india

Updated: Jan 26, 2019 19:57 IST

To tackle mortality and permanent disability from snake bites, it is essential for India to set up regional venom collection centres, says a series of reports published in the British Medical Journal looking at tackling neglected diseases in South Asia.

“Currently, all the antivenoms available in India and most of South Asia is based on the venoms collected from the only collection centre in Tamil Nadu. But it has been observed that the venom of same species of snake varies from place to place. For example, Russell’s viper venom causes neurological symptoms like paralysis in the south and just severe bleeding in north India,” said Dr Ravikar Ralph, associate professor of internal medicine from Christian Medical College, Vellore.

The Wildlife Protection Act makes it extremely difficult to procure license to set-up such venom collection centre, he said.

And, all the antivenoms available in India and most of South Asian countries that source it from India are against the big four -- the common krait, binocellate cobra, Russell’s viper, and saw-scaled viper.

“So it is ineffective against snakes of local importance apart from the big four. If we look at Bangladesh, it used antivenoms made in India, two of the big four species are not even found there. And, antivenoms come with several adverse effect,” said Ralph.

Globally, five million snake bites occur every year that result in anywhere between 81000 to 138000 deaths. And, 70% of the deaths are in India, Bangladesh, Nepal, Pakistan and Sri Lanka.

“Snakebite is definitely receiving more attention now that it has been flagged as a priority area. In fact, the department of biotechnology itself is supporting studies at various institutes on snake bites,” said Dr Renu Swarup, secretary, department of bio-technology in the Union government.

In India, every year an estimated 2.8 million people are bitten and 50,000 die, according to a country-wide study on causes of death. The National Health Profile - 2018 puts this figure at 1.4 million bites and a mere 948 deaths.

“The problem is that most of the figures that we have is based on hospital data, when the fact is that anywhere between 70 to 80% of the snake bite victims die before reaching a healthcare facility, resulting in a massive underreporting,” said Ralph.

“There is limited evidence to guide treatment protocols,” the study states.

There is also a need to strengthen the rural healthcare system.

“The primary healthcare centre must not only be stocked with antivenoms, the staff must be trained to administer and manage the adverse effects of the antivenoms,” said Ralph.

The lack of supportive care such as ventilators and dialysis machines needed to manage respiratory paralysis and acute kidney injury from snake bite at rural healthcare also leads to patients being referred to higher centres and a delay in treatment.