Snakebites kill more than 100,000 people per year, the World Health Organization estimates. The organization recently took a step to reduce that number by adding venomous snake bites to its list of neglected tropical diseases – a classification that could help get more resources allocated to fighting this public health problem.
(WHO did acknowledge that snakebites aren’t a disease but “an injury” but the “envenoming” — the injection of the snake’s venom — can be considered a disease.)
Doctors Without Borders, which had previously criticized the global health community for not paying enough attention to snakebites, welcomed the announcement.
In sub-Saharan Africa, the best estimate is that 20,000 to 32,000 people die from snakebites each year, says Julien Potet, a neglected tropical diseases policy adviser at Doctors Without Borders, where he focuses on sub-Saharan Africa and the Middle East. It can take several hours for victims in sub-Saharan Africa to reach clinics, Potet says, and he worries about a lack of access to anti-venom.
Banywich Bone, 18, of South Sudan was bitten by a snake while sleeping at home. His left leg had to be amputated above the knee after the wound became infected.
According to WHO, many snakebite victims are farmers and people in poor, rural communities far from capital cities. Farmers, including migrant workers, are sometimes bitten while walking through fields. Some of them sleep in the fields where they work, putting them at greater risk for bites, he says.
Potet remembers the case of a teenage boy in the lowlands of Ethiopia who had been walking back from the fields to his village at night, without a flashlight and with no boots. A snake bit him on the ankle. About 12 hours passed between the time when the snake bit the boy and the time he arrived at the hospital, because the family had struggled to find someone to take the boy to the hospital during the night. A farm manager finally brought the boy to the hospital on a farm tractor.
This boy’s story isn’t so unusual — it can take victims 6 to 12 hours to get to the hospital after a snake bite, Potet says.
“In some cases, it may be too late,” he says.
In this case, the teenage boy was treated in time and survived.
Still, Potet says, “We need to reduce as much as possible the time between the bite and the treatment.”
The cost of treatment for snake bites can also deter victims from seeking help, Potet says. Clinics or hospitals may charge from $80 to $150. Doctors Without Borders provides free treatment for snake bites.
A common source of poisonous bites in some parts of Africa is the carpet viper, he says. It’s one of the snakes whose venom can cause bleeding and prevent blood from coagulating.
Potet also worries about the supply of anti-venom in sub-Saharan Africa.
“As the [African] market is not very lucrative for pharmaceutical companies,” he says, “some of the companies recently stopped production.”
Anti-venom quality can also be a concern. Some products are put on the market without robust testing, he says.
WHO is conducting a formal evaluation of anti-venom products intended for use in sub-Saharan Africa in an effort to improve the quality.
Then there’s the matter of prevention. It’s actually very basic, says Potet: using flashlights when walking home at night from fields, wearing boots and shoes in the fields and educating people so they know to seek treatment as quickly as possible — and stressing that local healers cannot substitute for anti-venom treatment.
Other diseases on the list of neglected tropical diseases include rabies, scabies and leprosy.
Long-term effects of envenoming compromise the quality of life of the survivors of snakebite. We searched MEDLINE (from 1946) and EMBASE (from 1947) until October 2018 for clinical literature on the long-term effects of snake envenoming using different combinations of search terms. We classified conditions that last or appear more than six weeks following envenoming as long term or delayed effects of envenoming. Of 257 records identified, 51 articles describe the long-term effects of snake envenoming and were reviewed. Disability due to amputations, deformities, contracture formation, and chronic ulceration, rarely with malignant change, have resulted from local necrosis due to bites mainly from African and Asian cobras, and Central and South American Pit-vipers. Progression of acute kidney injury into chronic renal failure in Russell’s viper bites has been reported in several studies from India and Sri Lanka. Neuromuscular toxicity does not appear to result in long-term effects. Endocrine anomalies such as delayed manifestation of hypopituitarism following Russell’s viper bites have been reported. Delayed psychological effects such as depressive symptoms, post-traumatic stress disorder and somatisation have been reported. Blindness due to primary and secondary effects of venom is a serious, debilitating effect. In general, the available studies have linked a clinical effect to a snakebite in retrospect, hence lacked accurate snake authentication, details of acute management and baseline data and are unable to provide a detailed picture of clinical epidemiology of the long-term effects of envenoming. In the future, it will be important to follow cohorts of snakebite patients for a longer period of time to understand the true prevalence, severity, clinical progression and risk factors of long-term effects of snake envenoming. View Full-Text
Keywords: long-term; chronic; delayed; envenoming; snakebite
March 19, 2019
Catching a snake’s venom to produce antivenoms
Snake antivenoms have been around for 125 years, are effective and can be produced cheaply at scale. Yet Africa, with its abundance of deadly snakes, has an alarming shortage of the life-saving medicine.
The method of antivenom production has changed very little since it was first developed by French immunologist Albert Calmette in the late 19th century. It remains a painstaking, time-consuming process, although researchers are working to develop synthetic alternatives.
First, a technician has to milk a snake’s venom in a dangerous manoeuvre that sees it holding the animal’s head still while it bites a cup covered in plastic film, releasing its poison — a small amount each time — into the container.
Small venom doses are then injected into a large domestic animal, usually a horse, to trigger an immune response and the production of toxin-attacking antibodies.
After several doses over a period of about a year, the horse produces so many antibodies that it becomes immune to the venom, at which point blood can be taken from the animal.
In a lab, antibodies are then separated from the blood, to be given to snakebite victims — who may need several doses.
An antivenom usually works only for a specific species, or small group of species of snake.
A key challenge, especially in poor, remote areas of the world where most snakebites occur, is that most antivenoms need to be refrigerated.
A ‘SHAMEFUL FAILURE’
Already patchy, availability of antivenoms in Africa was thrown into disarray when French laboratory SANOFI stopped production in 2014 of its FAV-Afrique drug, which was effective against a number of species, including some of the most dangerous on the continent.
The last available doses expired mid-2016.
SANOFI was moved mainly by financial considerations. The prohibitive price of a single dose — more than $100 — rendered sales in Africa unprofitable.
The failure to use antivenom “to save tens of millions of lives… is a shameful failure. Nowhere in the world is this more confronting than in Africa,” says the Global Snakebite Initiative, adding in a report on its website that the “collapse of the snake antivenom market in Africa” was a “medical tragedy”.
The cause is multifold.
In a vicious circle, unaffordability leads to lower demand and falling sales, which result in reduced production, higher costs, and raised prices for consumers.
Even an antivenom produced on the continent and effective against multiple snake species, is nigh impossible to find further north than South Africa, where it is made, a 2018 study by the Liverpool School of Tropical Medicine found.
“The market remains volatile because they are small producers and the African antivenom market is limited,” said Julien Potet, an expert in neglected tropical diseases with aid group Doctors Without Borders.
Inconsistent quality standards and lacking oversight have also seen an infiltration of counterfeit and “inappropriate” antivenoms developed for different snake types in other countries. Using the wrong antivenom can be dangerous, even deadly.
Doctors Without Borders, which describes Africa’s antivenom shortage as a public health crisis, has launched its own survey of available antivenoms.
Most were brought to the market “without any clinical information, without any data on their efficacy or safety in humans,” said Potet.
A further problem: even if antivenoms were available, people most likely to be bitten by a venomous snake live prohibitively far from a clinic or hospital, some of which have no refrigeration capacity, and with medical staff that have never been trained in treating snakebites.
HALF A MILLION BITES
“We are losing around 1,000 people in Kenya each year from snakebites,” said Royjan Taylor, director of the Bio-Ken snake farm and research centre on the country’s east coast.
This is out of 81,000-138,000 worldwide.
Africa alone sees about half a million snakebites that need treatment every year, according to the World Health Organization (WHO).
“Governments and the international community therefore should really pick that up… What I would like to see over the next five to 10 years, maybe even 15 years, is for an antivenom to be produced for each area of the world that has a problem and that antivenom should be provided to those people free of charge,” Royjan said.
The WHO has launched a massive review of the availability, efficacy and safety of snakebite serum available in Africa, where the majority of countries have no effective or affordable antivenom at all.
Snake Pharm South Africa invites the community to a live snake demonstration and education in Hluhluwe
Posted By: Jonckieon: February 21, 2019In: Road
Join Fortune Sibiya, herpetologist and snake bite survivor, and Donald Schultz (Discovery Planet’s Venom Hunter) as he and the Snake Pharm team will be hosting a free snake education and awareness at SNAKE PHARMS new location.
Fortune, Donald and the whole Snake Pharm team is creating a community based project in Hluhluwe. Snake Pharm is internationally recognized with branches in the USA researching and developing anti-venom making treatment accessible and affordable to any snake bite victim.
SAVE THE DATE, join the team on SUNDAY 24TH FEBRUARY 2019 from 10am – 1pm.
Address: is 33 D448, Makhasa district. On the road to Phinda off the R22 between Sodwana and Hluhluwe
Please contact snakepharm@gmail or Kim Nixon 079-222-9048 or Fortune Sibiya 081-053-2612
Pedestrians and safety from snakes and snake bites | Arrive Alive South Africa https://t.co/AJMXqN1Aem @EMERGCONTROL #ArriveAlive pic.twitter.com/ulzENwO9HD
— Arrive Alive (@_ArriveAlive) June 27, 2017
Durban – A former Phoenix resident whose lifelong passion was snakes died at the weekend after being bitten by a Black Mamba while extracting its venom for medical use.
Ryan Soobrayan, a professional herpetologist died in hospital on Saturday, a day before his 27th birthday.
Soobrayan, who relocated with his parents from Durban to Gauteng, was a snake farm manager for African Reptiles and Venom (ARV). The company provides snake identification and awareness, snakebite treatment and first aid venomous snake handling.
On Wednesday, the fang of a Black Mamba punctured his finger while he was extracting its venom.
Mike Perry the owner of ARV said Soobrayan was in control of the snakes, venom extraction and due to his experience he sometimes stood in for him in presenting training.
Perry explained Soobrayan had a severe anaphylactic reaction from the Mamba venom.
“His untimely demise was not due to the bite but as a result of anaphylaxis. We are devasted by the incident. Anaphylaxis is a severe allergic reaction,” he said.
Ryan Soobrayan, 26, who relocated with his parents to Gauteng, was a snake farm manager for African Reptiles and Venom(ARV). Picture supplied.
Eugene Soobrayan, his uncle, said Ryan was born in Durban and lived with the family in Phoenix where he attended Northlands Primary. They had relocated to Gauteng 17 years ago.
“He died before he could turn 27 years old. Snakes had been his passion. The family, his two sisters and his parents are still coming to grips with what happened. Funeral arrangements are still being made,” he said.
Catherine René Soobrayan said her brother was trained in snake handling lost his life doing what he loved.
“To all who have sent their love, we appreciate it. Our Ryan has left us and we feel empty. Our life will never ever be the same. He made a difference in everyone’s life, where ever he went. We miss him so much and we ask that if you did not know my brother and you have nothing but speculation to post please desist. Everyone who knows my brother knows that he was careful, always. This was a terrible accident,” Soobrayan wrote on Facebook.
Shaun Venter, a close friend of Soobrayan and a Bluff snake and reptile rescuer, said professional snake handlers took the risk of being bitten every day. He said people like Soobrayan, who worked on extracting venom for medicine were unpraised heroes.
“This is exactly why I got out of dealing with hots (dangerous snakes). He got a small pinprick on the thumb and had a massive negative reaction. He was assisted by the best in the country and everything was done to try an save this awesome soul. He was a friend to a lot of us,” Venter added.
Tributes were pouring for Soobrayan on Facebook.
Kurt Schatzl, the President at New England Herpetological Society, said there are folks being kept alive by medications created with snake venom and venoms are also used in research to find cures or treatments for a variety of illnesses.
“There’s only one way to get that venom; you have to handle adult venomous snakes with your hands. It’s incredibly dangerous and also incredibly altruistic and heroic. I have friends who extract for scientific research and it’s always a worry that you’ll get a call sometime,” he said.
Schatzl said, “If you’re taking high blood pressure or anticoagulant medicines, you owe your very life to individuals like this man. People in the field of venomous herpetology that work behind the scenes and out of the limelight for the good of humanity.”
Robert Wedderburn, a wildlife film-maker, said he was amazed by Ryan’s passion for snakes and his dedication to learning as much about them as possible.
“He recently went out of his way to help me through a rather traumatic experience and gave me support when I had not even asked for it,” he said.
The black mamba (Dendroaspis polylepis) is one of the most feared snake species of the African savanna. It has a potent, fast-acting neurotoxic venom comprised of dendrotoxins and α-neurotoxins associated with high fatality in untreated victims. Current antivenoms are both scarce on the African continent and present a number of drawbacks as they are derived from the plasma of hyper-immunized large mammals. Here, we describe the development of an experimental recombinant antivenom by a combined toxicovenomics and phage display approach. The recombinant antivenom is based on a cocktail of fully human immunoglobulin G (IgG) monoclonal antibodies capable of neutralizing dendrotoxin-mediated neurotoxicity of black mamba whole venom in a rodent model. Our results show the potential use of fully human monoclonal IgGs against animal toxins and the first use of oligoclonal human IgG mixtures against experimental snakebite envenoming.