The Need for Full Integration of Snakebite Envenoming within a Global Strategy to Combat the Neglected Tropical Diseases: The Way Forward

Gutiérrez, José Marı́a; Warrell, David A.; Williams, David J.; Jensen, S.; Brown, Nicholas; Calvete, Juan J.; Harrison, Robert A.

doi:10.1371/journal.pntd.0002162

Cited by 140 publications

(141 citation statements)

References 16 publications

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“…Due to the low response rates encountered in this study, the coverage of the results presented here is not universally applicable to the global situation of antivenom management. Nonetheless, the results provide focused empirical data that verify what others have discussed before; the lack of momentum and resources made available to combat this neglected disease (12,13,17). In the course of this research, it quickly became clear that there is an absence of empirical data of the global snakebite burden.…”

Section: Discussionsupporting

confidence: 77%

“…The surveys showed that snakebite management in most participating countries is patchy at best. An applauded achievement lies in the recent addition of snakebite to the WHO list of NTDs, which may garner increased attention and perhaps even funding from the international community (7,13). The findings in this study verify the notion of a global antivenom crisis; they are still largely inaccessible to those who need them most, and often traded inefficiently (8).…”

Section: Discussionsupporting

confidence: 60%

“…Production expenses, production complexity, and lack of a lucrative market largely drove such shutdowns. Integrating antivenom production into a global strategy to combat snakebites may be the key in preventing further reduction of producers in the 21st century (11,13). The aforementioned drawbacks point to a central problem faced by antivenoms: access.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…cOnfLIcT Of InTeresT accordance with the Millennium Development Goals (MDGs), which were established by the United Nations and incentivized by the WHO, governments health organizations, support agencies, and foundations (7) . Unfortunately, snakebites were not included in the projects that were designed to reduce the impact of neglected diseases, perhaps because snakebite is not an infectious disease, and it is therefore believed that snakebiterelated public health burdens would not benefit from the same strategies that are used to combat infections.…”

mentioning

confidence: 99%

“…In addition, AVs are part of the WHO's list of essential medications (7) , and should therefore be available in all regions where snakebites occur (although this is not always the case in practice). The production of, distribution of, and free access to effective AV should be the right of all citizens without discrimination, especially those who are more vulnerable and marginalized.…”

mentioning

confidence: 99%

Bites and stings from venomous animals: a neglected Brazilian tropical disease

Cupo

2015

Rev. Soc. Bras. Med. Trop.

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An agonist of the CXCR4 receptor is therapeutic for the neuroparalysis induced by Bungarus snakes envenoming

Stazi

Tan

et al. 2022

Clinical & Translational Med

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An agonist of the CXCR4 receptor is therapeutic for the neuroparalysis induced by Bungarus snakes envenomingDear Editor, Here, we report the therapeutic properties of a small molecule agonist of the CXCR4 receptor on the recovery from the peripheral flaccid neuroparalysis caused by Bungarus snakebites. Snake envenoming is a neglected disease that, each year, causes >100 000 deaths in tropical and subtropical areas of the world and leaves >400 000 envenomed patients with permanent disabilities, with associated high social costs (https://www.who.int/news-room/ fact-sheets/detail/snakebite-envenoming). This is a disease of poverty believed by experts to be under reported. 1 Moreover, snake envenoming strikes particularly in lower income and rural parts of the world where advanced hospital care may not be rapidly available to the envenomed patient.A major number of neuropathological snakebites are produced by snakes of the Bungarus genus widely distributed in Asia. 2 Their venoms induce a descending flaccid paralysis with respiratory failure and autonomic dysfunctions. A large reduction of the function of the neuromuscular junction (NMJ) can be recorded electrophysiologically within few hours from snakebite, 2 and death may occur by respiratory failure. Mechanically ventilated patients survive because the Bungarus neurotoxins do not kill motor neurons but induce a rapid degeneration limited to the axon terminals which is followed by a slow regeneration requiring prolonged hospitalization (3-5 weeks) and eventual recovery. 2,3 However, hospitalization with mechanical ventilation poses major problems in lowincome countries associated with high costs and risks of in-hospital complications.The pathophysiology of Bungarus snake envenoming is primarily driven by neurotoxicity caused by protein neurotoxins. 2,3 The presynaptically acting βbungarotoxins (β-BTX) are phospholipases A 2 that cleave the ester bond of the fatty acid in the sn-2 site of the glycerol moiety of phospholipids, causing accumulation of fatty acids and lysophospholipids leading to rapid degeneration of axon terminals within few hours in mice. 4 This is fol-This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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The Need for Full Integration of Snakebite Envenoming within a Global Strategy to Combat the Neglected Tropical Diseases: The Way Forward

Cited by 140 publications

References 16 publications

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

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

Bites and stings from venomous animals: a neglected Brazilian tropical disease

An agonist of the CXCR4 receptor is therapeutic for the neuroparalysis induced by Bungarus snakes envenoming

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