Bites by exotic snakes reported to the UK National Poisons Information Service 2009–2020

Abstract

Introduction: Snakebite is recognised as a neglected tropical disease and a cause of substantial morbidity and mortality. Whilst the most medically important snakes are typically native of Asia, Africa, Latin America and Oceania, the possibility of encountering these snakes is no longer limited by geography due to an increasing number of exotic (non-native) snakes being held in captivity. Methods: A retrospective review of snakebite enquiries to the UK National Poisons Information Service (NPIS) between 2009 and 2020. Enquiries about the European adder (Vipera berus) or where the identity of the snake was unknown were excluded. Results: There were 321 exotic snakebites in 300 patients involving 68 different species during this period. Ten patients were bitten on more than one occasion. The majority of patients (64.5%) were male. Most bites were inflicted by snakes of the family Colubridae (184/321, 57.3%); seventeen bites resulted in moderate symptoms (predominantly swelling of the bitten limb). There were 30 (9.3%) bites by Viperidae and 14 (4.3%) bites by Elapidae. All severe cases (n ¼ 15) resulted from bites by either Viperidae (n ¼ 10) or Elapidae (n ¼ 5). Antivenom was given in 17 cases. One fatality was recorded. Conclusions: Despite their low incidence, exotic snakebites present a substantial challenge for UK healthcare professionals. Although rare, these bites typically occur in individuals (usually male) who keep snakes as part of their occupation or hobby and are therefore at risk of multiple bites. Bites can result in venom hypersensitisation and the risk of venom-induced anaphylaxis. Rapid access to expert clinical advice is available in the UK on a 24-hour basis through the National Poisons Information Service and is strongly recommended in all cases of exotic snakebite.

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“…In the past decade the UK has counted 321 bites from a wide range of non-native venomous snakes such as the Mexican jumping pit viper, the Namibian puff adder, the black mamba, seven species of cobra, and half a dozen varieties of rattlesnake. Many were kept by hobbyists 8…”

African polyvalent antivenom can maintain pharmacological stability and ability to neutralise murine venom lethality for decades post-expiry: evidence for increasing antivenom shelf life to aid in alleviating chronic shortages

“…In emergency cases, the use of ‘recently’ expired antivenom is recommended by the WHO if no other option is available 22. This advice seems to be reflected in practice, with reported cases of expired antivenoms being used in several countries, perhaps routinely, when in-date antivenoms were not available, with reported positive outcomes 23 24. The most extensive report detailing the use of expired antivenom was a clinical study of 31 patients suffering from systemic effects of envenoming in the Lao People’s Democratic Republic 25.…”

Early Adverse Reactions to Snake Antivenom: Poison Center Data Analysis

“…Snakebite incidents are no longer restricted to tropical and subtropical countries because of environmental and human factors; for instance, climate change, rapid urbanization, and the growing global trade in non-native snakes [ 15 , 16 ]. Therefore, QSMI antivenoms are not only used throughout Thailand but also exported to save the lives of patients bitten by specific types of venomous snakes or closely related species in other countries [ 14 ], such as Laos [ 17 ], Hong Kong [ 18 ], and the United Kingdom [ 19 , 20 ]. This means that several QSMI antivenoms are distributed, stocked, and used globally, and they are regarded as some of the most effective antivenoms in the world [ 21 ].…”