Academic journal article Bulletin of the World Health Organization

A Multicomponent Strategy to Improve the Availability of Antivenom for Treating Snakebite envenoming/Une Strategie a Composants Multiples Pour Ameliorer la Disponibilite Des Antivenimeux Dans le Traitement Des Envenimations Par Morsure De serpent/Una Estrategia Multicomponente Para Mejorar la Disponibilidad del Suero Antiofidico Para El Tratamiento del Envenenamiento Por Mordedura De Serpiente

Academic journal article Bulletin of the World Health Organization

A Multicomponent Strategy to Improve the Availability of Antivenom for Treating Snakebite envenoming/Une Strategie a Composants Multiples Pour Ameliorer la Disponibilite Des Antivenimeux Dans le Traitement Des Envenimations Par Morsure De serpent/Una Estrategia Multicomponente Para Mejorar la Disponibilidad del Suero Antiofidico Para El Tratamiento del Envenenamiento Por Mordedura De Serpiente

Article excerpt

Introduction

Envenoming following snakebite is a very common but globally neglected public health problem that primarily affects poor agrarian and pastoralist communities of Africa, Asia, Latin America and Oceania. (1-5) According to estimates, more than 5 million people in the world suffer snakebite every year. Of those who are bitten, approximately 125 000 die and around 400000 are left with permanent sequelae. (2,3,6,7) However, more recent nationwide community-based surveys in Bangladesh and India have shown that the scale of this problem is far greater than suggested by hospital-based statistics (8,9) and that these global figures greatly underestimate the actual incidence of snakebite envenoming and the resulting mortality and disability.

An important factor that contributes to the morbidity and mortality associated with snakebites, particularly in sub-Saharan Africa and parts of Asia, is the poor availability of the only validated treatment for this disease: antivenoms. (2,3) Antivenoms are immunoglobulins, or immunoglobulin fragments, purified from the serum or plasma of animals hyperimmunized with snake venom. The basic technological platforms for antivenom manufacture are readily available in the public domain and the World Health Organization (WHO) has issued detailed guidelines for the production, quality control and regulation of snake antivenoms, (10) which have long been recognized as essential medicines. Our understanding of the key determinants of the quality and safety of antivenom manufacture continues to improve with advances in research and development strategies. (11) As a result, protocols for producing antivenoms with improved clinical effectiveness and safety are readily available. This makes snakebite envenoming one of the "tool-ready" diseases, unlike other neglected tropical diseases. (12) Nevertheless, in many regions of the world, the availability of effective and safe antivenoms remains abysmally poor. (1,3)

To substantially improve the availability of and access to effective and safe antivenoms, it is necessary to undertake coordinated efforts, at the national, regional and global levels, to tackle key aspects of antivenom production, financing, distribution and post-marketing surveillance, and to promote government policy engagement. Herein we propose a multicomponent strategy targeting several bottlenecks in global antivenom availability. Concerted attention to these proposals on the part of stakeholders working at different levels should result in substantial improvements in the production, coordinated supply and use of antivenoms worldwide. Although we focus on snake antivenoms, similar considerations generally apply to antivenoms for other types of envenomings, such as those induced by scorpions and spiders, and to antisera for use against important bacterial and viral infections, such as tetanus and rabies. (1)

The components of our proposed strategy are presented in the four sections that follow. A fifth section describes additional measures that can mitigate the morbidity and mortality associated with snakebite envenomings. The sixth and final section summarizes the advantages of the proposed strategy.

Preparing validated, representative venom pools

For antivenoms to be fully effective, the venoms used in their manufacture must be representative of the toxin profiles of the snake species against whose venom effective neutralization is sought. Establishing captive collections of geographically representative populations of target species should be a priority both nationally and regionally. Epidemiological data should be combined with the taxonomic and venom proteomic profiles of snake populations to ensure that snakes of the appropriate species and geographic origin are collected, in accordance with national and international regulations. Snakes should be maintained under secure, environmentally appropriate, and hygienic conditions in well designed herpetaria (see WHO guidelines for the production, control and regulation of snake antivenom immunoglobulins (10) for specific recommendations on snake husbandry and venom collection and storage). …

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