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Kharusha, Isra K., Suha S. Sulaiman, Ahmad M. Samara, Samah W. Al-Jabi, and Sa’ed H. Zyoud. "Assessment of Knowledge about First Aid Methods, Diagnosis, and Management of Snakebite among Nursing Students: A Cross-Sectional Study from Palestine." Emergency Medicine International 2020 (December 16, 2020): 1–10. http://dx.doi.org/10.1155/2020/8815632.
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Background. Snakebite is a serious and important medical emergency encountered in many parts of the world. The estimated number of victims of venomous snakebites in Palestine is about 100 to 150 annually, with death occurring in 2 to 3 of them. This study was designed to assess the level of knowledge on the diagnosis and management of snakebites among nursing students in Palestine, as well as their attitude towards snakebites. Methods. This was a cross-sectional survey that took place at An-Najah National University. Two hundred nursing students were asked to fill a questionnaire that was developed to assess the participants' knowledge and attitude regarding snakebite's diagnosis and management. Different knowledge scores were calculated, and the relationships between students' knowledge and their characteristics were calculated by implementing the Mann–Whitney U test and the Kruskal–Wallis test. The statistical significance limit of p values was set at 0.05. Results. The majority of the participants (57%) were fourth-year students with an average age of 20.7 ± 1. Areas of knowledge and the participants’ mean scores on them were as follows: Vipera palaestinae snake, 5.1/13; signs and symptoms, 9.6/16; laboratory investigations, 6.1/10; anti-venom, 4.2/11; and first aid, 6.6/15. The only statistically significant differences in knowledge were between male and female students on Vipera palaestinae (male students scored higher, p value = 0.004) and between different types of residence (village dwellers scored the highest, p value = 0.041). Conclusions. We found knowledge gaps in many aspects of snakebite’s diagnosis and management among nursing students in Palestine. Based on the results of this study, we suggest integrating more materials on this topic in the curriculum of Palestinian nursing schools, as well as more practical training, which will positively reflect on the care for snakebite victims.
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Pandey, Deb P. "News Media Coverage of Snakebite Incidence in Nepal during 2010–2022." Advances in Clinical Toxicology 8, no. 4 (2023): 1–15. http://dx.doi.org/10.23880/act-16000285.
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Background: Despite snakebite being a medical emergency, it is still a neglected health issue in Nepal. Further, there exists gap of knowledge on snakebite epidemiology. Therefore, an analysis of incidence of snakebites reported in news is essential to understand snakebite epidemiology in Nepal and fill up existing knowledge gap in some extent. Objectives: We aimed analysing incidence of snakebites reported in the news media to know whether news-based incidence of snakebite is comparable to the similar incidence reported most comprehensively by Nepal Government, know the snakebite distribution patterns across its geo-climatic regions, provinces, and districts, understand supra-annual variations of snakebite incidence, and measure association between incidences of snakebites with the respective districts’ human population density. Methods: We retrospectively searched and analyzed incidence of snakebites reported in news articles published between 2010 and 2022. Using line graphs and plotted maps, we compared the annual patterns of snakebites with the national data of snakebites reported by Department of Health Services of Nepal Government. Further, we used non-parametric inferential statistics to know representativeness of our dataset and association of snakebite incidence with population density of snakebite prone districts. Results: Snakebites were reported from 53 out of 77 districts of Nepal. People inhabiting 50 out of 53 districts were affected by snakebite envenoming (with 11% of collective envenoming rate) that resulted in deaths of people inhabiting 43 districts (with 15% of collective case fatality rate). The most of envenomings and deaths occurred in the lowlands of Nepal along the northern border of India. We deemed at least 10,339 snakebites, 2,113 envenomings, and 101 deaths annually in Nepal. Conclusions: The incidences of snakebites were high in flood affected areas, terai regions as well as some districts in the hills and mountains. Therefore, improvement of the snakebite risk map released by Nepal Government is essential to ensure prevention and control of snakebite envenoming in these high affected areas. Inclusion of urban areas in terai regions of this country is essential while designing the next more representative community-based study
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Jadhav, Dhanashree, Vivek Pakhmode, AV Resham, Snehal Ingole, and Sanpreet Singh Sachdev. "Fanged encounter: A case report of snakebite on the tongue." Southeast Asian Journal of Case Report and Review 10, no. 4 (November 15, 2023): 90–93. http://dx.doi.org/10.18231/j.sajcrr.2023.020.
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Snakebites are uncommon but potentially life-threatening events that can result in a range of clinical manifestations, often dependent on factors such as the snake species, venom potency, and bite location. While snakebites affecting limbs and exposed body parts are more frequently encountered, snakebites directly to the tongue represent a rare and intriguing clinical scenario. This case report presents a unique case of snakebite to the tongue, emphasizing the significance of early recognition, appropriate medical intervention, and the need for comprehensive snakebite education, even in regions with low snakebite incidence.
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Jaramillo, Joshua D., Nicholas A. Hakes, Lakshika Tennakoon, David Spain, and Joseph D. Forrester. "The “T’s” of snakebite injury in the USA: fact or fiction?" Trauma Surgery & Acute Care Open 4, no. 1 (October 2019): e000374. http://dx.doi.org/10.1136/tsaco-2019-000374.
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BackgroundVenomous snakebites can result in serious morbidity and mortality. In the USA, the “T’s of snakebites” (testosterone, teasing, touching, trucks, tattoos & toothless (poverTy), Texas, tequila, teenagers, and tanks) originate from anecdotes used to colloquially highlight venomous snakebite risk factors. We performed an epidemiologic assessment of venomous snakebites in the USA with the objective of evaluating the validity of the “T’s of snakebites” at a national level.MethodsWe performed a retrospective analysis of the National Emergency Department Sample. Data from January 1, 2016 to December 31, 2016 were obtained. All emergency department (ED) encounters corresponding to a venomous snakebite injury were identified using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Primary outcomes were mortality and inpatient admission. Demographic, injury, and hospital characteristics were assessed. Data were analyzed according to survey methodology. Weighted values are reported.ResultsIn 2016, 11 138 patients presented to an ED with a venomous snakebite. There were 4173 (37%) persons aged 18 to 44, and 7213 (65%) were male. Most snakebites were reported from the South (n=9079; 82%), although snakebites were reported from every region in the USA. Only 3792 (34%) snakebites occurred in rural counties. Persons in the lowest income quartile by zip code were the most heavily represented (n=4337; 39%). The most common site of injury was the distal upper extremity (n=4884; 44%). Multivariate analysis revealed that species of snake (OR=0.81; 95% CI 0.73 to 0.88) and older age (OR=1.42; 95% CI 1.08 to 1.87) were associated with hospital admission. There were <10 inpatient deaths identified, and no variables were predictive of death.DiscussionSome of the “T’s of snakebites” may be valid colloquial predictors of the risk for venomous snakebites. Based on national data, common demographics of venomous snakebite victims include lower income, Caucasian, and adult men in the South who are bit on the upper extremity. Understanding common demographics of venomous snakebite victims can effectuate targeted public health prevention messaging.Level of evidenceIV.
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Braga da Silva, Tatiane, Johann Aly, Marcelo Figueira, Calleb Mendonça da Gama Araújo, Isadora Karolina Freitas de Sousa, Alexandre Alberto Tonin, Leíse Gomes Fernandes, and Rejane Dos Santos Sousa. "Epidemiological aspects of snakebites in the state of Amazonas, Brazil, from 2007 to 2017." Revista de Patologia Tropical / Journal of Tropical Pathology 50, no. 4 (December 22, 2021): 315–26. http://dx.doi.org/10.5216/rpt.v50i4.67841.
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This study comprises a retrospective analysis of snakebites in the State of Amazonas, Brazil, from 2007 to 2017. Data were collected from the Notifiable Diseases Information System (NDIS). 17,056 snakebites were recorded in Amazonas between 2007 and 2017. During the study period, the Rio Negro and Tefé micro-regions had the highest accumulated incidence, while small municipalities such as São Gabriel da Cachoeira, Uarini and Alvarães presenting a high incidence rate during the same period. Snakes in the genera Bothrops and Lachesis caused 69.5% and 20.3% snakebites. Snakebites occurred more frequently in the Amazonian winter, between January and April, and most of the snakebite victims (78.6%) were men. The most affected individuals were between 20 and 39 years of age (59.4%). The time elapsed between snakebites and medical assistance varied from one to six hours (51.4%). 7,705 of the snakebite cases, were classified as moderate, 7,328 as mild, and 1,299 as severe. Of the 104 deaths that occurred in the period, Bothrops genus caused the highest mortality (68.3%). The State of Amazonas recorded both high numbers of snakebites in the period 2007-2017 and the time elapsed between snakebite and medical assistance, which may affect the clinical status of patients. KEY WORDS: Bothrops; Lachesis; Amazon; snakes; viperidae
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Menon, Jaideep C., Denny John, Geeta R. Menon, Joseph K. Joseph, P. Rakesh Suseela, and VV Pillay. "Estimating epidemiological and economic burden and community derived disability weights for snake bite in Kerala: a study protocol." F1000Research 10 (March 1, 2021): 167. http://dx.doi.org/10.12688/f1000research.50970.1.
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Background: In India, geographical variation, lack of data and underreporting on cases and deaths due to snakebite makes it difficult to estimate socio-economic burden of snakebites. Previous studies measuring economic burden of snakebite in low-and-middle-income countries (LMICs) using different approaches have been conducted, but none so far in India. The proposed study aims to provide evidence on disability weights, epidemiological and economic burden due to snakebites in Kerala state, India. Protocol: A cross-sectional community based study for estimating epidemiological and economic burden of snakebite, recruiting victims of snakebite occurring over a nine month period prior to start and over the three month period of the study, across Ernakulam district, Kerala state, India. For the community derived disability weights, 60 adult patients admitted and treated at Amrita Institute of Medical Sciences, Kochi or Little Flower Hospital, Angamaly would be interviewed. The sample size to determine the mortality rate is calculated at 108,458 persons in Ernakulam.The study will measure annual incidence, mortality, treatment cost of snakebites along with community-derived disability weights for snakebites. Standard methods for analysis and reporting of mortality, morbidity, years of lives lost, years lived with disability, disability weights, and costs of treatment will be calculated and presented. The study will be started in March 2021 and is expected to be completed by June 2021. Discussion: This protocol is the first published for estimating epidemiological, economic burden and community derived disability weights for snakebites in India. Besides, the Global Burden of Disease has not attached a particular disability weight to snakebite and this would be an attempt to do so.The protocol has been developed using guidelines for both cross-sectional studies and for conducting community derived disability weights. The evidence generated will contribute to knowledge regarding epidemiology, economic burden and community-derived disability weights for snakebites in India and other LMICs.
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Bogati, Sunil, Navin Bhatt, Shristi Nepal, Prakash Nepali, and Sanjib Kumar Sharma. "Snakebite in the Hills and Mountains of Nepal." Journal of Nepal Medical Association 60, no. 256 (November 30, 2022): 1066–69. http://dx.doi.org/10.31729/jnma.7562.
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Snakebite is an important public health issue around the world. In Nepal, it affects a huge number of people mostly belonging to low-income households who are involved in agriculture. Although snakebite has a serious impact on the Terai population, a few studies suggest that snakebite also occurs frequently in hills and mountains. In the absence of sufficient studies related to snakebites in these geographical regions, it is tough to sketch a true picture and estimate the magnitude of snakebites in those areas. Because of this, the healthcare system is probably not prepared enough to handle the victims of snakebites. This demands a proper study of the burden of the issue in these regions and appropriate initiatives for addressing it.
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Menon, Jaideep C., Denny John, Geeta R. Menon, Joseph K. Joseph, P. Rakesh Suseela, VV Pillay, and Amitava Banerjee. "Estimating epidemiological and economic burden and community derived disability weights for snake bite in Kerala: a study protocol." F1000Research 10 (June 11, 2021): 167. http://dx.doi.org/10.12688/f1000research.50970.2.
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Background: In India, lack of data and underreporting of cases and deaths due to snakebite makes it difficult to estimate its socio-economic burden. Previous studies measuring economic burden of snakebite in low-and-middle-income countries (LMICs) using different approaches have been conducted, but none in India. The proposed study aims to provide evidence on disability weights, epidemiological and economic burden due to snakebites in Kerala state, India. Protocol: The study is a community based cross-sectional study recruiting victims of snakebite occurring over a 12 month period prior to start of the study , across Ernakulam district, Kerala state, India. For the community-derived disability weights,70 adult patients who were treated within a 3 month period prior to commencement of the study at Amrita Institute of Medical Sciences, Kochi or Little Flower Hospital, Angamaly would be interviewed. The study will measure annual incidence, mortality, treatment cost of snakebites along with community-derived disability weights for snakebites in Ernakulam district.. Standard methods for analysis and reporting of mortality, morbidity, Years of Lives Lost (YLL), Years lived with disability (YLD), disability weights, and costs of treatment will be calculated. The study will be started in April 2021 and is expected to be completed by July2021.. Discussion: This protocol is the first published for estimating epidemiological, economic burden and community derived disability weights for snakebites in India. Besides, the Global Burden of Disease has not attached a particular disability weight to snakebite and this would be an attempt to do so. The protocol has been developed using guidelines for cross-sectional studies, cost of illness studies and international guidelines for conducting community derived disability weights. The evidence generated by this study will contribute significantly to knowledge regarding the epidemiology, economic burden and community-derived disability weights for snakebites in India and other countries where incidence of snakebite is high.
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Elmoheen, Amr, Waleed Awad Salem, Mahmoud Haddad, Khalid Bashir, and Stephen H. Thomas. "Experience of Snakebite Envenomation by a Desert Viper in Qatar." Journal of Toxicology 2020 (October 10, 2020): 1–5. http://dx.doi.org/10.1155/2020/8810741.
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Crotaline and elapid snakebites are reported all over the world as well as in the Middle East and other countries around this region. However, data regarding snakebites and their treatment in Qatar are limited. This review paper is going to investigate the presentation and treatment of snakebite in Qatar. A good assessment helps to decide on the management of the snakebites envenomation. Antivenom and conservative management are the mainstays of treatment for crotaline snakebite. Point-of-care ultrasound (POCUS) has been suggested to do early diagnosis and treatment of soft tissue problems, such as edema and compartment syndrome, after a snakebite. The supporting data are not sufficient regarding the efficiency of POCUS in diagnosing the extent and severity of tissue involvement and its ultimate effect on the outcome. Further research is suggested in this case. Systemic complications, such as bleeding diathesis, can be managed by administering clotting factors and platelets.
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Ooms, Gaby I., Janneke van Oirschot, Benjamin Waldmann, Dorothy Okemo, Aukje K. Mantel-Teeuwisse, Hendrika A. van den Ham, and Tim Reed. "The Burden of Snakebite in Rural Communities in Kenya: A Household Survey." American Journal of Tropical Medicine and Hygiene 105, no. 3 (September 15, 2021): 828–36. http://dx.doi.org/10.4269/ajtmh.21-0266.
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ABSTRACT. Annually, about 2.7 million snakebite envenomings occur worldwide, primarily affecting those living in rural regions. Effective treatment exists but is scarce, and traditional treatments are commonly used. To inform context-specific policies in Kenya, this study aimed to determine the health-seeking behavior and the health, social, and economic burden of snakebites in rural communities. Nonprobability sampling was used to survey 382 respondents from four snakebite-endemic counties, from February to August 2020, using a structured questionnaire. Descriptive statistics, Fisher’s exact tests, binary logistic regressions, and Mantel-Haenszel tests were used for analysis. Life-time experience with snakebites included 13.1% of respondents who reported being personally bitten and 37.4% who reported knowing of a community member being bitten. Respondents reported death after a snakebite in 9.1% of bitten community members and in 14.6% of bitten family members. Risk of snakebite was not significantly associated with sex, educational level, or occupation. Snakebite victims were most often walking (38%) or farming (24%) when bitten. Of those bitten, 58% went to a health facility, 30% sought traditional treatment, and 12% first went to a traditional healer before visiting a facility. Significant differences existed in perceptions on the financial consequences of snakebites among those who had been personally bitten and those who had observed a snakebite. Most commonly mentioned preventive measures were wearing shoes and carrying a light in the dark. Community engagement, including engagement with traditional healers, is needed to reduce snakebites. This should be done through education and sensitization to improve used preventive measures and effective health-seeking behavior.
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Shrestha, Carmina, and Sajan Acharya. "Neurotoxic snakebites at a primary healthcare center in Nepal: an experience of a PAHS graduate." Journal of Patan Academy of Health Sciences 7, no. 2 (September 12, 2020): 85–90. http://dx.doi.org/10.3126/jpahs.v7i2.31108.
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Nepal has one of the highest snakebite fatalities in South Asia. Most bites occur in rural areas where there is a lack of both adequate facilities for treatment and transport. Despite several limitations, prompt access and focus on supportive care are the major strengths of peripheral healthcare centers. Here we present the management of two cases of neurotoxic snakebites. Timely intervention can save lives in case of snakebites; hence establishment of snakebite treatment centers in the periphery can mitigate the problem of delay in care. Patan Academy of Health Sciences can contribute by training medical graduates in snakebite management.
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Menon, Jaideep C., Omesh K. Bharti, Rupinder S. Dhaliwal, Denny John, Geetha R. Menon, Ashoo Grover, and Joy K. Chakma. "ICMR task force project- survey of the incidence, mortality, morbidity and socio-economic burden of snakebite in India: A study protocol." PLOS ONE 17, no. 8 (August 22, 2022): e0270735. http://dx.doi.org/10.1371/journal.pone.0270735.
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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 states of India in order to obtain annual incidence of snakebites from the community. Frontline health workers will be trained to gather information on new cases of snakebite over the study period of 1-year, from “wards “(smallest administrative subunit of a village or town) that they represent in the study districts. Dedicated field officers would collect data on snakebites, victim characteristics, outcomes, utilization of health facilities on a questionnaire sheet designed for this purpose. The study duration is for 18 months from April 2022 to October 2023. Discussion The study would be the first of its kind in India looking prospectively at the incidence of snakebite covering 13 states in 5 zones of India and a population of 84 million. Our study covers 6.12% of the total population of the country as compared to the incidence study conducted in Sri Lanka which covered 1% of the total population.
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Devkota, Gaurav. "Factors associated with treatment outcomes in anti-snake venom (ASV) administered snakebite patients." Journal of Patan Academy of Health Sciences 7, no. 2 (August 30, 2020): 129–35. http://dx.doi.org/10.3126/jpahs.v7i2.31142.
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Introduction: Snakebite is a neglected tropical disease causing many deaths and serious consequences in Asia and Africa. Anti-snake Venom (ASV) is effective to prevent or reverse the venomous effects of snakebites. The aim of this study was to identify the prevalence of venomous snakebites and factors associated with treatment outcomes in a district hospital of Western Terai in Nepal.
Method: A single health facility-based retrospective cross-sectional study was conducted with collection of information from the record section of Bhim Hospital, Rupandehi, Nepal. All snakebite cases treated during July 2013 to July 2018 were included. The data on prevalence of snakebite and treatment outcomes were analyzed. Fischer’s exact test and exact logistic regression were performed to identify factors associated with treatment outcomes of venomous snakebites.
Result: The prevalence of venomous snakebites was 3.71% (163/4399). Among cases with complete information (N=120), two-third were cured, and one-fourth were referred. Median number of ASV vials used was 12. Age and ASV vials used showed significant positive moderate correlation (r=0.38, p-value<0.001). Year of treatment showed significant association with treatment outcomes. In multivariate analysis, though insignificant, higher adjusted odds of cure was present with one unit increase in ASV vial (AOR= 1.16) and when the bite was in extremities (upper extremities AOR = 11.46 and lower extremities AOR= 21.68).
Conclusion: Snakebite cases require urgent management with administration of ASV, and proper recording of the cases in order to provide tangible evidence for policy and guideline formulation.
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Sebe, A., S. Satar, and A. Acikalin. "Snakebite during pregnancy." Human & Experimental Toxicology 24, no. 7 (July 2005): 341–45. http://dx.doi.org/10.1191/0960327105ht535oa.
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Little is known about snakebites during pregnancy and only a few cases have been reported in the literature. The fact that venomous snakebites during pregnancy result in high fetal wastage and may cause maternal mortality makes this an important, albeit, uncommonly encountered entity in emergency medicine. In this paper, we report on the successful treatment of three cases of snakebite in pregnancy.
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Chaaithanya, Itta Krishna, Dipak Abnave, Himmatrao Bawaskar, Ujwal Pachalkar, Sandip Tarukar, Neha Salvi, Prabhakar Bhoye, Arun Yadav, Smita D. Mahale, and Rahul K. Gajbhiye. "Perceptions, awareness on snakebite envenoming among the tribal community and health care providers of Dahanu block, Palghar District in Maharashtra, India." PLOS ONE 16, no. 8 (August 5, 2021): e0255657. http://dx.doi.org/10.1371/journal.pone.0255657.
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Introduction India has remarkably the highest number of snakebite cases contributing to nearly 50% of the global snakebite deaths. Despite this fact, there is limited knowledge and awareness regarding the management practices for snakebite in the Indian population. The study aimed to explore the knowledge, awareness, and perception of snakes and snakebites, first aid, and treatment amongst the community and the frontline health workers in a tribal block of Dahanu, Maharashtra, India. Methods A cross-sectional study was carried out from June 2016 to October 2018 in the Dahanu Block, Maharashtra. Perceptions, knowledge, awareness, and first-aid practices on the snakebites among the community were studied through focus group discussions (FGDs). Semi-structured questionnaires were used to assess the knowledge, awareness, and experience of the traditional faith healers, snake rescuers, frontline health workers on the snakebites and their management. A facility check survey was conducted using pre-tested questionnaires for different levels of the government health care facilities. Results Most of the tribal community was aware of the commonly found snakes and their hiding places. However, there was inadequate knowledge on the identification and classification of venomous snakes. Belief in a snake god, the perception that snakes will not come out during thunderstorms, change in taste sensation, the ability of tamarind seeds or magnet to reduce the venom effect were some of the superstitions reported by the tribal community. The application of a harmful method (Tourniquet) as the first aid for snakebite was practiced by the tribal community. They preferred herbal medicines and visiting the traditional faith healers before shifting the patient to the government health facility. The knowledge on the ability to identify venomous snakebites and anti-venom was significantly higher amongst nurses and accredited social health activists (ASHAs) than auxiliary nurse midwives (ANMs) and multi-purpose workers (MPWs) (p < 0.05). None of the traditional faith healers; but nearly 60% of snake rescuers were aware of anti-venom. Fifty percent of the medical officers in Dahanu block did not have correct knowledge about the Krait bite symptoms, and renal complications due to the Russell viper bite. Conclusions Inappropriate perception, inadequate awareness, and knowledge about snakes and snakebites may predispose the tribal community to increased risks of venomous snakebites. Unproven and harmful methods for snakebite treatment practiced by the community and traditional faith healers could be dangerous leading to high mortality. Therefore, a multi-sectoral approach of community awareness, mapping of vulnerable populations, capacity building of health care facility, empowerment of health care workers (HCWs) could be useful for reducing the mortality and morbidity due to snakebite envenoming in India.
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Ediriweera, Dileepa Senajith, Anuradhani Kasthuriratne, Arunasalam Pathmeswaran, Nipul Kithsiri Gunawardene, Shaluka Francis Jayamanne, Kris Murray, Takuya Iwamura, et al. "Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample." PLOS Neglected Tropical Diseases 15, no. 6 (June 1, 2021): e0009447. http://dx.doi.org/10.1371/journal.pntd.0009447.
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Background Snakebite incidence shows both spatial and temporal variation. However, no study has evaluated spatiotemporal patterns of snakebites across a country or region in detail. We used a nationally representative population sample to evaluate spatiotemporal patterns of snakebite in Sri Lanka. Methodology We conducted a community-based cross-sectional survey representing all nine provinces of Sri Lanka. We interviewed 165 665 people (0.8% of the national population), and snakebite events reported by the respondents were recorded. Sri Lanka is an agricultural country; its central, southern and western parts receive rain mainly from Southwest monsoon (May to September) and northern and eastern parts receive rain mainly from Northeast monsoon (November to February). We developed spatiotemporal models using multivariate Poisson process modelling to explain monthly snakebite and envenoming incidences in the country. These models were developed at the provincial level to explain local spatiotemporal patterns. Principal findings Snakebites and envenomings showed clear spatiotemporal patterns. Snakebite hotspots were found in North-Central, North-West, South-West and Eastern Sri Lanka. They exhibited biannual seasonal patterns except in South-Western inlands, which showed triannual seasonality. Envenoming hotspots were confined to North-Central, East and South-West parts of the country. Hotspots in North-Central regions showed triannual seasonal patterns and South-West regions had annual patterns. Hotspots remained persistent throughout the year in Eastern regions. The overall monthly snakebite and envenoming incidences in Sri Lanka were 39 (95%CI: 38–40) and 19 (95%CI: 13–30) per 100 000, respectively, translating into 110 000 (95%CI: 107 500–112 500) snakebites and 45 000 (95%CI: 32 000–73 000) envenomings in a calendar year. Conclusions/significance This study provides information on community-based monthly incidence of snakebites and envenomings over the whole country. Thus, it provides useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which take into account both location and season.
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Senek, Mohd Zaki Fadzil, So Yeon Kong, Sang Do Shin, Kyong Min Sun, Jungeun Kim, and Young Sun Ro. "Epidemiological profile and outcomes of snakebite injuries treated in emergency departments in South Korea, 2011–2016: a descriptive study." Transactions of The Royal Society of Tropical Medicine and Hygiene 113, no. 10 (June 21, 2019): 590–98. http://dx.doi.org/10.1093/trstmh/trz050.
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Abstract Background Snakebite is a global public health crisis, but there are no nationwide data on snakebite in South Korea. The aim of this study was to describe the epidemiological profile and outcomes of snakebite cases in South Korea seasonally. Methods The selected subjects were patients of all ages with a chief complaint of snakebite who presented to participating emergency departments (EDs) between 1 January 2011 and 31 December 2016. Results A total of 1335 patients were eligible for the study. There were an average of 223 snakebite cases reported each year. Most snakebites occurred during the summer months (55.9%) in patients aged 40–59 y (36.3%) and males (61.5%). Snakebites occurred most frequently on Mondays (22.9%) between 12:00 and 17:59 h (42.0%) outdoors (57.9%) and in farm areas (20.7%). Over 82% of the bites were by venomous snakes across all seasons, and 66% of the patients visited EDs without using emergency medical services. Based on the excess mortality ratio-adjusted injury severity score, 88, 9.2 and 2.8% had mild, moderate and severe injuries, respectively. There were 10 fatalities during the study period. Conclusion This study provides essential information to understand and assess the burden and distribution of snakebites in South Korea and provides valuable information for developing appropriate prevention and control interventions to address it.
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Aron, Moses Banda, Manuel Mulwafu, Bright Mailosi, Benno Kreuels, Luckson Dullie, Chiyembekezo Kachimanga, Jörg Blessmann, et al. "Experiences and practices of traditional healers on snakebite treatment and prevention in rural Malawi." PLOS Neglected Tropical Diseases 17, no. 10 (October 4, 2023): e0011653. http://dx.doi.org/10.1371/journal.pntd.0011653.
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Snakebite envenoming remains a public health threat in many tropical countries including Malawi. Traditional healers (THs) have been consulted by victims of snakebites as primary caregivers for millennia. There are no studies in Malawi to understand this phenomenon, therefore, our study aimed to explore the experiences and practices of THs regarding snakebite treatment and prevention in rural Malawi. Between August and September 2022, we conducted semi-structured interviews with 16 THs who were purposefully selected from various locations across Neno District, Malawi. We analysed the interview data using Dedoose software, where we generated codes and grouped them into themes. Out of the 16 THs interviewed, 68.8% (n = 11) were male, and 43.8% were aged between 40 and 60 years. Our study identified five themes: THs’ knowledge of snakes and treatment, the continuum of care they provide, payment procedures, snakebite prevention, and their relationship with health facilities. They claimed a good understanding of the snakes in their area, including the seasons with more snakebites, and were confident in their ability to provide treatment, however, this was not scientifically proven. They offered a comprehensive care package, including diagnosis, first aid, main treatment, and follow-up care to monitor the victim’s condition and adjust treatment as needed. THs provide free treatment for snakebites or use a “pay later” model of service delivery. All THs claimed a “vaccine” for snakebites that could prevent bites or neutralize the venom. However, no formal relationship existed between THs and Health Care Workers (HCWs). We recommend collaboration between HCWs and THs, establishing clear referral pathways for snakebite victims and educating THs on identifying danger signs requiring prompt referral to healthcare facilities.
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Lin, Chih-Chuan, Yen-Chia Chen, Zhong Ning Leonard Goh, Chen-Ken Seak, Joanna Chen-Yeen Seak, Gao Shi-Ying, and Chen-June Seak. "Wound Infections of Snakebites from the Venomous Protobothrops mucrosquamatus and Viridovipera stejnegeri in Taiwan: Bacteriology, Antibiotic Susceptibility, and Predicting the Need for Antibiotics—A BITE Study." Toxins 12, no. 9 (September 7, 2020): 575. http://dx.doi.org/10.3390/toxins12090575.
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Snakebites from Taiwan habus (Protobothrops mucrosquamatus) and green bamboo vipers (Viridovipera stejnegeri) account for two-thirds of all venomous snakebites in Taiwan. While there has been ongoing optimization of antivenin therapy, the proper management of superimposed bacterial wound infections is not well studied. In this Bacteriology of Infections in Taiwanese snake Envenomation (BITE) study, we investigated the prevalence of wound infection, bacteriology, and corresponding antibiotic usage in patients presenting with snakebites from these two snakes. We further developed a BITE score to evaluate the probability of wound infections and guide antibiotic usage in this patient population. All snakebite victims who presented to the emergency departments of seven training and research hospitals and received at least one vial of freeze-dried hemorrhagic antivenin between January 2001 and January 2017 were identified. Patient biodata, laboratory investigation results, and treatment modalities were retrieved. We developed our BITE score via univariate and multiple logistic regression analyses. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance of the BITE score. Out of 8,295,497 emergency department visits, 726 patients presented with snakebites from a Taiwan habu or a green bamboo viper. The wound infection rate was 22.45%, with seven positive wound cultures, including six polymicrobial infections. Morganella morganii, Enterococcus spp., Bacteroides fragilis, and Aeromonas hydrophila were most frequently cultured. There were no positive blood cultures. A total of 33.0% (n = 106) of snakebite patients who received prophylactic antibiotics nevertheless developed wound infections, while 44.8% (n = 73) of wound infection patients were satisfactorily treated with one of the following antibiotics: amoxicillin/clavulanic acid, oxacillin, cefazolin, and ampicillin/sulbactam. With the addition of gentamicin, the success of antibiotic therapy increased by up to 66.54%. The prognostic factors for the secondary bacterial infection of snakebites were white blood cell counts, the neutrophil lymphocyte ratio, and the need for hospital admission. The area under the ROC curve for the BITE score was 0.839. At the optimal cut-off point of 5, the BITE score had a 79.58% accuracy, 82.31% sensitivity, and 79.71% specificity when predicting infection in snakebite patients. Our BITE score may help with antibiotic stewardship by guiding appropriate antibiotic use in patients presenting with snakebites. It may also be employed in further studies into antibiotic prophylaxis in snakebite patients for the prevention of superimposed bacterial wound infections.
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Davi, Saskia Dede, Anita Lumeka, Teite Rebecca Hildebrandt, Lilian Rene Endamne, Cedric Otchague, Dearie Glory Okwu, Rica Artus, et al. "Assessing the Incidence of Snakebites in Rural Gabon—A Community-Based, Cross-Sectional Pilot Survey." Tropical Medicine and Infectious Disease 9, no. 4 (March 23, 2024): 68. http://dx.doi.org/10.3390/tropicalmed9040068.
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Snakebite envenoming (SBE) is a neglected tropical disease (NTD). Community-based studies from sub-Saharan Africa are urgently required as data on the incidence are scarce. This study aimed to determine the lifetime prevalence of snakebites in rural Gabon by preparing the conduct of a larger regional survey. A cross-sectional community-based epidemiological survey in Sindara, Ngounie province, was conducted. Households were interviewed about the history of snakebites of household members to calculate lifetime prevalence. In addition, the average annual incidence rate per 100,000 over the last 5 years was calculated. A total of 771 inhabitants were enrolled, of which 5 (0.65%; 95% confidence interval (95% CI: 0.2–1.5%)) were victims of snakebites. Over the past 5 years, annual incidence was 77 bites per 100,000 (95% CI: 0–620). This study provides a first rough estimate of the incidence of SBE from rural central Gabon, demonstrating the importance of this NTD. Key Contribution: The estimated annual incidence of snakebites found was 77 per 100,000. Snakebites occurred mainly during agricultural activities.
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Schneider, Maria Cristina, Kyung-duk Min, Patricia Nájera Hamrick, Lucia R. Montebello, Tani Maria Ranieri, Lucia Mardini, Volney M. Camara, et al. "Overview of snakebite in Brazil: Possible drivers and a tool for risk mapping." PLOS Neglected Tropical Diseases 15, no. 1 (January 29, 2021): e0009044. http://dx.doi.org/10.1371/journal.pntd.0009044.
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Snakebite envenoming affects close to 2.7 million people globally every year. In Brazil, snakebites are reported to the Ministry of Health surveillance system and cases receive antivenom free of charge. There is an urgent need to identify higher risk areas for antivenom distribution, and to develop prevention activities. The objective of this study is to provide an overview of the epidemiological situation of snakebite envenoming in Brazil and explore possible drivers; as well as to create a flowchart tool to support decision-makers identify higher risk areas. An ecological-type study was carried out using data by municipality (2013–2017). Study parts: 1) Create a geocoded database and perform a descriptive and cluster analysis; 2) Statistical analysis to measure the association of snakebite and possible environmental and socioeconomic drivers; 3) Develop a flowchart to support decision-makers and the application of this tool in one state (Rio Grande do Sul) as an example. An average of 27,120 snakebite cases per year were reported at the country level. Clusters of municipalities with high numbers of snakebites are mostly found in the Amazon Legal Region. The negative binomial regression model showed association with the snakebite case count: the type of major habitat, tropical or non-tropical; temperature; percentage of urbanization; precipitation; elevation; GDP per capita; a weaker relation with forest loss; and with venomous snake richness. The state where the instrument was applied reported 4,227 snakebites in the period. Most municipalities were considered as medium risk and 56/496 as high risk according to the tool created. Snakebite cases are distributed across the entire country with the highest concentration in the Legal Amazon Region. This creates a complex situation both for better understanding of the association of environmental and socioeconomic factors with snakebites and for the distribution and maintenance of antivenom to remote areas. Research into types of antivenom with a longer shelf life without the need for refrigeration is needed.
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Sapkota, Sunil, Deb P. Pandey, Guru P. Dhakal, and Dhan B. Gurung. "Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan." PLOS Neglected Tropical Diseases 14, no. 11 (November 30, 2020): e0008793. http://dx.doi.org/10.1371/journal.pntd.0008793.
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Background Published information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries. Aims and methodology Structured questionnaire was used to collect knowledge of health workers in snakebite management and health seeking behavior of snakebite victims as observed by health workers. Study was conducted in purposively sampled 10 Dzongkhags (district level administrative units) with higher incidence of snakebites. Result Heath workers scored 27–91% (with an average of 63%, SD = 14) for 52 questions related to snake identification and snakebite management. Among 118 health workers interviewed, 23% had adequate knowledge on snakes and snakebite management while 77% had inadequate knowledge. Among 32 Doctors, 63% of them scored above or equal to 75%. Health workers from Sarpang scored higher (76%, SD = 11) than those from other Dzongkhags. Snakebite victim's visit to local (traditional) healers prior to seeking medical help from hospital was observed by 75 (63%) health workers. Fifty one percent of health workers observed patients treated with local methods such as the use of black stone called Jhhar Mauro (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of Khenpa Shing (Artemisia myriantha Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (Azadirachta indica Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers. Conclusion Health workers lack confidence in snakebite management. Snakebite victims are likely to suffer from harmful local practices and traditional beliefs on local treatment practices. Empowering health workers with adequate knowledge on snakebite management and making locals aware in pre-hospital care of snakebites are needed to improve the pre- and in-hospital management of snakebite in Bhutan.
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Gebrewold, Gashaw, Timothy J. Colston, Ashebir Abebe, Karifa Kourouma, Robinah Najjemba, Demise Mulugeta, Hailu Lumma, et al. "Distribution of snake species and snakebites in hotspots of Ethiopia." Journal of Infection in Developing Countries 16, no. 08.1 (August 31, 2022): 45S—51S. http://dx.doi.org/10.3855/jidc.15973.
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Introduction: In Sub-Saharan Africa, snakebites are a public health problem. In Ethiopia, clinical cases have been described, but little information exists on snakebites burden and its geographical distribution. The aim of this study was to document the spatial distribution of venomous snakes and snakebites in Ethiopia.
Methodology: In a cross-sectional observational study, venomous snakes were collected during snake catching activities in six Ethiopian hotspot areas between April 2015 and September 2020. Species and habitat were described. In the hotspot areas, routine health information data on reported snakebites was collected in 78 districts and subsequently used to map annual incidence per district.
Result: A total of 333 snakes were collected and 14 species were identified. The most prevalent species were Bitis arietans, Bitis arietanus somalica, Echis pyramidum, known as vipers, and Naja pallida, known as cobra. The highest number of snakes (75) was observed in the Northwest and Eastern parts of Ethiopia, mostly in cultivation and man-made farm land, wooded and moist dry savanna. In each hotspot a wide variety of species was observed, although composition was different. The highest snakebite incidence overlapped with the high snakes densities in Northwest Ethiopia. The snakebite annual average incidence at district level was very heterogeneous and ranged from < 15 cases/100,000 inhabitants (44% of the districts) to 309.2 cases/100,000 inhabitants.
Conclusions: Snake diversity and distribution, linked to high incidence of snakebites in the hotspots, suggests a close interconnection between human, animal and environmental systems and could inform the need for antivenoms per geographical locality.
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Koirala, Bal Krishna, Jaganath Koirala, and Sunil Sapkota. "Retrospective study on epidemiology of snakebites in Sarpang District, southern Bhutan." Journal of Threatened Taxa 10, no. 13 (November 26, 2018): 12749–54. http://dx.doi.org/10.11609/jott.3882.10.13.12749-12754.
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Although snake bite envenomation is considered as a medical emergency with significant morbidity and mortality, accurate figures on snakebite envenomation remains scarce. We conducted a retrospective study to evaluate the snakebite epidemiology in Sarpang District located in the subtropical zone of southern Bhutan. In this study, 78 snakebite cases treated in Gelephu Referral Hospital over a period of three years from 2013 to 2015 were evaluated based on the statistical record maintained by the medical administration. Twenty-eight (35.89%) cases developed signs and symptoms of envenomation and the remaining 50 (64.01%) were found to be cases of non-venomous bites. Forty-four males and 34 females were found to be affected by snakebites within the period. While snakebites were observed in all age groups, the large majority (n=51, 65.38%) were in adults aged between 21 and 50 years. Most of the venomous bites (68%) occurred during the monsoon season, particularly between May and August. It was found that adults in the economically productive age group were the ones most affected by poisonous bites. There is an urgent need for development and adoption of snakebite management guidelines and awareness among the vulnerable sections of the population, improvement of medical facilities in referral hospitals and rural health centres, and reduction of the morbidity and mortality associated with snakebites.
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Goldstein, Eyal, Joseph J. Erinjery, Gerardo Martin, Anuradhani Kasturiratne, Dileepa Senajith Ediriweera, Hithanadura Janaka de Silva, Peter Diggle, David Griffith Lalloo, Kris A. Murray, and Takuya Iwamura. "Integrating human behavior and snake ecology with agent-based models to predict snakebite in high risk landscapes." PLOS Neglected Tropical Diseases 15, no. 1 (January 22, 2021): e0009047. http://dx.doi.org/10.1371/journal.pntd.0009047.
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Snakebite causes more than 1.8 million envenoming cases annually and is a major cause of death in the tropics especially for poor farmers. While both social and ecological factors influence the chance encounter between snakes and people, the spatio-temporal processes underlying snakebites remain poorly explored. Previous research has focused on statistical correlates between snakebites and ecological, sociological, or environmental factors, but the human and snake behavioral patterns that drive the spatio-temporal process have not yet been integrated into a single model. Here we use a bottom-up simulation approach using agent-based modelling (ABM) parameterized with datasets from Sri Lanka, a snakebite hotspot, to characterise the mechanisms of snakebite and identify risk factors. Spatio-temporal dynamics of snakebite risks are examined through the model incorporating six snake species and three farmer types (rice, tea, and rubber). We find that snakebites are mainly climatically driven, but the risks also depend on farmer types due to working schedules as well as species present in landscapes. Snake species are differentiated by both distribution and by habitat preference, and farmers are differentiated by working patterns that are climatically driven, and the combination of these factors leads to unique encounter rates for different landcover types as well as locations. Validation using epidemiological studies demonstrated that our model can explain observed patterns, including temporal patterns of snakebite incidence, and relative contribution of bites by each snake species. Our predictions can be used to generate hypotheses and inform future studies and decision makers. Additionally, our model is transferable to other locations with high snakebite burden as well.
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Nimzing, Timnan, Y. A. Arigbede, and I. Muhammad. "EXAMINATION OF SNAKEBITE PREVALENCE AND FACTORS PREDISPOSE TO BITE IN LANGTANG NORTH, PLATEAU STATE, NIGERIA." FUDMA JOURNAL OF SCIENCES 6, no. 3 (July 2, 2022): 130–37. http://dx.doi.org/10.33003/fjs-2022-0603-935.
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Snakebite poisoning is a public health concern to persons in agrarian environments and Langtang North Local Government Area is not an exception. Agricultural and field workers have been reported to be at higher risk of snakebite in this area. The objective of this paper is to examine the prevalence rate and factors predisposed to snakebite. The primary data was gotten from information drive from questionnaire interview of the respondents (victims) while secondary data was obtained from hospital records at Zamko Comprehensive Health Centre (CHC) and National Population Commission and was analysed by using frequency table and trend line as well as the prevalence rate formula (equation). The results showed that the highest number of snakebites incidence was recorded in 2017 with 117 cases, followed by 2008 and 2018 with 109 cases each. The lowest was recorded in 2014 with 33 cases of snakebites. The result further depicts that the highest number of the snakebite cases was recorded at Zamko ward with 117 cases, followed by Nyer with 100 cases, Lipchok and Kuffen C ward had 78 cases each. The prevalence rate of snakebite cases in Langtang north LGA was found to be 424/100000. The findings of the study shows that majority of the snakebite victims were farmers with 36.23% and was observed from the findings that majority 37.68% of the bites occurred in the morning time as compared to the number in the night with 33.33%. Thus, the major factors found to be associated with snakebites included farming activities
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Chen, Xi, Hongmei He, and Hongke Cai. "Clinical and epidemiologic profile of venomous snakebites in Chongqing Wuling mountainous area, western China." Transactions of The Royal Society of Tropical Medicine and Hygiene 113, no. 10 (July 11, 2019): 587–89. http://dx.doi.org/10.1093/trstmh/trz061.
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Abstract Background In China, venomous snakebites are an important medical emergency and cause of hospital admission, but few studies have looked at the clinical and epidemiologic profile of human snakebite victims. Methods We conducted a retrospective study of 440 snakebite cases encountered at a single hospital in the Chongqing Wuling mountainous area of western China from July 2004 to August 2018. Data were collected from the electronic medical record system. Results The majority of bite victims were male (58.4%), 41–60 y of age (37.9%) and the bites occurred during the daytime (51.1%) in July–September (62.5%). The lower limbs were the most vulnerable sites to snakebites (73.9%). The most common local toxicity consisted of pain (86.1%), oedema (78.4%) and bleeding (35.9%). Of the systemic toxicities, haematuria (14.3%) and ophthalmoplegia (9.5%) were common. The majority (86.4%) of individuals presented to the hospital within 6 h. Conclusions This study describes the clinical and epidemiologic profile of venomous snakebites in the Chongqing Wuling mountainous area of western China. Multicentre prospective studies were needed in the entire country of China.
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Martín, Gerardo, Joseph J. Erinjery, Dileepa Ediriweera, H. Janaka de Silva, David G. Lalloo, Takuya Iwamura, and Kris A. Murray. "A mechanistic model of snakebite as a zoonosis: Envenoming incidence is driven by snake ecology, socioeconomics and its impacts on snakes." PLOS Neglected Tropical Diseases 16, no. 5 (May 12, 2022): e0009867. http://dx.doi.org/10.1371/journal.pntd.0009867.
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Snakebite is the only WHO-listed, not infectious neglected tropical disease (NTD), although its eco-epidemiology is similar to that of zoonotic infections: envenoming occurs after a vertebrate host contacts a human. Accordingly, snakebite risk represents the interaction between snake and human factors, but their quantification has been limited by data availability. Models of infectious disease transmission are instrumental for the mitigation of NTDs and zoonoses. Here, we represented snake-human interactions with disease transmission models to approximate geospatial estimates of snakebite incidence in Sri Lanka, a global hotspot. Snakebites and envenomings are described by the product of snake and human abundance, mirroring directly transmitted zoonoses. We found that human-snake contact rates vary according to land cover (surrogate of occupation and socioeconomic status), the impacts of humans and climate on snake abundance, and by snake species. Our findings show that modelling snakebite as zoonosis provides a mechanistic eco-epidemiological basis to understand snakebites, and the possible implications of global environmental and demographic change for the burden of snakebite.
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Khimani, Amina, Afton Mcnierney, Sara Surani, and Salim Surani. "Snake Envenomation Causing Distant Tracheal Myonecrosis." Case Reports in Pulmonology 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/364195.
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Snakebites are often believed to be poisonous. However, this is not always the case. In fact, each bite differs from snake to snake, depending on if the snake is poisonous and if there is envenomation. Venom in pit viper snakebites is often associated with local necrosis. The abundant literature selections and research articles justify local myonecrosis due to envenomation, but there is not much in the literature regarding myonecrosis at a site distant from the snakebite. We hereby present a case of a 42-year-old man who was transferred to our emergency department after a rattlesnake bit him twice. The patient, besides developing local myonecrosis at the site of the snakebite, developed necrosis of the scrotum as well as tracheal pressure myonecrosis at the site of the endotracheal tube balloon. In this review, we will attempt to discuss the myonecrosis pathophysiology and management related to the rattle snakebite.
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Rinta Prasetiyanti and Yetti Hernaningsih. "Hemocoagulation Conditions Associated with Venom-Induced Consumption Coagulopathy due to Snakebite in Humans." Folia Medica Indonesiana 60, no. 2 (June 10, 2024): 156–66. http://dx.doi.org/10.20473/fmi.v60i2.49436.
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Highlights:1. This review comprehensively highlighted aspects of hematologic abnormalities in snakebites, a topic that remains understudied globally.2. This review contributes insights into the field of snakebite research and improves the management of snakebites by examining the diverse effects of different types of snakebites on hemocoagulation status. Abstract Snakebite remains an underreported health hazard worldwide. The most common effects of snakebite envenomation globally are hematological disorders, with venom-induced consumption coagulopathy (VICC) being the most prevalent and significant condition. This review aimed to explore the hematological aspects of snakebite, with a focus on snakebite-induced consumption coagulopathy. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a search across several databases, namely PubMed, ScienceDirect, and Google Scholar. The inclusion criteria for this review were studies on snakebite envenomation in humans with a discussion of relevant cases. Additionally, the included studies were conducted between 2010 and 2023 and published in the English language. Studies on animal models were excluded. We used the keywords “venom-induced consumption coagulopathy AND snake" in the search. The critical appraisal was performed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports and the Mixed Methods Appraisal Tool (MMAT). The findings were presented as a qualitative synthesis of 14 articles covering 316 patients and various snakebite types. The studies on snakebite came from various countries, but mostly from Sri Lanka. The snake types exhibited variation, with certain species existing only in specific areas. The subjects fell into different age groups, from children to the elderly. The majority of the subjects were male. The subjects' youngest age was 6 years old, while the oldest was 70 years old. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were the most discussed variables. Some of the studies demonstrated an increase in PT and APTT, although other studies reported contrasting findings. In conclusion, certain types of snakebite have a different impact on the hemocoagulation status.
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Jayawardana, Subashini, Carukshi Arambepola, Thashi Chang, and Ariaranee Gnanathasan. "Prevalence, vulnerability and epidemiological characteristics of snakebite in agricultural settings in rural Sri Lanka: A population-based study from South Asia." PLOS ONE 15, no. 12 (December 28, 2020): e0243991. http://dx.doi.org/10.1371/journal.pone.0243991.
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Background The burden of snakebite remains poorly characterised because of the paucity of population-based data. Further, factors determining the vulnerability of individuals within rural communities to snakebite have been rarely investigated. We undertook a population-based study to determine the prevalence, vulnerability and epidemiological characteristics of snakebite in rural Sri Lanka. Methods and findings A population-based cross-sectional study was conducted among 8707 current residents in the district of Ampara, representing typical rural Sri Lanka. The sample was recruited using multi-stage cluster sampling with probability proportionate-to-size. Snakebite victims were identified using the WHO criteria. Data were collected using a pre-tested interviewer-administered questionnaire. Each household had on average 3.8 persons; mean age 28.3 years (SD = 18.2); 51.3% males. The one-year point prevalence of snakebites was 17.6 per 1000 residents (95% CI: 15–20.6) and 6.12 per 100 households (95% CI: 5.25–7.13), while the lifetime prevalence was 9.4 per 100 residents (95% CI: 8.8–10.0) and 30.5 per 100 households (95% CI: 28.6–32.2) with a case fatality ratio of 0.033. Venomous snakebites accounted for 28.1%; snakes were unidentified among 30.1%. Compared to the non-snakebite victims, being single, males, of Sinhala ethnicity, aged >19 years, low education and socioeconomic status, engaging in farming or unskilled outdoor occupations denoted vulnerability to snakebites. Outdoor bites (77.8%) were more common among males; during daytime; mostly while walking; within the rural terrains and home gardens; on lower limbs; mostly by hump-nosed and Russell viper. Indoor bites were more common among females; during night-time; while sleeping and barefooted; on lower limbs; mostly by hump-nosed vipers, kraits and non-venomous snakes. Conclusions The burden of snakebite is considerably high among rural populations. The concept of vulnerability can be useful in healthcare decision-making and resource allocation.
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Ameade, Evans Paul Kwame, Isaac Bonney, and Evans Twumasi Boateng. "Health professionals' overestimation of knowledge on snakebite management, a threat to the survival of snakebite victims—A cross-sectional study in Ghana." PLOS Neglected Tropical Diseases 15, no. 1 (January 19, 2021): e0008756. http://dx.doi.org/10.1371/journal.pntd.0008756.
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Background According to the World Health Organization, snakebites, a common occupational hazard in developing countries accounts for an annual loss of between 81,000 and 138, 000 lives following 5 million bites of which 2.7 million results in envenomation. Since snakebite-associated morbidity and mortality are more prevalent in agricultural economies such as Ghana, health professionals should be optimally knowledgeable on how to manage the incidence of snakebites. Lack of knowledge or overestimation of a professional's knowledge can affect heath delivery especially for emergencies such as snakebites. The three rurally situated Tongu districts in South-Eastern Ghana with agriculture as the major source of livelihood for their inhabitants, are prone to snakebites. This study, therefore, brings up the need to assess whether the health professionals in these districts are well-equipped knowledge-wise to handle such emergencies and whether they can rightly estimate their knowledge with regards to snakebite management. Methodology/Principal findings Data was collected using a de novo semi-structured questionnaire administered through google form whose link was sent via WhatsApp to 186 health workers made up of nurses, midwives, physician assistants, medical doctors, pharmacists, and pharmacy technicians. This data was analyzed using Statistical Package for the Social Sciences (SPSS) Version 25. Association between variables was determined using the appropriate tools where necessary, using a confidence interval of 95% and significance assumed when p ≤ 0.05. This study found male health workers significantly more knowledgeable about snakebite management (11.53±5.67 vs 9.64±5.46; p = 0.022) but it was the females who overestimated their knowledge level (27.9% vs 24.1%). The medical doctors exhibited the best knowledge on snakebite management with the registered general nurses least knowledgeable. Although most professionals overestimated their knowledge, the registered general nurses were the worst at that (53.7%). Overall knowledge of health care professionals on snakebite management was below average [10.60±5.62/22 (48.2%)] but previous in-service training and involvement in the management of snakebite were associated with better knowledge. Respondents who had no previous training overestimated their knowledge level compared to those who had some post-qualification training on snakebite management (38.1% vs 7.5%). The greatest knowledge deficit of respondents was on the management of ASV associated adverse reactions. Conclusion Health workers in rural Ghana overestimated their knowledge about snakebite management although their knowledge was low. Training schools, therefore, need to incorporate snakebite management in their curriculum and health authorities should also expose health workers to more in-service training on this neglected tropical disease.
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Tabbara, Faysal, Sarah Abdul-Nabi, Riad sADEK, Ziad Kazzi, and Tharwat El Zahran. "A Case Report of a Lebanon Viper (Montivipera bornmuelleri) Envenomation in a Child." Clinical Practice and Cases in Emergency Medicine 6, no. 4 (August 6, 2022): 319–23. http://dx.doi.org/10.5811/cpcem.2022.2.56176.
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Introduction: Snake envenomation is a serious public health concern. In the Middle East little is known about snakebite envenomation, which raises several challenges for emergency physicians caring for these patients. Case report: We report the case of a five-year-old boy bitten by a rare snake, Montivipera bornmuelleri, who presented to an emergency department in Lebanon. We also discuss the proper management of snake envenomation. Conclusion: This case is unique as snakebites in Lebanon are poorly studied, and little is known about the epidemiology and clinical manifestations of local snakebites.
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Moon, Youngjoo, Chaewan Kim, Sungsoo Yoon, and Wanmo Kang. "Identification of Risk Areas for Gloydius Snakebites in South Korea." Animals 13, no. 12 (June 12, 2023): 1959. http://dx.doi.org/10.3390/ani13121959.
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Snakebites can pose a significant threat to human health as the destruction of natural habitats and increased human intrusion into ecosystems result in more frequent encounters with snakes. Mitigation measures for snakebites are particularly crucial for hiking trails where transportation of snakebite victims to medical facilities is challenging due to limited emergency resources and difficult access. This study employed a random forest-based species distribution model approach to investigate the potential habitats of Gloydius spp., specifically Gloydius saxatilis, Gloydius brevicaudus, and Gloydius ussuriensis, in South Korea and to assess the snakebite risk in national parks. Potential habitats of Gloydius spp. were identified and visualized by overlaying binary maps derived from species distribution models (SDMs) of each Gloydius spp. that corresponded to high-risk snakebite areas. In addition, hiking trails with high snakebite risk in the national parks were identified after demonstrating the statistical correlation between the potential habitat distribution of Gloydius spp. and the actual snakebite incidents in major regions of South Korea. The primary environmental variables determining Gloydius spp. habitat were the topographic position index, slope, and the annual average of the maximum and minimum temperatures. The potential habitat of G. saxatilis generally appeared in high-altitude mountainous areas, mostly in the eastern part of the study area. Favorable habitats for G. brevicaudus and G. ussuriensis were predominantly located in mountainous areas throughout the study area, with the exception of some high-altitude mountainous terrain in the east. The number of snakebite incidents per 10,000 people was significantly correlated with the area ratio of Gloydius spp. potential habitat (Spearman’s rho = 0.638, p < 0.01). The proportion of snakebite risk areas among national parks in South Korea ranged from 18% to 57%. This study can support practical solutions to prevent injuries and fatalities among hikers due to snakebites by identifying areas with a high risk of snakebite accidents at the hiking-trail level.
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Vasquez, Chloe, Edgar Neri Castro, and Eric D. Carter. "Therapeutic itineraries of snakebite victims and antivenom access in southern Mexico." PLOS Neglected Tropical Diseases 18, no. 7 (July 5, 2024): e0012301. http://dx.doi.org/10.1371/journal.pntd.0012301.
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Access to antivenoms in cases of snakebite continues to be an important public health issue around the world, especially in rural areas with poorly developed health care systems. This study aims to evaluate therapeutic itineraries and antivenom accessibility following snakebites in the states of Oaxaca and Chiapas in southern Mexico. Employing an intercultural health approach that seeks to understand and bridge allopathic and traditional medical perceptions and practices, we conducted field interviews with 47 snakebite victims, documenting the therapeutic itineraries of 54 separate snakebite incidents that occurred between 1977 and 2023. Most victims used traditional remedies as a first line of treatment, often to withstand the rigors of a long journey to find antivenoms. The main obstacles to antivenom access were distance, poor antivenom availability, and cost. Standard antivenom treatment is highly valued and sought after, even as traditional beliefs and practices persist within a cultural framework known as the "hot-cold" system. The findings are crucial for informing future enhancements to antivenom distribution systems, health education initiatives, and other interventions aimed at mitigating the impact of snakebites in the region.
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Magalhães, Samara Freire Valente, Henry Maia Peixoto, Jacqueline de Almeida Gonçalves Sachett, Sâmella S. Oliveira, Eliane Campos Alves, Hiochelson Najibe dos Santos Ibiapina, Wuelton Marcelo Monteiro, and Maria Regina Fernandes de Oliveira. "Snakebite envenomation in the Brazilian Amazon: a cost-of-illness study." Transactions of The Royal Society of Tropical Medicine and Hygiene 114, no. 9 (April 1, 2020): 642–49. http://dx.doi.org/10.1093/trstmh/traa005.
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Abstract Background Snakebites account for significant morbidity and mortality. Their occurrence in the Brazilian Amazon warrants an analysis that will enable better understanding of their economic impact and thus contribute to their management and prevention. This study aimed to estimate the cost of snakebite envenomation in the Brazilian Amazon in 2015. Methods We conducted a cost-of-illness study of snakebite in the Brazilian Amazon in 2015 based on official surveillance data to estimate burden from a societal, patient and public health system perspective. Direct medical costs were estimated via a top-down approach. Loss of productivity was estimated by a human capital approach. Results The study included 11 503 cases and 56 deaths. The estimated cost to the health system was US$3.115.861,28. The estimated cost due to premature death caused by snakebite was US$3031 300.38. The cost attributed to the loss of productivity due to absence from work was US$1539 518.62. The estimated cost from the patient's perspective was US$268 914.18. Therefore the total cost of snakebite in the Brazilian Amazon was estimated to be almost than US$8 million in 2015. Conclusions The economic burden of snakebite in Brazilian Amazon is notably high. Snakebites cause loss of productivity through inpatient treatment or deaths.
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Salim, Anika, Jarred Williams, Samir Abdel Wahab, Tade Adeshokan, José R. Almeida, Harry F. Williams, Rajendran Vaiyapuri, et al. "Identifying key factors contributing to treatment costs for snakebite envenoming in private tertiary healthcare settings in Tamil Nadu, India." PLOS Neglected Tropical Diseases 17, no. 10 (October 16, 2023): e0011699. http://dx.doi.org/10.1371/journal.pntd.0011699.
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Background India suffers ~58,000 annual deaths due to snakebites. The ‘Big Four’ snakes (Russell’s viper, Indian cobra, common krait, and saw-scaled viper) that are responsible for most bites cause diverse clinical effects. Delayed treatment increases the risk of serious complications and treatment costs. Although government hospitals offer free treatment for snakebites in India, most patients opt for private healthcare, which is an out-of-pocket expense as they often lack health insurance coverage. This study aims to determine snakebite treatment costs in private tertiary care hospitals in Tamil Nadu, India and identifies the key factors contributing to treatment costs. Methodology/Principal findings The treatment cost details for 913 snakebite victims were collected from 10 private tertiary care hospitals across Tamil Nadu. The data were classified into hospital, pharmacy, investigation, and laboratory costs, and analysed to determine various factors that contribute to the costs. The results demonstrate that the average treatment costs vary widely for different snakes. The hospital and pharmacy costs are higher than investigation and laboratory costs for all snakebites. Notably, Russell’s viper bites cost significantly more than the bites from other snakes. Overall, the type of snake, nature of complications, specialist treatments required, and arrival time to hospitals were identified as some of the key factors for higher treatment costs. Conclusions/Significance These data demonstrate that ~80% of snakebite patients can be treated with INR 100,000 (~GBP 1000 or USD 1200) or less. This study emphasises the urgent need to improve rural medical care by providing appropriate training for healthcare professionals and essential resources to facilitate early assessment of patients, administer the initial dose of antivenom and refer the patients to tertiary care only when needed. Moreover, the outcome of this study forms a basis for developing appropriate policies to regulate snakebite treatment costs and provide affordable medical insurance for vulnerable communities.
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de Farias, Altair Seabra, Joseir Saturnino Cristino, Macio da Costa Arévalo, Alceonir Carneiro Junior, Manoel Rodrigues Gomes Filho, Sediel Andrade Ambrosio, João Nickenig Vissoci, et al. "Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives." Toxins 15, no. 6 (May 23, 2023): 352. http://dx.doi.org/10.3390/toxins15060352.
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Snakebites are a major public health problem in the Brazilian Amazon and may lead to local complications and physical deficiencies. Access to antivenom treatment is poorer in indigenous populations compared to other populations. In this study, we report three cases of long-term severe disabilities as a result of Bothrops atrox snakebites in indigenous children, according to the narratives of the parents. The three cases evolved to compartment syndrome, secondary bacterial infection and extensive necrosis. The cases are associated with delayed antivenom treatment due to very fragmented therapeutic itineraries, which are marked by several changes in means of transport along the route. The loss of autonomy at such an early stage of life due to a disability caused by a snakebite, as observed in this study, may deprive children of sensory and social experiences and of learning their future roles in the community. In common to all cases, there was precarious access to rehabilitation services, which are generally centralized in the state capital, and which leads to a prolonged hospitalization of patients with severe snakebite, and distances them from their territory and family and community ties. Prospective studies should be conducted in the Amazon that estimate the burden of disabilities from snakebites in order to formulate public policies for the treatment and rehabilitation of patients through culturally tailored interventions.
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Pach, Sophie, Jacqueline Le Geyt, José María Gutiérrez, David Williams, Kalana Prasad Maduwage, Abdulrazaq Garba Habib, Rafael Gustin, María Luisa Avila-Agüero, Kyaw Thu Ya, and Jay Halbert. "Paediatric snakebite envenoming: the world’s most neglected ‘Neglected Tropical Disease’?" Archives of Disease in Childhood 105, no. 12 (September 30, 2020): 1135–39. http://dx.doi.org/10.1136/archdischild-2020-319417.
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Snakebite disproportionally affects children living in impoverished rural communities. The WHO has recently reinstated snakebites on its list of Neglected Tropical Diseases and launched a comprehensive Strategy for the Prevention and Control of Snakebite Envenoming. In the first of a two paper series, we describe the epidemiology, socioeconomic impact and key prevention strategies. We also explore current challenges and priorities including the production and distribution of safe and effective antivenom.
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Joseph, Nesarajan, Sathishkumar Durairaj, Oviya Gowthaman, and Vinoth Kumar Ganesan. "Updated review on venomous snakebites, therapeutic uses and future prospects of Indian traditional medicine." Natural Resources for Human Health 2, no. 3 (January 28, 2022): 293–99. http://dx.doi.org/10.53365/nrfhh/145144.
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Herbal medicines can make therapeutic drugs and are an essential part of the worldwide healthcare system. Plants have always been an essential part of many indigenous peoples' life. Snakebite is a typical tropical condition that goes unnoticed. Snakebite is still a significant public health issue in many parts of the world, particularly in India, where the disease is particularly prevalent. Morbidity and mortality rates among rural and indigenous populations in the country are among the highest in the world. The problem is made worse by people delaying or refusing to seek medical care because they believe in traditional healers. People worldwide use plants to treat poisonous snakebites as folk medicine. Five hundred twenty-three plant species belonging to the 122 families are recognized as a source of drugs/compounds recognized as a possible cure for snakebite. However, this assessment is limited to a small number of essential plants used in snakebite poisoning in India. The most important groups from which various plants are employed include Acanthaceae, Amaranthaceae, Apocynaceae, Cucurbitaceae, Euphorbiaceae, and Fab Lamiaceae and Moraceae. In this investigation, phytocompounds with anti-venom action were discovered in 29 plants belonging to 22 families used as a traditional medicine to treat poisonous snakebites.
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Padidar, Sara, Ara Monadjem, Thea Litschka-Koen, Brent Thomas, Nondusimo Shongwe, Clare Baker, Lindelwa Mmema, et al. "Snakebite epidemiology, outcomes and multi-cluster risk modelling in Eswatini." PLOS Neglected Tropical Diseases 17, no. 11 (November 10, 2023): e0011732. http://dx.doi.org/10.1371/journal.pntd.0011732.
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Background Halving snakebite morbidity and mortality by 2030 requires countries to develop both prevention and treatment strategies. The paucity of data on the global incidence and severity of snakebite envenoming causes challenges prioritizing and mobilising resources for snakebite prevention and treatment. In line with the World Health Organisation’s 2019 Snakebite Strategy, this study sought to investigate Eswatini’s snakebite epidemiology and outcomes, and identify the socio-geographical factors associated with snakebite risk. Methodology Programmatic data from the Ministry of Health, Government of Eswatini 2019–2021, was used to assess the epidemiology and outcomes of snakebite in Eswatini. We developed a snake species richness map from the occurrence data of all venomous snakes of medical importance in Eswatini that was subjected to niche modelling. We formulated four risk indices using snake species richness, various geospatial datasets and reported snakebites. A multivariate cluster modelling approach using these indices was developed to estimate risk of snakebite and the outcomes of snakebite in Eswatini. Principal findings An average of 466 snakebites was recorded annually in Eswatini. Bites were recorded across the entire country and peaked in the evening during summer months. Two cluster risk maps indicated areas of the country with a high probability of snakebite and a high probability of poor snakebite outcomes. The areas with the highest rate of snakebite risk were primarily in the rural and agricultural regions of the country. Significance These models can be used to inform better snakebite prevention and treatment measures to enable Eswatini to meet the global goal of reducing snakebite morbidity and mortality by 50% by 2030. The supply chain challenges of antivenom affecting southern Africa and the high rates of snakebite identified in our study highlight the need for improved snakebite prevention and treatment tools that can be employed by health care workers stationed at rural, community clinics.
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Wani, Ajaz A., and Younis Rashid. "Facts and Perception about Snakes, Snake Bite and Its Management: A Review." Haya: The Saudi Journal of Life Sciences 8, no. 11 (December 25, 2023): 266–70. http://dx.doi.org/10.36348/sjls.2023.v08i11.006.
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Snakebites are a serious public health problem in many regions of the world, particularly in rural areas lacking medical facilities. The World Health Organization (WHO) estimates that 81,000–138,000 people die each year from snakebites worldwide. Venomous snakebite and its effects are a source of fear for people living in southern Nepal. As a result, people have developed a negative attitude towards snakes, which can lead to human-snake conflicts that result in killing of snakes. About 48 People from different walks of life which includes farmers, teachers, businessmen, students and others were interviewed regarding their perception about snakes. The study reveals that 46/ respondents feared from snakes, 33/ respondents dislike snakes and 25/ like to kill all the snakes particularly venomous snakes.
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Darshani, Saumya, Ariaranee Gnanathasan, Carukshi Arambepola, and Thashi Chang. "Knowledge on prevention, diagnosis and treatment of snakebite envenoming among doctors in snakebite-dense regions in Sri Lanka." Transactions of The Royal Society of Tropical Medicine and Hygiene 115, no. 9 (July 29, 2021): 984–91. http://dx.doi.org/10.1093/trstmh/trab112.
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Abstract Background Sri Lanka is one of the highest envenoming reporting countries globally with >80 000 snakebites per year. Among other factors, knowledge of snakebite among doctors predominantly determines patient outcomes. Methods Using a pretested 72-item self-administered questionnaire, we assessed knowledge on identifying common snake species, signs of envenoming and management of venomous snakebites among 280 doctors working in eight state hospitals in regions where snakebite prevalence is highest in Sri Lanka. Results Visually, 92.1% correctly identified a cobra and 74.3% identified a Russell's viper, but only 30% could identify a hump-nosed viper (HNV). Syndromic identification of snakes was best for the krait (71.8%) followed by the cobra (59.6%), but poor for the HNV (30%). The median knowledge scores of pictorial and syndromic snake identification, indoor preventive measures and indications of antivenom were <75% of the maximum score. Apart from 62.5% who expected the victim to bring the snake along to the hospital, most doctors selected the correct options of pre-hospital care. The duration of work experience did not influence the competency of syndromic identification. Utilisation of local guidelines was associated with better knowledge in antivenom usage (odds ratio 2.22 [95% confidence interval 1.04 to 5.36]; p=0.03). Conclusions Specific deficiencies of core knowledge in snakebite management exist among doctors working in snakebite prevalent regions.
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Adi Yunanto, Rismawan, Wantiyah Wantiyah, and Yusuf Gito Afandi. "Description of Snakebite's Prevention Efforts Towards Farmers in Panti Sub-District." Nursing and Health Sciences Journal (NHSJ) 1, no. 3 (December 29, 2021): 184–92. http://dx.doi.org/10.53713/nhs.v1i3.48.
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The knowledge toward snakebite prevention was related to preventive measures taken by farmers. Besides, a lack of farmer’s awareness about the importance of using personal protective equipment and a lack of public understanding regarding the level of danger and the types of venomous snakes were factors that cause snakebites. This study aimed to describe the efforts to prevent snakebite on farmers in Panti sub-district. The method used a quantitative descriptive with survey research design. This research was conducted on farmers in Panti with a sample of 100 respondents using cluster sampling technique. The results of this study showed respondents have known tree crevices, earthen holes, piles of wood, garbage, and twigs that are at risk of becoming snake habitats, use boots and trousers while working, maximize lighting using a lamp or flashlight, regularly mow grass and shrubs, clean up scattered leaves, and rest on higher ground when at home or in the fields. While only a few respondents participated in health education and counselling regarding snake bites. This study concluded that the majority of respondents conducted efforts to prevent snakebites.
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Snyder, Clifford C., and Robert P. Knowles. "Snakebites." Postgraduate Medicine 83, no. 6 (May 1988): 52–75. http://dx.doi.org/10.1080/00325481.1988.11700254.
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SILVA, Ageane Mota da, Mônica COLOMBINI, Ana Maria MOURA-DA-SILVA, Rodrigo Medeiros de SOUZA, Wuelton Marcelo MONTEIRO, and Paulo Sérgio BERNARDE. "Epidemiological and clinical aspects of snakebites in the upper Juruá River region, western Brazilian Amazonia." Acta Amazonica 50, no. 1 (March 2020): 90–99. http://dx.doi.org/10.1590/1809-4392201901561.
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ABSTRACT This study addresses the clinical and epidemiological aspects of envenoming cases resulting from snakebites treated at a hospital in Cruzeiro do Sul, in the upper Juruá River region, western Brazilian Amazonia. The specific identity of snakes that caused the envenomings was inferred (a) from the diagnosis of patient symptoms and signs upon hospital admission, (b) by enzyme immunoassay for detection of Bothrops atrox and Lachesis muta venom from serum samples taken from patients before antivenom therapy, or (c) by direct identification of the snake, when it was brought along to the hospital or photographed. There were 133 snakebites (76.2 cases per 100,000 inhabitants) registered during one year (July 2017 to June 2018). Most snakebites (88.7%) were caused by Bothrops spp., and the rest by non-venomous snakes or dry bites. Snakebites tended to occur more often during the rainy season, coinciding with the period of greater reproductive activity of the snakes and greater availability of their prey. In addition, the increase in the water level of rivers and lakes during the rainy season tends to concentrate snakes in dry places and, thus, to increase encounters with humans. Information campaigns on prevention and first aid, specially among the most vulnerable groups (indigenous people, farmers, and children and teenagers in rural areas), and the importance of using protective equipment (boots, leggings, leather gloves) in certain high risk activities (e.g. agriculture and extractivism in forests) are fundamental for the reduction of snakebite morbidity.
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Bowden, Mallory B., Dudley B. Christie, Kelly H. Hand, and Anne Montgomery. "Crotalidae Polyvalent Immune Fab and Cost-Effective Management of Hospital Admissions for Snakebites." American Surgeon 88, no. 3 (January 3, 2022): 368–71. http://dx.doi.org/10.1177/00031348211054566.
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Background Venomous snakebites are a common clinical scenario in the Southeastern United States. CroFab® (Crotalidae Polyvalent Immune Fab (Ovine), BTG, Wales, UK) antivenom is indicated in cases involving pit vipers and is known to be expensive. The treatment protocol for snakebites is based on clinically subjective measures triggering the application, or escalation of, antivenom administration. The purpose of this study is to characterize the use of CroFab at our institution and to evaluate the impact of its use regarding cost and overall outcomes. We suspect that it is often used but potentially less often needed. We hypothesized that CroFab use was associated with increased length of stay (LOS) without an observed difference in patient outcomes. Materials and Methods A retrospective chart review of snakebite patients at our level-1 trauma center from 2000 to 2016 was performed. Snakebite location, snake species, number of vials of CroFab administered, hospital LOS, intensive care unit (ICU) LOS, and complications were identified for each patient. Patients were divided into CroFab (C) and no CroFab (NC) groups. Results One hundred ninety patients with venomous snakebites were included. 53.7% of patients received CroFab. There was no difference in the complication rate of C versus NC groups, ( P = .1118). CroFab use was associated with longer hospital LOS ( P < .0001) and ICU LOS ( P < .0001). Discussion CroFab use was associated with increased LOS in our patient population. There was no difference in observed outcomes between the C and NC groups. These findings imply that CroFab is potentially over-used in our patient population.
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Abduljalil, M. M., U. F. Magaji, A. I. Daba, and S. U. Dandare. "Medicinal Plants for the Treatment of Snake Envenomation in Sub-Saharan Africa: Opportunities and Challenges." Nigerian Journal of Basic and Applied Sciences 30, no. 2 (October 18, 2023): 154–72. http://dx.doi.org/10.4314/njbas.v30i2.21.
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Snakes are primarily venomous animals that bite when frightened, which can be lethal. This is because snake venom is one of the most active biological fluids containing a wide range of peptides and proteins that can induce several effects, including hemo-, neuro-, cyto- and myotoxic effects, consequently becoming deleterious to life if untreated. Although snakes are found on almost all continents, the rural communities in sub-Saharan Africa are the most affected by snakebites, mainly due to increased humansnake interactions forced by their socioeconomic status and agricultural or rural practices. Consequently, this recently prompted the World Health Organisation to enlist snakebites envenoming among the category-A neglected tropical diseases with an estimated annual death of 7,300 in sub-Saharan Africa. Aside from mortality, snakebite envenomation also causes permanent disabilities in humans and a heavy burden on livestock, creating economic hardship for the already impoverished communities. Several animal-derived antivenoms have been developed for treating snakebites and wounds; they effectively attenuate venomrelated toxicity, tissue necrosis, and deaths. However, despite the efficacy of these antivenoms, several issues, such as problems in production and distribution, exorbitant prices, and adverse effects of the antivenoms, have challenged their practical use in subSaharan Africa. This review highlights the challenges that make conventional antivenoms unavailable to prone populations. We also discuss the plants used in the treatment of snake bites laying emphasis on Mucuna pruriens (Velvet bean) and Allium sativum (Garlic) as the two most studied medicinal plants. The progress and bottlenecks of using herbal antivenoms as alternatives in treating snakebite envenomation in sub-Saharan Africa are also discussed.
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Lin, Chih-Chuan, Chia-Pang Shih, Chia-Cheng Wang, Chun-Hsiang Ouyang, Chien-Chun Liu, Jau-Song Yu, and Chih-Hong Lo. "The Clinical Usefulness of Taiwan Bivalent Freeze-Dried Hemorrhagic Antivenom in Protobothrops mucrosquamatus- and Viridovipera stejnegeri-Envenomed Patients." Toxins 14, no. 11 (November 15, 2022): 794. http://dx.doi.org/10.3390/toxins14110794.
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Snakebites from Protobothrops mucrosquamatus (Taiwan habus) and Viridovipera stejnegeri (green bamboo vipers) account for the most venomous snakebites in Taiwan. The bivalent freeze-dried hemorrhagic (FH) antivenom is employed to treat these two snakebite patients without a strict clinical trial. We evaluated the clinical usefulness of Taiwan bivalent freeze-dried hemorrhagic (FH) antivenom in Taiwan habu- and green bamboo viper-envenomed patients. We checked ELISA- based serum venom antigen levels before and after FH antivenom to evaluate FH’s ability to neutralize patients’ serum snake venom and its usefulness in reducing limb swelling after snakebites. Patients who had higher serum venom antigen levels had more severe limb swelling. Of the 33 enrolled patients, most of their snake venom antigen levels were undetected after the appliance of antivenom. Most enrolled patients (25/33) had their limb swelling subside within 12 h after antivenom treatment. The failure to reduce limb swelling was probably due to an inadequate antivenom dose applied in more severely envenomated patients. Our data indicate the feasibility of the FH antivenom in effectively eliminating venom and resolving the affected limb swelling caused by Taiwan habu and green bamboo viper bites.
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Tianyi, Frank-Leonel, George O. Oluoch, Denis Otundo, Robert Ofwete, Cecilia Ngari, Anna Trelfa, Sayem Ahmed, et al. "Snakebite prevalence and risk factors in a nomadic population in Samburu County, Kenya: A community-based survey." PLOS Neglected Tropical Diseases 18, no. 1 (January 2, 2024): e0011678. http://dx.doi.org/10.1371/journal.pntd.0011678.
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Introduction Snakebite is an important public health concern, especially in tropical areas, but the true burden remains unclear due to sub-optimal reporting and over-reliance on health facility-based data. Methods A community-based cross-sectional survey was conducted in Samburu County, Kenya from December 2019 to March 2020. Geospatial techniques were used to create a sampling frame of all households in Samburu County and a multistage cluster sampling strategy to select households and recruit study participants. Five year prevalence and mortality rates were estimated, the characteristics and circumstances of snakebite were described, and multilevel logistic regression models were built to identify independent risk factors for snakebite. Results We recruited 3,610 individuals living in 875 households from 30 clusters. The 5-year prevalence of snakebite was 2.2% (95% CI 1.4%–3.4%), and the 5-year mortality rate was 138 (95% CI 44–322) deaths per 100,000 inhabitants, resulting in an estimated 1,406 snakebites and 88 deaths from snakebites per year in Samburu County. Snakebite incidents often occurred at night between 9pm and 6 am (44%, n = 36), and the participants were mostly walking/playing outdoors (51%, n = 41) or sleeping (32%, n = 27) when they were bitten. Lower household socioeconomic status and smaller numbers of people per house were significant independent risk factors. Conclusion Samburu County has a high snakebite burden and the most victims are bitten while sleeping or walking outdoors at night. Snakebite prevention and health promotion programs in Samburu County, and other endemic regions, need to be contextualised and consider the geographic, seasonal, and temporal specificities found in our study. Our findings also have implications for health care delivery, especially identification of the need for night-time staffing with expertise in snakebite management and antivenom availability to better manage patients and thereby improve outcomes.