Showing posts with label snakebite. Show all posts
Showing posts with label snakebite. Show all posts

Sunday, September 11, 2011

The African Snakebite Problem

© IRD / JF Trape
The following press eelease and some interesting photos can be found here.

A million and a half: the number of victims of poisoning after a snake bite each year in sub-Saharan Africa. An IRD researcher has analyzed hundreds of studies and medical reports published over the last forty years. So far, no large-scale review of the situation had been made and the health authorities underestimated the extent of the problem. Thus, today, only 10% of victims are treated because of lack of antivenoms and a non-medical staff awareness. However, clinical complications can be very serious or fatal. A bite of cobra or mamba can lead to death by asphyxiation - due to respiratory paralysis - in 6 hours following the accident. That of échide ocellated, a viper widespread in African savannahs, may in turn cause bleeding resulting in death within days. This new study provides the authorities with figures more accurate and reliable, allowing them to adjust their systems of care as close as needed

The best defense of snakes is a good offense. Some prove to be ruthless when they feel threatened. Each of his method. The Gabon viper, for example, injecting its venom deep into the muscles with its hooks than 5 cm long. The spitting cobra for his blind its victims of his venom. If only one bite of venomous snakes out of two, these reptiles are nonetheless a real danger to humans. The number of accidents is significant, particularly in sub-Saharan Africa where they constitute an important public health issue, neglected by health authorities.

Indeed, as recently shown in an IRD researcher, more than 300,000 people south of the Sahara are being treated each year as a result of a bite. But given the lack of access to health centers and the frequent use of traditional medicine, many cases go unreported. This figure does not reflect all of envenomation. Experts believe that it reflects that between one third and one fifth of reality. According to this new study, so there would be up to one and a half million victims a year. The death from a bite - probably also underestimated - reach for their number of 7000 and amputations in 6000 to over 14,000 per year.

While various specific studies have advanced estimates, no major review has been made so far. To fill this gap, the specialist conducted a meta-analysis, that is to say a critical review of existing scientific studies, taking into account the representation and heterogeneity of their results. To do this, he sifted through hundreds of scientific articles, conference proceedings, and clinical reports published from 1970 to 2010. This detailed study allows to announce much more reliable figures on the number of patients who had a snake.

This work has also helped point the finger at the conditions most conducive to accidents: 95% of bites occur in rural areas, especially in plantations. The people who run the greatest risk are farm workers. Yet in Africa, agriculture is the main economic activity.

Cities are not spared, even though the incidence of bites is about ten to twenty times lower than in rural areas. Thus, in some areas during the rainy season, the envenomation more than 10% of hospitalizations.

Among the most dangerous African species, two types of venom may be opposed, that of cobras and mambas, which is neurotoxic, and the snakes - which échide Frog Eye, the most common in savanna - which is bleeding and necrosis. In other words, the first cause respiratory paralysis, which can lead to death by asphyxiation between 1 and 6am. The second leads to edema and necrosis of the members and a hemorrhage can be fatal within days. The only effective treatment remains the injection of antivenin * intravenously as soon as possible after the bite to neutralize the toxic substance.

But the availability of these products is now small: only 10% of envenomations are treated. Given the lack of data so far, the problem remained underestimated by health authorities. Moreover, the high cost of these remedies and their short life span - 3-5 years - has discouraged supplies. Under these conditions, difficult to set budgets and allocate funds for the management of envenomation, the installation of equipment necessary for sensitization of medical personnel. In the absence of formation of the latter to the use of antivenoms, these treatments can produce disappointing results, discouraging reuse later. These chain reactions reduce claims. Manufacturers are reluctant to produce anti-venom so they are not safe to sell. Hence a reduction in terms of accessibility: the number of doses sold was divided by ten in Africa since the 1980s, from about 200,000 per year to less than 20,000 in the early 2000s.

This study suggests realistic figures needs antivenoms. Given the results, the specialist believes that 500 000 doses would be needed each year. The health authorities of these countries can now use these data to improve the quality of care for victims and deploy a system for identifying and monitoring.

Tuesday, August 16, 2011

Snakes kill three farmers in Adamawa, bite 13 others

Next is reporting the following story on snakebites in Nigeria
August 12, 2011 07:57AM

Three farmers have died as a result of snakebite in Shuwa village in Madagali local government area of Adamawa, the News Agency of Nigeria (NAN) reports.

Thirteen other persons have also been hospitalised and treated for snakebites at the Christian Health Centre, Shuwa, in the last two weeks, according to residents.

NAN learnt that large numbers of poisonous snakes are on the loose in Kwajiti, Dzuyal, Paalam and Shuwa villages due to the mountainous nature of the environment.

The growing density of snakes has been exposing communities to incessant attacks, especially during the rainy season when the snakes move about in the open.

At least 35 persons were killed and 143 others treated of snakebites during the last cropping season in the area.

Most of the victims, including women and children, were attacked while working in the farms or while at home.

Some villagers, who spoke with NAN in Shuwa, urged the National Emergency Management Agency (NEMA) to provide snake repellents and anti-snake injections to facilitate the quick treatment of victims.

Suleiman Duhu, the sole administrator of Shuwa Development Area, said the authority had expended more than ₦1.4 million to procure anti-snake injections for the treatment of patients in the last one year.

"The rate of snakebites is alarming and beyond our control. We are sponsoring the patients for treatment at the Christian Health Centre, Shuwa.

"We are calling for assistance from NEMA and other health related bodies to control the disaster," Mr Duhu said.

He also accused the Adamawa State Ministry of Health of neglect in spite of formal complaints lodged before it on the development.

"The ministry had promised to provide hand gloves, rain boot, snake repellents and other preventive kits, but it is yet to redeem its pledge.

"We are calling on the NEMA and the state government to come to our rescue and control the spate of destruction of lives by the snakes," he added.

A farmer, Gambo Turai, told NAN that the snakes were making life unbearable for the residents.

"We are living in perpetual fear of working in the farm or even staying at home because you do not know when the snakes will strike.

"Many people have lost their lives to the snakes," Mr Turai said and called for urgent measures to control the situation.

Saturday, April 23, 2011

"The Million Death Study" Published - Snakebite in India

Confusion over the number of people who die in India annully from snakebites is an on-going problem. In 1880, Joseph Fayrer suggested 19,060 Indians died from snake envenomation. His comment instituted a campaign of snake extermination , with 467,744 snakes killed for bounty. Fayrer reported a minimal decrease in deaths - 18,610 people died. However, by 1889, the snake bite deaths increased to 22,480 at a time when the population was 250 million. Swaroop and Grab (1954) assembled the World Health Organization's (WHO) first global snake bite estimates but they lacked reliable data from India, reporting 20,000 deaths. This number may have been based upon Fayrer's 1889 number. Sawai and Homma (1972) attempted to estimate the number by visiting Indian hospitals accompanied by extrapolation and estimated 10,000 deaths per year suggesting 90 per cent of the victims did not seek hospital treatment. Chippaux (1998) estimated snake envenomation killed between 9,900 and 21,600 per year when the population was nearing one billion. A 2005 WHO study estimated 50,000 snakebite deaths in India, but a 2008 follow-up,estimated 11,000 deaths; and a second 2008 report done by the Indian government estimated only 1,400 mortalities, possibly because 6 of the xx Indian states failed to respnd to the study. Snakebite in India does not have to be reported to the Ministry of Health, and traditional folk treatments are still relied upon in many regions. On April 12, 2011 a new study, with the nickname "The Million Death Study" was published in PLoS Neglected Tropical Diseases (Mohapatra et al. 2011 -see below)

The study examined 123,000 deaths from 6,671 randomly selected areas between 2001and 2003. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. The authors' summary follows:

Earlier hospital based reports estimate about 1,300 to 50,000 annual deaths from snakebites per year in India. Here, we present the first ever direct estimates from a national mortality survey of 1.1 million homes in 2001–03. Full-time, non-medical field workers interviewed living respondents about all deaths. The underlying causes were independently coded by two of 130 trained physicians. The study found 562 deaths (0.47% of total deaths) were assigned to snakebites, mostly in rural areas, and more commonly among males than females and peaking at ages 15–29. Snakebites also occurred more often during the rainy monsoon season. This proportion represents about 45,900 annual snakebite deaths nationally (99% CI 40,900 to 50,900) or an annual age-standardised rate of 4.1/100,000 (99% CI 3.6–4.5), with higher rates in rural areas (5.4) and with the highest rate in the state of Andhra Pradesh (6.2). Annual snakebite deaths were greatest in the states of Uttar Pradesh (8,700), Andhra Pradesh (5,200), and Bihar (4,500). Thus, snakebite remains an underestimated cause of accidental death in modern India, causing about one death for every two HIV-related deaths. Because a large proportion of global totals of snakebites arise from India, global snakebite totals might also be underestimated. Effective interventions involving education and antivenom provision would reduce snakebite deaths in India.
It seems unlikely that this study will end the on-going controversy over the number of snakebites and deaths from snake venom in India. However, it is an intriguing piece of work and if you are interested in the problem it is worth the time to ready the author's ideas. 

Thursday, March 17, 2011

Unfortunately Poor Advice and a Bad Situation

The following article was published by the Philippine Information Agency, March 11, 2011. It is unfortunate that there is an antivenom shortages, and it is even more unfortunate that the idea that antivenom can only be administered within a narrow window is still accepted in some parts of the world.

No snake anti-venom stockpile in hospitals
TAGBILARAN CITY, Mar. 11(PIA)--- FOR snake bites, immediately wash the bite wound with soap and water and rush the victim to the nearest hospital for proper administration.

This sums up Dr, Reymoses Cabagnot’s advice to patients in snake bite cases after admitting that snake anti-venom are not included in the stocked drugs at government hospitals.

Venomous snake bites may be treated with an anti-venom, Dr. Cabagnot said.

Snake antivenins are a man-made biological product called anti-ophidic serum, which can be extracted by milking a snake to extract its venom.

Collected snake anti-venom is then administered into the test animals with natural immune response to allow them to develop antibodies. These are then harvested and stored for medicinal use.

But, the presence of different poisonous snakes in the country also requires different kinds of effective anti-venom, usually obtained from the same kind of snake that bit.

“This makes stockpiling anti-venom for all kinds of snake difficult,” added another medical professional who refuses to be identified.

“While there are polyvalent antivenom-antivenins that are effective on a broad range of poisonous snakes, it would be hard to stockpile them with cases of snake bites rarely occurring,” she said.

Dr. Cabagnot, provincial health officer also added that the government hospitals have no stocks of these antivenins.

The doctor was interviewed after radio reported of a 9-year-old girl who died without treatment.

The child from barangay Napo, Alicia town was believed to be a victim of poisonous snake bite.

Neighbors and relatives brought the nine-year old victim to an alternative healer but the patient was not ushered in as the alternative medicine man had a lot of patients.

Relatives then brought the victim to Dr. Bienvenido Molina, around 6:00 but, sources said the child was dead for 30 minutes before the doctor saw her.

But even if antivenins are effective on most snake bite victims, they may be only if administered within an extremely narrow window of opportunity, the medical practitioner said.

Antivenins are normally administered to the victim as soon as possible that is 4-5 hours after a snake bite attack.

But, “doctors may also have some reservations in antivenins as these may have adverse reactions to some people, so these must be administered in extreme caution,” she warned. (rac)

Monday, February 21, 2011

African Viper Envenomation Needs to be Treated with Antivenom - Despite Delay Time to Treatment

Recently this blog reported on a forthcoming article by  P. Chippaux that suggests snake bite mortality in sub-Sahara Africa is much lower than previously thought - about 7000 deaths per annum. Now, a new study by Sebastien Larreche and colleagues examined 12-years of viper bite data from the Republic of Djibouti, and compared the impact of an early administration of antivenin versus a delayed administration on restoring the victims’ normal blood chemistry. The study looked at 73 cases (from 1994-2006), where patients presented with symptoms of viper bites in the intensive care unit of the French military Hospital, in Djibouti. Snakes involved in the bites were Echis pyramidum and Bitis arietans, and patients treated prior to 2001 received Echis-Bitis-Naja serum (Pasteur-Mérieux, Lyon, France), those treated after 2001 received FAV-Africa (Aventis-Pasteur), which is useful against Echis, Bitis, Naja, and Dendroaspis venoms. The research team examined antivenin efficiency in correcting blood chemistry to the time of treatment - before or after the 24th hour after the bite. Forty-two patients (58%) presented with bleeding - blood in their urine, coughing blood, or bleeding gums. Larreche and colleagues found antivenin was effective in improving hemostasis, and the time to normalization of blood chemistry was similar, whether the treatment was started before or after the 24th hour after the bite. They authors report that antivenin should ideally be administered as early as possible. In Africa, time to treatment often exceeds 24 hours because of the distances and transportation available. However, the results suggest that antivenom should be used despite the delay in getting treatment, and that the fact that time has elapsed between the envenomation and treatment should in no way prevent the use of antivenin immunotherapy for treatment of  African viper bites.
Larréché, S., G. Mion,  A. Mayet, C. Verret, M. Puidupin, A. Benois, F. Petitjeans, N. Libert, and M. Goyffon. 2011. Antivenin remains effective against African Viperidae bites despite a delayed treatment. The American Journal of Emergency Medicine, 29(2):155-161.