Showing posts with label antivenom availability. Show all posts
Showing posts with label antivenom availability. Show all posts

Wednesday, March 23, 2011

Antivenom: Neglect, Confusion, & Hope

The world wide availability of antivenom is quite variable, but no where does it seem to be adequate. There are very few antivenom products that work on more than just a few species of snakes, and therefore it is necessary for each country or geographical area to have antivenom available for local species. This means local production is important in areas where people are bitten by venomous snakes. In the USA this week (March 21-26) is Poison Prevention Week. A a check of the news suggests that while antivenom is, to a degree, available in many places - this is not the case in other countries.The All African.com website is carrying a story from the Nairobi Star, that emphasizes the problems of a lack of antivenom in some African hospitals.
A woman spent three hours writhing in pain in a Teso hospital at the weekend before passing on after she was bitten by a seven-foot snake in her Amagoro semi-permanent house in Teso North District. The death of Mama Flora Odikor, 77, has earned the hospital the wrath of the Anglican Church and the deceased family who accused Kocholia District Hospital administration of negligence that saw the deceased spend three hours without getting anti-venom injection. Medics in Western Province have also raised concerns over the increase in the number of people who die from snake bites due to failure by the government to supply anti-venom drugs to most hospitals and health centres, adding that the region is prone to snakes. Flora's daughters, Margaret Odikor and Jacqueline Amoit, watched helplessly as their mother took her last breath from the bite of the poisonous cobra to confirm the agony patients who seek medical attention at the referral institution were facing at the hands of the hospital staff. Margaret recounted how the staff at the pharmacy, consultation and injection rooms denied having any stock of anti-venom with the available ones allegedly having expired, but only to produce them three hours later after a nurse insisted the government had supplied the drug the previous day.
Antivenom continues to be short supply in many countries, both developed and undeveloped. The Tasmanian Examiner reported in January that a lack of snake antivenom at regional medical centres could leave tourists and hikers in a perilous situation, according to Tasmania's main reptile rescue organisation. 
Reptile Rescue ranger Bruce Press said the lack of access to antivenom in regional areas was particularly dangerous as visitors to the state and possibly many locals do not realise they can only get full bite treatment in Launceston or Hobart. "If a bushwalker is out in the bush then they'll probably have to travel many kilometres just to get back into a town, only to then be told to go on to Hobart or Launceston," said Mr Press, who recovers snakes from an area spanning Buckland to Bicheno. "All the snakes here in Tasmania are dangerous and their venom can kill a human."
The Associated Press Pakistan has a story available on Dawn.com that describes an initiative in Pakistan to increase antivenom supplies. This article is interesting for several reasons, but it seems to somehow blame the US and Australia  for the shortage so those countries could make money by exporting antivenom. 
LAHORE, March 20 (APP): The University of Veterinary and Animal Sciences (UVAS) has launched an anti-venom production project to treat snake-bite victims in the country. Head of the project Dr Ziaullah Mughul told APP that every year around 50,000 people died in Pakistan from snake-bite. “Only five to six percent of anti-venom vaccine is made by the National Institute of Health (NIH) against a requirement of 150,000 dozes per annum and that too is not easily available in the market,” he added. “Most of the patients die due to the unavailability of anti-venom vaccine in the country, putting the number of deaths to 50,000 annually. Around 90 per cent of snake-bite deaths can be prevented if anti-venom is produced at local level. “During the recent flood, snake-bite contributed to five to six per cent of total deaths and vaccine had to be imported from India,” he said.Dr Ziaullah said locally produced vaccine, which would be effective against four snakes, could be available at Rs400 while vaccine imported from India cost Rs1,900 and it was effective for only one kind of snake. “A snake-bite victim needs four doses for complete treatment,” he added. For commercialization of the project, Rs400 million is needed while after its completion, anti-venom will also be available for export to earn foreign exchange, he said. The US and Australia were earning a big amount of money by exporting anti-venom drugs, he added.
Of course, US and Australian antivenoms are all but useless for venomous snakes in Pakistan.


Poison Prevention Week (PPW), in the USA, is the third week of March each year, and provides an opportunity for BTG, the International Healtcare Company that markets and distributes CroFab® (antivenom for crotalid snakes include rattlesnakes, copperheads and cottonmouths/water moccasins).  Their press release (follow link for complete press release) for 2011's PPW states that,
"Beginning in April when the weather gets warmer, one potential poisoning source – venomous snakebite – is more likely to occur.  Approximately 8,000 cases of venomous snakebite and five to six related deaths occur in the United States each year.  Venomous snakebites may have other serious consequences, including loss of a finger or toe, if not treated promptly.  Victims of snakebite should react calmly but swiftly in seeking medical attention.  CroFab® Crotalidae Polyvalent Immune Fab (ovine), an antidote for venomous snakebites from North American pit vipers, or crotalids (rattlesnakes, copperheads and cottonmouths/water moccasins), usually is available at emergency facilities in hospitals....Early use of CroFab® (within 6 hours of snakebite) is advised to prevent a patient's clinical deterioration and the occurrence of systemic blood-clotting (coagulation) abnormalities....For CroFab® full prescribing information, visit:  http://www.crofab.com."
Antivenom is a medical technology that has been available since the 1890's. It is relatively inexpensive to produce, works exceptionally well, and should be available to those who need it. However, the lack of profit, and the fact that each geographic region needs its own supply seems to be barriers to its availability. There is a company, looking for partners in the production of antivenoms, if you are interestes, visit Good Biotech Corporation's website.