Taking precautions against snakebites can be the best way to reduce the resultant risk, a researcher from Oxford University has said.
Snakes bite nearly 5.5 million people every year and this leads to about 400,000 amputations and anything between 20,000 to 125,000 deaths.
AdvertisementEven so, the global heath community has chosen to overlook the suffering caused by snakebites.
Now, a seminar by Professor David A Warrell from the University of Oxford and linked Viewpoint have appeared in this week's Lancet.
They talk about how spreading education about snakebite can reduce its risk.
"For a long time, the specialty has had an inadequate evidence base, uncritical attitudes to results that scarcely deserved consideration as data, rigid adherence to outworn traditional ideas, poor understanding of pathophysiological mechanisms, and inadequate discussion and collaboration with laboratory scientists," says Prof Warrell, who is a co-author on the Viewpoint.
Snakes' poison can harm the human nervous, cardiovascular and haemostatic systems, and lead to tissue death.
In 2009, the WHO recognised snakebite as a neglected tropical disease.
The yet unpublished Million Deaths Study, conducted during 2001-03, will show that a large number of people die in India due to snakebites, Even those who survive may require skin grafts or amputation.
Professor Warrell points out: "Community education to reduce the risk of bites is a better approach than is the eradication of venomous snakes. It should be based on knowledge of the circumstances in which most bites occur, the preferred habitats of dangerous species, and their peak periods of activity-ie, time of day, season, and climate. For example, people are bitten by kraits (genus Bungarus) in south Asia almost exclusively at night while lying asleep on the ground in their homes. Such distinctive epidemiology predicates a means of prevention. In a high-risk area of eastern Terai, Nepal, sleeping under a mosquito net afforded protection."
When a snake bites a person, immediate professional medical care is needed. Antivenom is the only antidote to snake venom but can sometimes cause complications like a potentially fatal anaphylactic shock.
Professor Warrell says: "Improvement of the treatment of snake bite requires solutions to many economic, logistical, marketing, distribution, and storage difficulties associated with production and supply of antivenom, and provision of improved training for medical personnel so that the best possible use of antivenom and other treatments is achieved.
"The development of safe, effective, and affordable antivenoms is a priority addressed by WHO...A fundamental difficulty associated with antivenom use, and recognised since the early 20th century, is the absolute requirement for specificity. Therefore, appropriate venoms need to be used in the production of antivenoms, which means that the market for a particular antivenom is restricted to a geographical area for which its specificity is relevant, usually in impoverished developing countries. Attempts to overcome this difficulty by discovery of universal venom antigens or immunogens have so far been unsuccessful."
He adds: "Snake bite is a neglected disease that afflicts the most impoverished inhabitants of rural areas in tropical developing countries. It is an unusually challenging medical problem that deserves further investigation after the prolonged neglect by medical science."
The authors of the Viewpoint write: "As long as product safety and efficacy remain untested and unproven, cost effectiveness and market sizes are unquantified, and regulatory frameworks remain fragile, the demand for antivenom in countries around the world will continue to be insufficient and organisations such as the Global Alliance for Vaccination and Immunization will be reluctant to become actively involved in the issue."
They add: "Snake bite is a neglected condition that, rather than competing for resources, can benefit from integration with programmes funded to address HIV/AIDS, tuberculosis, and malaria, and contribute to the achievement of Millennium Development Goals."
The researchers conclude: "With powerful, passionate advocacy, and at the same time, greatly improved information about the burden of human suffering attributable to snake bite, and compliance with the requirements of organisations with the capacity to mobilise resources, we can give snake bite global public health recognition so that it is no longer an obscure, denied, and neglected condition. In so doing, we can protect, save, and repair millions of lives, relieve an enormous personal and collective economic burden, and provide sustainable contributions to improving health in some of the world's poorest regions.
"To quote Bill Gates: 'humanity's greatest advances are not in its discoveries-but in how those discoveries are applied to reduce inequity'."