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SNAKES

The World Health Organisation’s (WHO’s) 71st World Health Assembly in Geneva adopted a resolution “to accelerate and coordinate global efforts to control snakebite ‘envenoming’ — the life-threatening disease that follows the bite of a venomous snake”.

Between 1.8 million and 2.7 million people are bitten worldwide every year, between 81,000 and 1,38,000 of them die, and four or five times that number are disabled, according to the WHO.

In India, which was a signatory to the resolution, some 50,000 die every year; however, the WHO fears this estimate may be just 10% of the actual burden.

In 2017-18, 1.96 lakh cases of snakebites were recorded, with West Bengal, Maharashtra and Tamil Nadu reporting the biggest numbers.

In June 2018, Maharashtra approved the setting up of a National Venom Research Centre, and asked the Centre to aid the public sector Haffkine Institute in its work on snake species and poisons.

Of the 300-odd species of snakes found in India, 52 are venomous, but all their poisons are different.

India’s battle against snakebites : Problem which persists

1.Private companies do not find  financially feasible for Research and Development

2.Poorly Trained Doctors

3.Lack of Anti-Snake Venom

4.Duration of Manufacturing process is very long which accounts for nearly one year

Lack of research

A decade ago, Sri Lanka stopped importing ASV from Haffkine citing inefficacy.The potency of ASV is reducing in the last few years. There is need for research to understand which combination works best.

Doctors say locally produced ASVs are the most effective.

A snake’s venom changes with terrain, diet and environment.

But most manufacturers source their venom from Irula Cooperative Venom Centre in Tamil Nadu, which houses a large number of snakecatchers.

This explains why, to treat a saw-scaled viper’s bite in Tamil Nadu, less than 10 vials may be required, while in Maharashtra it could be 30-80 vials, and in Jammu and Kashmir, over 80.

The cost of treatment in a private hospital can be huge — a Russell’s viper’s bite requires 30-40 vials, which could cost upwards of Rs 20,000.

Untrained doctors

In a study of 1,686 snakebite cases from 2013-16 in Maharashtra’s tribal Palghar district, researchers found poor training among doctors, and high wastage of ASV.

The research, funded by the Tribal Health Research Forum of the Indian Council of Medical Research (ICMR), showed that “in most cases, primary health centres referred patients elsewhere and the golden hour was lost”.

In most cases, doctors do not identify the bite mark as it is small, and the victim is attacked while asleep. Within hours, the victim develops neuroparalysis.

In 2009 and 2016, snake bite protocols were drafted by the central government. But the training is yet to cover all doctors.

Monovalent vs polyvalent

A monovalent ASV, made from the venom of one species, can treat the bite of only that species. It is more efficient, but the purpose is lost if the snake is not identified correctly.

A polyvalent combines the venoms of India’s four most common poisonous snakes — cobra, common krait, Russell’s viper, and saw-scaled viper. More venom is wasted in the manufacture of the ASV, and more vials are required to treat the patient.

WAY FORWARD

India currently manufactures only polyvalent ASV. It needs to train doctors to identify snakes by their bites before switching to the production of monovalent ASVs.

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