Snakebite: the true disease burden has yet to be determined

Abstract

Snakebite: the true disease burden has yet to be determined Venomous snakes are a significant cause of morbidity and mortality, particularly in tropical and subtropical countries in Africa, Asia, Oceania and Latin America. Most snake bites occur in the rural tropics, and result in a high medical and economic toll. The reasons include poor access to [often suboptimal] health services, scarcity of effective and safe antivenom (AVS), survival with disability, and the economic impact of disabled young victims [1]. Despite this, snakebite has not received due attention and the main reason for this is the paucity of sound epidemiological data with which to make the case. Difficulties in obtaining accurate data on snakebiteSnakebite mainly occurs in the poorest countries of the world that are least able to deal with the problem [2]. Data on snakebite are based mainly on hospital returns or incomplete central databases. Bites and associated mortality are underreported because many victims do not seek treatment in government health facilities, preferring traditional treatments. Studies from rural Nigeria and Kenya have reported that only 8.5% and 27% of snakebite victims, respectively, sought hospital treatment [3,4]. In rural Bangladesh only 3% of victims went directly to a medical doctor or hospital [5].Two qualitative studies, investigating beliefs regarding snakebite and their influence on health seeking behavior in Sri Lanka found that people living in four rural communities believed that Ayurvedic treatment was effective for snakebite [6,7]. Common misconceptions regarding hospital treatment were based mainly on misinformation regarding AVS therapy. Traditional healers were respected and perceived to be able to cure snakebite, and although many people may finally seek treatment in a hospital, they would first consult a traditional healer. Similar situations are likely to be common to many countries where health-seeking behaviour, health beliefs and access to health care are not optimal.The incidence of snakebite varies seasonally (e.g. high during agricultural activity) and geographically. Studies from India and Bangladesh have clearly shown increased rates of bites during periods of high rainfall and flooding [5,8]. Therefore, data obtained during seasonal surveys would not represent true annual incidence. Marked regional variations in incident snakebite deaths have been demonstrated in a recent nationwide survey conducted in India [8].This type of geographical variation in snake bites is seen even in small countries like Sri Lanka [9]. In the face of such heterogeneity, localised surveys will not reflect true national or regional values [3].Estimates of snakebite mortality are based mainly on hospital data, because other recording systems are unavailable or unreliable in most

Chronic Musculoskeletal Disabilities following Snake Envenoming in Sri Lanka: A Population-Based Study

“…However, population-based epidemiological studies of musculoskeletal disorders, possible causes and residual sequelae of snake envenoming are sparse [5,17,18]. Our study, which systematically screened over eight and a half thousand residents in a highly-vulnerable rural community for snakebites and its musculoskeletal complications, addresses this neglected area of research.…”

“…These effects mediated by snake venom toxins in the acute phase have been widely studied and well characterised in practice as clinical syndromes [2]. However, the long term sequelae of these toxins that may result in disabilities have not been studied to the same extent [5]. …”

Mallet Deformity of Distal Phalanx of Index Finger after Snake Bite

“…There are some studies describing snakebite envenomation as the cause of various musculoskeletal system diseases such as arthritis, osteomyelitis, muscle necrosis and also amputation of extremities. However, there is a dearth of literature detailing the species of snakes involved, and the epidemiology, disease course and prognosis of musculoskeletal disorders by snakebites [4,5]. In particular, chronic mallet deformities caused by snakebites have not been explored in research yet, partially owing to the low incidence of snakebites in modern life.…”

Toxinology: Taxonomy, Interpretation, and Information Resources

“…Snakebite, arguably the best researched subtype of "poisoning" (envenoming) by biologic organisms, is nevertheless characterized by the WHO as a "neglected tropical disease"(World Health Organization 2014), with likely greater than 100,000 human deaths annually and a global cost in the billions of dollars. Even for snakebite, epidemiologic data is restricted, often inadequate, and many published estimates of the global burden are likely to be underestimates (Chippaux 1998;De Silva et al 2013;Kasturiratne et al 2008;Mohapatra et al 2011;Swaroop and Grab 1954;Warrell et al 2013;White 2000). There are many other types of venomous or poisonous organisms, each presenting particular risks for humans and exacting an often ill-defined toll.…”