India is estimated to be 4.1 per 1,00,000 population while in Maharashtra, it is 3.0 per 1,00,000 population. The objective of this study is to observe the management of snake bite and their outcome in central India. It was a prospective observational study of 203 patient of snake bite from June 2011 to September 2013. Inclusion criteria: all the adult patients of poisonous snake bite admitted in medical wards and intensive care unit. Exclusion criteria: patient of non-poisonous snake bite & scorpion bite. Most important investigation to be performed in vasculotoxic snake bite was 20 minute whole blood clotting time which helped in early detection of coagulopathy and subsequent acute renal failure. Complete blood count, liver function test, renal function tests, urine examination to rule out hae...