Snakebites: shining a light on a neglected disease
One of the deadliest and yet most neglected tropical diseases (NTDs), is finally getting the attention it deserves – snakebite. Despite the fact that snakebites are avoidable, and snake bite envenomings are treatable, the WHO estimates that they result in up to 138,000 human deaths and 400,000 cases of chronic disability each year. Snake bites disproportionally affect the most impoverished people living in rural areas of tropical countries. Specific antidotes to snake venoms – antivenoms – are available but are often scarce and costly. Supportive treatments for respiratory and kidney failure are equally important, but require trained staff and equipment. Due to a lack of data and infrastructure, as well as political and social conflicts in affected countries, many victims are denied treatment. In May, the World Health Assembly (WHA) passed a resolution on raising awareness of deaths due to snakebite, a cause that has been close to my heart for many years.
In 2013, I met Professor David Warrell, who has dedicated decades to helping those affected by snakebites, when he was the Royal College of Physician’s International Director. I could not believe some of his stories. His interest in snakebites was sparked after witnessing a series of disastrous cases during the first few months of his work in Ahmadu Bello University Hospital in Northern Nigeria in 1970. He had countless tales of people bitten by snakes, all of whom could have avoided tragedy had they received the appropriate medical treatment.
One man, a 50-year-old Nigerian farmer, was bitten by a West African carpet viper (Echis ocellatus) while working in the fields. He stayed at home for 5 days, drinking and applying to the wound a traditional herbal remedy, despite local swelling, loin and abdominal pain and passing blood in his urine. Finally, on the 6th day after the bite, in despair, he travelled to a large regional hospital arriving faint, shocked and severely anaemic from blood loss. No antivenom was available and, despite attempts to resuscitate him, he died 7 hours later. An autopsy showed that he had bled into almost every part of his body.
In contrast, a 5-year-old girl was awoken from sleeping on the floor of her home in rural Sri Lanka by a bite by a common krait (Bungarus caeruleus). She was given oxygen on the 4 hour ambulance journey to a provincial hospital, but arrived in a state of respiratory arrest and shock. After successful resuscitation and 48 hours of mechanical ventilation, she made a full recovery.
While this latest resolution by the WHA is extremely welcome – it is not enough. There is much that can be done to reverse this situation and ensure that treatment is delivered to the people who need it most.
First, an interdisciplinary approach must be taken to raise awareness and find solutions. Only by bringing together medical professionals, policymakers, NGOs and humanitarian groups (such as the Global Snakebite Initiative), as well as willing and enthusiastic donors, can we hope to bring this under-recognised issue effectively into the spotlight. An recent event at Leiden University, “Snakebite – from science to society”, brought together an unusually wide constituency of scientists and activists interested in all aspects of the zoology, behaviour and conservation of venomous snakes and the prevention and treatment of snakebites. Discussions focused on improving antivenom production, development of new treatment modalities, enhancing epidemiological and surveillance techniques, and promoting community education towards reducing risk of snakebites. This was an excellent example of exactly the types of interdisciplinary dialogue needed comprehensively to address this issue.
Secondly, we must recognise the importance of empowering and educating communities in need. “During my travels around Nigeria, I discovered that hospitals admitted many cases of carpet viper bites every evening during the farming season after the annual rains. Snake envenoming is an occupational disease of agricultural workers and pastoralists as well as affecting particularly children and other villagers bitten as they walk along country tracks after dusk or before dawn”, says Professor David Warrell. Educating these communities and raising awareness among them will be essential both for reducing the risk of bites and encouraging appropriate actions after bites have occured. A serious lack of resources for treating snakebite victims in hospitals and difficulties in transporting them to medical care have encouraged a preference for traditional herbal practitioners, who are accessible, but whose interventions are of no proven benefit.
Lastly, we must back those organisations who make a difference. That is why my foundation, the Hamish Ogston Foundation, is committed to supporting research and initiatives such as the Global Snakebite Initiative. Progress cannot be made without individuals such as Professor David Warrell, whose instrumental role in developing highly effective antivenoms saves lives in several countries every year.
For far too long, snakebite victims have been abandoned by health services and medical scientists, their plight neglected and forgotten, despite the fact that tools are available to reduce the risk of bites and to treat their life-threatening consequences. I look forward to seeing this trend reversed with WHA’s recent resolution.