The Union Health Ministry has requested all private and public hospitals to report cases of snakebites to the government.
The government has introduced the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE), aiming to reduce snakebite fatalities by 50% by 2030. NAPSE suggests classifying snakebites as a notifiable disease to enable effective surveillance and accurately track the number of snakebite cases and related deaths across India.
India is home to 310 snake species, of which 66 are venomous while 42 are mildly venomous.
Indian cobra, Common krait, Russell’s Viper, and Saw-scaled viper make up 90% of poisonous snake bite deaths in our country. If a venomous snake bites without injecting venom it is called a dry bite.
Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh. Andhra Pradesh, Telangana, Rajasthan, and Gujarat in India report maximum cases.
WHO estimates fifty thousand die in India due to an estimated 3-4 million snake bites in a year accounting for half of snakebite deaths worldwide.
Highlighting the gravity of the issue that snake bites are a significant public health concern, causing mortality, morbidity, and disability. Rural communities face a higher risk. The Ministry of Health and Family Welfare (MOHFW) has designated snake bite as a 'notifiable disease.'
WHO’s International Health Regulations 1969 require disease reporting to help in global surveillance and advisory roles. Diseases that require reporting to government authorities are called notifiable diseases. Under the 1969 regulation, diseases such as cholera, yellow fever, plague, and tuberculosis are mandated for reporting.
The notifiable diseases are specific to each state, region, or country. The list is not static; diseases are added or removed based on present public health needs.
Physicians and diagnostic laboratories report cases to local health authorities who launch immediate control and prevention activities. They report cases to state or national health departments.
Owing to the widespread impact on public health snake bites have been added to the Neglected Tropical Diseases (NTD) list of WHO.
Snake Bites cause severe health issues, like paralysis, fatal hemorrhages, and tissue damage, making timely interventions crucial. Immediate antivenom treatment prevents death and long-term effects.
This move will enhance surveillance, track the number of cases, and improve treatment strategies.
Antivenom in regions where snake bites are frequent will be provided
Medical staff will be trained to handle snakebite cases to reduce mortality rates.
Snake bite victims preferred treatment from faith healers and did not reach healthcare centers.
Tests to confirm snake bites are not available.
Arms, wrists, legs, or hands are the common sites where a snake bites.
A nonvenomous snake bite causes pain, injury, and scratches at the site of the bite.
A venomous snake bite causes pain and tenderness at the local site of the bite. Swelling and bruising occur up to the arm or leg and the condition worsens.
Other symptoms are nausea, labored breathing, feelings of weakness, and an odd taste in the mouth.
Snake venom toxins affect the brain and nerves. The venom causes upper eyelids to droop, fingers or toes to tingle, difficulty swallowing, and muscle weakening.
Move far away from the snake.
Remove any jewelry, watches, or tight clothing worn before swelling starts.
Sit or lie down in a comfortable position.
Clean the bite with soap and water. Cover or wrap it.
Don't tie a tourniquet or apply ice.
Avoid cutting the bite and removing the venom.
Don't drink caffeine or alcohol.
Don't take pain-relieving medicine, such as aspirin, or ibuprofen. This can increase the risk of bleeding.
Don't try to catch the snake. Remember its color and shape as knowing which type of snake bit helps in treatment.
The antidote for snake venom is Snake antivenom (also known as snake venom antiserum or snake antivenom immunoglobulins)
These antibodies are raised against several species of venomous snakes and are called polyvalent antivenom. In India, polyvalent antivenom is available. It has antibodies against the Big Four- Cobra, Russell’s Viper, Saw-scaled Viper, and Common Krait.
Snake antivenom reverses most of the symptoms caused by snake biting and significantly reduces morbidity and mortality.
Each ml. of antivenom neutralizes the venom of the following snakes:
0.6 mg of dried Indian cobra venom
0.6 mg of dried Russell’s viper venom
0.45 mg of dried saw-scaled viper venom
0.45 mg of dried common krait venom
It should be remembered that there are several other poisonous snakes in India, against which this polyvalent antivenom will be ineffective.
Banded krait, monocled cobra, and green pit viper are local species of the Northeast against which the commercially available antivenom does not work.
Snake charmers of the Irula tribe who provide venom used to develop antivenom live in Tamil Nadu, Karnataka, and Kerala.
The biochemical constituents of the venom from the same snake species differ in different geographies.
A 2020 study published in the Indian Journal of Medical Research (IJMR) highlighted variations in the efficacy of commercial anti-snake venom (ASV) produced for the same snake species across different geographic locations.
Studies reveal that the venom potency changes with age. For instance, the venom of Russell’s viper neonates is far more toxic than that of the adults.
Antivenoms themselves also cause various reactions.
These limitations of antivenoms have forced researchers to develop artificially produced antibodies that can help neutralize the toxins across various snake species. Synthetic antivenom peptides are also being prepared to fight the toxin.
To address these limitations, scientists are developing synthetic antibodies to neutralize toxins across multiple snake species and design artificial peptides to combat venom toxins.
Experts suggest establishing zonal venom collection banks to develop antivenoms for regional differences. Wildlife (Protection) Act of 1972 makes snakes out of bounds and setting up such banks difficult.
References:
1. Oliveira, Ana L., Matilde F. Viegas, Saulo L. Da Silva, Andreimar M. Soares, Maria J. Ramos, and Pedro A. Fernandes. “The Chemistry of Snake Venom and Its Medicinal Potential.” Nature Reviews Chemistry 6, no. 7 (June 10, 2022): 451–69. https://doi.org/10.1038/s41570-022-00393-7.
2. Mayo Clinic. “Snakebites: First Aid.” Accessed December 17, 2024. https://www.mayoclinic.org/first-aid/first-aid-snake-bites/basics/art-20056681.
3. DOI: 10.20959/wjpr20181-10495
(Input from various sources)
(Rehash/Dr. Swati Sharma/MSM)