Snake Envenoming: A Disease of Poverty

Harrison, Robert A.; Hargreaves, Adam D; Wagstaff, Simon C.; Faragher, Brian; Lalloo, David G.

doi:10.1371/journal.pntd.0000569

Cited by 514 publications

(478 citation statements)

References 22 publications

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“…Of all venomous animals, snakes are the most wellknown because of their medical importance: As many as 90,000 people die each year as the result of snakebite, with the majority of those inhabiting rural poor regions of the tropics (2,3). This substantial mortality burden of snakebite victims is surprising because antivenom treatment (immunoglobulins from venom-immunized horses/sheep) can be highly effective at neutralizing the toxic components present in snake venom (4,5).…”

mentioning

confidence: 99%

Medically important differences in snake venom composition are dictated by distinct postgenomic mechanisms

Casewell

Wagstaff

Wüster

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

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Variation in venom composition is a ubiquitous phenomenon in snakes and occurs both interspecifically and intraspecifically. Venom variation can have severe outcomes for snakebite victims by rendering the specific antibodies found in antivenoms ineffective against heterologous toxins found in different venoms. The rapid evolutionary expansion of different toxin-encoding gene families in different snake lineages is widely perceived as the main cause of venom variation. However, this view is simplistic and disregards the understudied influence that processes acting on gene transcription and translation may have on the production of the venom proteome. Here, we assess the venom composition of six related viperid snakes and compare interspecific changes in the number of toxin genes, their transcription in the venom gland, and their translation into proteins secreted in venom. Our results reveal that multiple levels of regulation are responsible for generating variation in venom composition between related snake species. We demonstrate that differential levels of toxin transcription, translation, and their posttranslational modification have a substantial impact upon the resulting venom protein mixture. Notably, these processes act to varying extents on different toxin paralogs found in different snakes and are therefore likely to be as important as ancestral gene duplication events for generating compositionally distinct venom proteomes. Our results suggest that these processes may also contribute to altering the toxicity of snake venoms, and we demonstrate how this variability can undermine the treatment of a neglected tropical disease, snakebite.

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mentioning

confidence: 99%

Medically important differences in snake venom composition are dictated by distinct postgenomic mechanisms

Casewell

Wagstaff

Wüster

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

283

256

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“…Management of snake bite, initiation of therapy, type of ASV, its dosage have all been surrounded by controversies for decades [1,2,[4][5][6][7]12,16] . The WHO guidelines for snakebite management in Southeast Asia (2010) clearly mentions on the indications and dosage of ASV [5] .…”

Section: Discussionmentioning

confidence: 99%

“…Snakebite is a major public health issue in the tropical and subtropical nations of South Asia, Southeast Asia, and sub-Saharan Africa [1][2][3][4] . Snake bites are among the common emergency room cases in the tropical countries.…”

Section: Introductionmentioning

confidence: 99%

‘A life threatening scratch on little toe’ – at most clinical suspicion the essential key in management of snake bite

George

Georgy

2012

Asian Pacific Journal of Tropical Biomedicine

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“…Snakebite is a recognized medical emergency in those parts of the world inhabited by venomous snakes. It generally affects people living in rural communities, with children and agricultural workers most at risk (3,4). Estimates show that snakebites occur most in South and Southeast Asia, in SubSaharan Africa, and Latin America (2,3,5).…”

Section: Introductionmentioning

confidence: 99%

Needs and availability of snake antivenoms: relevance and application of international guidelines

Scheske

Ruitenberg

Bissumbhar

2015

Int J Health Policy Manag

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Background: Snakebite has recently been declared a global public health emergency. Empirical data showing the true burden of snakebite is lacking. Treatment with specific antivenoms is considered the only cure. However, several factors have led to an ongoing antivenom crisis. This study offers recommendations concerning the improvement of antivenom access and control, by providing an overview of the factors limiting the successful implementation of international guidelines within the international industry and state institutions. It further investigates the reasons for the epidemiological knowledge gap regarding snakebites. Methods: Data for this study was collected using surveys with closed-and open-ended questions, which allowed for descriptive and thematic analysis, respectively. Participants for this study were selected as follows: 46 manufacturers were contacted from the open-access World Health Organization (WHO) Database for antivenom producers; 23 National Health Authorities (NHAs) of high-burden countries were contacted; and 11 poison centers or experts were randomly contacted. Results: In total, responses from 6/46 (13%) manufacturers, 10/23 (43%) NHAs, and 3/11 (27%) poison centers were received. The low response rates had a limiting effect on the coverage of this study, allowing only exploratory conclusions to be drawn. Based on the gathered information, a probable reason for the epidemiological knowledge gap is the low priority given to snakebites on public health agendas, driving interest and funding away from research in this field. As a consequence, the ensuing lack in funding is preventing state institutions and manufacturers from implementing international guidelines to the highest standards. Furthermore, manufacturers indicated that international guidelines were often not applicable in the field, lacking technical information and protocols. Conclusion: Snakebite ranks low on international public health agendas, and partially due to this low priority, NHAs have shown limited efforts in conducting epidemiological studies, training health workers on snakebite management and creating national snakebite management strategies. The lack of NHA involvement is reflected in poor access to appropriate antivenoms as well as a lack of antivenom regulation. Manufacturers are taking positive steps toward full implementation of international guidelines and are improving quality control procedures. However, in order for international guidelines to become truly useful in the field, more technical guidance is required. This study reflects that there is a general lack of knowledge transfer amongst various actors: most producers, health authorities, and experts expect increased and improved communication and guidance from leading international bodies. Due to the low response rates observed in this study, conclusions drawn herein are not representative of the global situation; yet provide an exploratory insight on the difficulties facing antivenom management. Keywords: Snakebite, Antivenom, Envenomation, Gu...

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Snake Envenoming: A Disease of Poverty

Cited by 514 publications

References 22 publications

Medically important differences in snake venom composition are dictated by distinct postgenomic mechanisms

Medically important differences in snake venom composition are dictated by distinct postgenomic mechanisms

‘A life threatening scratch on little toe’ – at most clinical suspicion the essential key in management of snake bite

Needs and availability of snake antivenoms: relevance and application of international guidelines

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