Paediatric snakebite in Kilifi County, Kenya: A 19-year observational study

Abstract

Introduction Estimates suggest that one-third of snakebite cases in sub-Saharan Africa affect children. Despite children being at a greater risk of disability and death, there are limited published data describing the burden of paediatric snakebite. This study describes the clinical features, hospital management, population-incidence, and mortality of consecutive paediatric snakebite cases over a 19-year period. Methods Using the Kilifi Health and Demographic Surveillance System (KHDSS), all children with snakebite presenting to Kilifi County Hospital were identified. All cases were prospectively registered, admitted for at least 24-hours, and managed on a paediatric high dependency unit (HDU). Households within the KHDSS study area have been included in 4-monthly surveillance and verbal autopsy, enabling calculation of population-incidence and mortality. Predictors of severe local tissue damage were identified using a multivariate logistic regression analysis. Results Between 2003 and 2021, there were 19,798 admissions to the paediatric HDU, of which 619 were due to snakebite. Amongst infants (<=5-years age) the population-incidence of hospital- attended snakebite was 9.8/100,000 person-years; for children aged 6-13-years this was 26.4/100,000 person-years. The number of children attending hospital with snakebite has increased over time. Children aged 8-11 years had the highest incidence. There were six snakebite associated deaths. At admission, low haemoglobin, raised white blood cell count, and an upper limb bite-site were associated with the development of severe local tissue damage. Conclusion There is a substantial burden of disease due to paediatric snakebite and this has increased in-line with population growth. Most cases present with local rather than systemic envenoming, and many of these receive antivenom. The mortality rate was low, which may reflect the quality of care delivered on the paediatric HDU. There is an urgent need to better define the burden of paediatric snakebite across Africa, to initiate community engagement to prevent snakebites, and to improve treatments for local tissue damage.

Dermonecrosis caused by spitting cobra snakebite results from toxin potentiation and is prevented by the repurposed drug varespladib

“…The myonecrosis-reducing effects of both intramuscular and intravenous injected varespladib ( Fig 6E ) suggests that both local and central methods of administration could be effective at preventing muscle toxicity associated with cobra snakebites. We hypothesise this difference in efficacy between myo- and dermo-necrosis rescue is due to the comparatively greater abundance of blood vessels in muscle versus cutaneous tissue, resulting in a greater and more rapid distribution of intravenously administered varespladib to the former ( 71, 72 ).…”

“…Such an approach has the potential to drastically reduce the time between bite to initial treatment from hours or days (25,26,69) to minutes, thus drastically improving the prognosis of tropical snakebite victims.…”