Challenges and prospects of snake antivenom supply in sub-Saharan Africa

Habib, Abdulrazaq G.; Musa, Baba Maiyaki; Iliyasu, Garba; Hamza, Muhammad; Kuznik, Andreas; Chippaux, Jean-Philippe

doi:10.1371/journal.pntd.0008374

Cited by 56 publications

(58 citation statements)

References 28 publications

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“…This situation is underpinned by the lack of financial sustainability of antivenoms, dictated by their high production costs and geographically restricted market use. Despite being listed by the WHO as essential medicines, national procurement of antivenom is variable and inconsistent in Africa [77], thereby further compounding a lack of sustainability and financial security for manufacturers. A 2007 survey of antivenom producers revealed that a lack of consistent market demand, inconsistencies receiving payment, corruption within some global markets/government agencies, inappropriate clinical use of products, and high costs of maintaining immunised animals were among the main barriers to increasing antivenom output [23].…”

Section: Small Molecule Drugs As Novel Snakebite Treatmentsmentioning

confidence: 99%

“…However, hope for snakebite victims and antivenom manufacturers may come from the WHO's snakebite roadmap, which recently advocated for the large-scale provision and stockpiling of antivenom to address current supply issues in Africa [10]. While major challenges associated with implementing this strategy remain [77], it may deliver an effective short-term solution to the current treatment vacuum, at least until more affordable and sustainable snakebite therapeutics can be implemented in neglected tropical health systems.…”

Section: Small Molecule Drugs As Novel Snakebite Treatmentsmentioning

confidence: 99%

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Small Molecule Drug Discovery for Neglected Tropical Snakebite

Clare

Hall

Patel

et al. 2021

Trends in Pharmacological Sciences

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Section: Small Molecule Drugs As Novel Snakebite Treatmentsmentioning

confidence: 99%

Section: Small Molecule Drugs As Novel Snakebite Treatmentsmentioning

confidence: 99%

Small Molecule Drug Discovery for Neglected Tropical Snakebite

Clare

Hall

Patel

et al. 2021

Trends in Pharmacological Sciences

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“…The conditions producing a potential underestimate, incomplete statistics and low care-seeking for SBE in central Africa result partly from multiple scarcities, notably poor antivenom (AV) availability and affordability and weak rural health care structures ( Chippaux, Massougbodji, Diouf, Baldé and Boyer, 2015 ; Ditekemena et al, 2020 ; Habib et al, 2020 ). Out of 46 AV producers globally, the African continent has just one in South Africa, which manufactures AV in relatively low volumes and at comparatively high costs ($US 315 per dose) ( Habib et al, 2020 ). Few AVs are available in African markets ( Potet et al, 2019 ).…”

Section: The Epidemiology Of Snakebites In Central Africamentioning

confidence: 99%

Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation

2021

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The WHO has identified the goal of halving deaths and disability from snakebite envenomation (SBE) by 2030 through a four-pillar program that promotes accessible and affordable treatments, strengthens health systems, promotes community and multi-level engagement, and mobilizes partnerships, coordination and resources to advocate for global action. This initiative could accelerate multi-disciplinary research and action in central Africa, a “hotspot” for SBE, but it offers little specific guidance about anthropological research to be conducted. This commentary develops that research agenda. It surveys anthropological, ethnohistorical investigations in the central African forest to elaborate the socio-cultural and historical significance and practices around snakes and snakebites. It draws from south and southeast Asian and Latin American literatures to illustrate anthropological contributions to SBE research. It then outlines a Central African research agenda employing ethnobiological investigation of snake ecologies, participatory evaluations of humans-snake contacts, and interviews and participant-observation of local prevention and treatment practices and knowledge. This research will co-develop policies and practices with forest communities and leaders and regional and national authorities to reduce the burden of SBE.

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“…This creates another barrier to use if the need for treatment is unclear due to the uncertainty of the severity and anticipated clinical course of the SBE patient (24,25). There is also little economic incentive to pharmaceutical companies to develop and overcome the regulatory hurdles in order to distribute antivenom to where it is most needed (22,(26)(27)(28). This fact, combined with the lack of healthcare infrastructure in these low resource areas with a high prevalence of SBE, results in a lack of a consistently replaceable antivenom supply (28,29).…”

mentioning

confidence: 99%

“…There is also little economic incentive to pharmaceutical companies to develop and overcome the regulatory hurdles in order to distribute antivenom to where it is most needed (22,(26)(27)(28). This fact, combined with the lack of healthcare infrastructure in these low resource areas with a high prevalence of SBE, results in a lack of a consistently replaceable antivenom supply (28,29). The concern for wasting antivenom when not absolutely needed, is accompanied by the risk of undertreatment for patients that would otherwise benefit (12,30,31).…”

mentioning

confidence: 99%

Association of a Network of Immunologic Response and Clinical Features With the Functional Recovery From Crotalinae Snakebite Envenoming

Gerardo

Silvius²,

Schobel

et al. 2021

Front. Immunol.

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BackgroundThe immunologic pathways activated during snakebite envenoming (SBE) are poorly described, and their association with recovery is unclear. The immunologic response in SBE could inform a prognostic model to predict recovery. The purpose of this study was to develop pre- and post-antivenom prognostic models comprised of clinical features and immunologic cytokine data that are associated with recovery from SBE. Materials and MethodsWe performed a prospective cohort study in an academic medical center emergency department. We enrolled consecutive patients with Crotalinae SBE and obtained serum samples based on previously described criteria for the Surgical Critical Care Initiative (SC2i)(ClinicalTrials.gov Identifier: NCT02182180). We assessed a standard set of clinical variables and measured 35 unique cytokines using Luminex Cytokine 35-Plex Human Panel pre- and post-antivenom administration. The Patient-Specific Functional Scale (PSFS), a well-validated patient-reported outcome of functional recovery, was assessed at 0, 7, 14, 21 and 28 days and the area under the patient curve (PSFS AUPC) determined. We performed Bayesian Belief Network (BBN) modeling to represent relationships with a diagram composed of nodes and arcs. Each node represents a cytokine or clinical feature and each arc represents a joint-probability distribution (JPD).ResultsTwenty-eight SBE patients were enrolled. Preliminary results from 24 patients with clinical data, 9 patients with pre-antivenom and 11 patients with post-antivenom cytokine data are presented. The group was mostly female (82%) with a mean age of 38.1 (SD ± 9.8) years. In the pre-antivenom model, the variables most closely associated with the PSFS AUPC are predominantly clinical features. In the post-antivenom model, cytokines are more fully incorporated into the model. The variables most closely associated with the PSFS AUPC are age, antihistamines, white blood cell count (WBC), HGF, CCL5 and VEGF. The most influential variables are age, antihistamines and EGF. Both the pre- and post-antivenom models perform well with AUCs of 0.87 and 0.90 respectively.DiscussionPre- and post-antivenom networks of cytokines and clinical features were associated with functional recovery measured by the PSFS AUPC over 28 days. With additional data, we can identify prognostic models using immunologic and clinical variables to predict recovery from SBE.

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Challenges and prospects of snake antivenom supply in sub-Saharan Africa

Cited by 56 publications

References 28 publications

Small Molecule Drug Discovery for Neglected Tropical Snakebite

Small Molecule Drug Discovery for Neglected Tropical Snakebite

Integrating lay knowledge and practice into snakebite prevention and care in central Africa, a hotspot for envenomation

Association of a Network of Immunologic Response and Clinical Features With the Functional Recovery From Crotalinae Snakebite Envenoming

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