Snakebite has always been low on the public health agenda at national and international levels, although recently it has started to receive greater attention. More than 20,000 people die from snakebites each year in sub-Saharan Africa alone, where Doctors Without Borders/Médecins Sans Frontières (MSF) treats several thousand victims of snakebite every year and witnesses the devastating impact of snakebites on victims, their families, and communities. Access to proper treatment is limited, with quality antivenoms often unavailable or unaffordable.
Who is most at risk from snakebite?
People bitten by snakes typically live in tropical or subtropical countries where venomous species are endemic. Those most at risk include farmers or rural communities that depend on agriculture or subsistence hunting and gathering. The risk of death or permanent disabilities is increased in remote communities where access to care is poor, as it is in many regions with highly venomous snakes. This limited access may reflect the lack of effective, affordable antivenoms available, of health workers trained in treating snakebite, or of nearby health facilities, or ambulances that can transport patients to health facilities, so they can receive care quickly after being bitten. For these reasons, many victims turn to traditional healers, or to ineffective traditional medicines or low-quality antidotes. Young children under five have a higher risk of death, due to their lower body mass.
What symptoms do snakebites cause?
Different species of poisonous snakes often produce different venoms. But in general, their effects fall into three main categories:
- The first is rapid, painful swelling that can kill tissue around the bite or even the entire limb. Swelling can also affect the airway, which in severe cases may quickly lead to death.
- Second, venoms can cause bleeding and at the same time prevent blood from clotting, so that victims may bleed profusely from the bite and from other wounds. This can progress to further bleeding, shock, and convulsions.
- Third, venoms can be toxic to the central nervous system, initially causing numbness, excessive sweating, and other mild symptoms but sometimes progressing to life-threatening problems such as breathing difficulties and eventually paralysis, and complete inability to breathe.
Other common symptoms include low blood pressure, increased heart rate, upper back pain, vomiting, and diarrhea.
How are different types of snakebites diagnosed?
The first sign of a snake bite is the bite itself, often to the victim’s arms or legs, and showing two distinct puncture wounds from the snake’s fangs. Ideally, medical staff should quickly determine the species of snake involved since this information guides the type of antidote required. At our clinics, patients can often do this using photos of local venomous snakes.
How are snakebites treated?
Bites from venomous snakes can kill or maim people quickly. So saving lives and reducing disability requires that snakebite victims can quickly reach a health facility that has staff trained to diagnose and manage poisonous bites and has good-quality antivenoms on hand. Serious cases may also require intravenous fluids, breathing support, control of bleeding, and wound care. Some patients, especially those that reach care late, may have such severe tissue damage, that they require surgery or even amputation of the affected limb.
Patients who survive but lose limb function—or lose their limb altogether—need extensive rehabilitation, but this is often not available where they live. Many go on to lead lives of poverty and exclusion from their community, while families may also suffer financial ruin due to the loss of their breadwinner’s ability to work.
How MSF responds
In many poor regions where venomous snakes are a significant threat to local populations, MSF is the only provider of free, quality medical care. This begins with caring for patients who arrive at our clinics, from diagnosing the type and severity of their envenoming to the extent possible, to treating their symptoms, giving antivenoms when appropriate, and providing follow-up care. We also provide surgical care for those who need it. Of the patients we treat for snakebite, the majority are in Central African Republic, South Sudan, Ethiopia, and Yemen.
Advocacy is another key pillar of our response to snakebite. Our advocacy focuses on overcoming the barriers to care, which range from low global investment in developing and testing antivenoms effective specifically against the bites of local snakes—which vary widely by geography—to the unaffordably high prices of those few products that may be locally available. We have also strongly supported the World Health Organization in adding snakebite to its list of priority Neglected Tropical Diseases and in its strategy, launched in May 2019, to tackle the crisis. Looking ahead, we will continue to press for full implementation and rapid expansion of access to care.
We also conduct research to help address these barriers, focusing on gathering clinical data about the safety and effectiveness of antivenoms in specific geographic regions. Recent findings from Agok, South Sudan, where the only antivenom with known effectiveness against local snakes is no longer produced, showed that two new antivenoms were both safe and highly effective against the bites of specific types of local snakes.
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