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Rodrigo C, Gnanathasan A. Lack of controlled studies on snakebite prevention: a rapid review. Trans R Soc Trop Med Hyg 2024; 118:247-252. [PMID: 38088196 DOI: 10.1093/trstmh/trad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/31/2023] [Accepted: 11/23/2023] [Indexed: 04/07/2024] Open
Abstract
Globally, snakebites cause an estimated 80 000-140 000 deaths annually. While there are evidence-based recommendations for managing snakebite victims, recommendations on the prevention of snakebites are limited to expert opinions. We conducted a rapid review to summarise evidence from human studies with a control group on preventing snakebites. Searching PubMed, Web of Science, Scopus, CINAHL and EMBASE with inclusive search terms without language or time limits only yielded three eligible studies (one case control study and two prospective controlled clinical studies), highlighting a knowledge gap. Two studies in Nepal by the same group showed that health education of stakeholders and sleeping under a bednet can significantly reduce snakebite incidence (p<0.05), but these observations are not confirmed elsewhere, and because of the high risk of bias the certainty of evidence was low. The third study from Sri Lanka, which assessed if sleeping above ground would prevent snakebites, had inconclusive results. This demonstrates an urgent need for studies with a control group to guide evidence-based recommendations for snakebite prevention. Potential interventions tested can range from low-cost measures such as wearing appropriate footwear in resource-limited settings to testing the efficacy of chemical, biological (e.g. rodent control) or device-based methods and community-supported platforms tracking snakebite sightings with real-time geolocation data in highly resourced settings.
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Affiliation(s)
- Chaturaka Rodrigo
- Department of Pathology, School of Biomedical Sciences, UNSW, Sydney, NSW 2052, Australia
| | - Ariaranee Gnanathasan
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 00800, Sri Lanka
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Gopal G, Muralidar S, Prakash D, Kamalakkannan A, Indhuprakash ST, Thirumalai D, Ambi SV. The concept of Big Four: Road map from snakebite epidemiology to antivenom efficacy. Int J Biol Macromol 2023; 242:124771. [PMID: 37169043 DOI: 10.1016/j.ijbiomac.2023.124771] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
Snake envenomation is a life-threatening disease caused by the injection of venom toxins from the venomous snake bite. Snakebite is often defined as the occupational or domestic hazard mostly affecting the rural population. India experiences a high number of envenoming cases and fatality due to the nation's diversity in inhabiting venomous snakes. The Indian Big Four snakes namely Russell's viper (Daboia russelii), spectacled cobra (Naja naja), common krait (Bungarus caeruleus), and saw-scaled viper (Echis carinatus) are responsible for majority of the snake envenoming cases and death. The demographic characteristics including occupation, stringent snake habitat management, poor healthcare facilities and ignorance of the rural victims are the primary influencers of high mortality. Biogeographic venom variation greatly influences the clinical pathologies of snake envenomation. The current antivenoms against the Big Four snakes are found to be less immunogenic against the venom toxins emphasizing the necessity of alternative approaches for antivenom generation. This review summarizes the burden of snake envenomation in India by the Big Four snakes including the geographic distribution of snake species and biogeographic venom variation. We have provided comprehensive information on snake venom proteomics that has aided the better understanding of venom induced pathological features, summarized the impact of current polyvalent antivenom therapy highlighting the need for potential antivenom treatment for the effective management of snakebites.
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Affiliation(s)
- Gayathri Gopal
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Shibi Muralidar
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Diwahar Prakash
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Abishek Kamalakkannan
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Srichandrasekar Thuthikkadu Indhuprakash
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Diraviyam Thirumalai
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Senthil Visaga Ambi
- Biopharmaceutical Research Lab, Anusandhan Kendra-1, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India; School of Chemical and Biotechnology, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India.
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National snakebite project on capacity building of health system on prevention and management of snakebite envenoming including its complications in selected districts of Maharashtra and Odisha in India: A study protocol. PLoS One 2023; 18:e0281809. [PMID: 36800356 PMCID: PMC9937454 DOI: 10.1371/journal.pone.0281809] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Snakebite envenoming (SBE) is an acute, life-threatening emergency in tropical and subtropical countries. It is an occupational hazard and a major socioeconomic determinant. Limited awareness, superstitions, lack of trained health providers, poor utilization of anti-venom results in high mortality and morbidity. India is the snakebite capital of the world. Yet, information on awareness, knowledge, and perceptions about snakebite is limited. Data on capacity building of health systems and its potential impact is lacking. Recommended by the National Task Force on snakebite research in India, this protocol describes the National Snakebite Project aiming for capacity building of health systems on prevention and management of snakebite envenomation in Maharashtra and Odisha states. METHODS A cross-sectional, multi-centric study will be carried out in Shahapur, Aheri blocks of Maharashtra, and Khordha, Kasipur blocks of Odisha. The study has five phases: Phase I involves the collection of retrospective baseline data of snakebites, facility surveys, and community focus group discussions (FGDs). Phase II involves developing and implementing educational intervention programs for the community. Phase III will assess the knowledge and practices of the healthcare providers on snakebite management followed by their training in Phase IV. Phase V will evaluate the impact of the interventions on the community and healthcare system through FGDs and comparison of prospective and baseline data. DISCUSSION The National Snakebite Project will use a multi-sectoral approach to reduce the burden of SBE. It intends to contribute to community empowerment and capacity building of the public healthcare system on the prevention and management of SBE. The results could be useful for upscaling to other Indian states, South Asia and other tropical countries. The findings of the study will provide critical regional inputs for the revision of the National Snakebite Treatment protocol. TRIAL REGISTRATION Registered under the Clinical Trials Registry India no. CTRI/2021/11/038137.
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Bhaumik S, Kadam P, Pati S, Di Tanna GL, Jagnoor J. Community-based interventions for bite prevention, improved care-seeking and appropriate first aid in snakebite. Hippokratia 2022. [DOI: 10.1002/14651858.cd015097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute of Global Health, Faculty of Medicine; University of New South Wales; Sydney Australia
- Meta-research and Evidence Synthesis Unit; The George Institute for Global Health; New Delhi India
| | | | - Sanghamitra Pati
- Regional Medical Research Centre; Indian Institute of Medical Research; Bhubaneswar India
| | - Gian Luca Di Tanna
- Meta-research and Evidence Synthesis Unit; The George Institute for Global Health; Sydney Australia
| | - Jagnoor Jagnoor
- The George Institute of Global Health, Faculty of Medicine; University of New South Wales; Sydney Australia
- Injury Division; The George Institute for Global Health; New Delhi India
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Ramana LN, Mathapati SS, Salvi N, Khadilkar MV, Malhotra A, Santra V, Sharma TK. A paper microfluidic device based colorimetric sensor for the detection and discrimination of elapid versus viper envenomation. Analyst 2022; 147:685-694. [PMID: 35072182 DOI: 10.1039/d1an01698a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Snake bites are a neglected tropical disease, causing mortality and severe damage to various vital organs like the nervous system, kidneys and heart. There is increasing interest in designing new antivenom treatments that are more specific to particular groups (either taxonomic or regional) of species, given the increasing evidence that current polyvalent Indian antivenom is ineffective in many situations. Under these circumstances, being able to detect the species, or a group of species, responsible for the envenomation becomes important. Unfortunately, no such diagnostic tool is available in the Indian market. Such a tool will need to be rapid, sensitive and affordable. To address this need, we have combined the power of nanotechnology and paper microfluidics and herein report a device that has the ability to detect and differentiate viper venom from elapid and scorpion venom. In principle, this assay is based on the release of the dye from the stimuli-responsive glutaraldehyde cross-linked methylene blue-loaded gelatin (GMG) nanoparticles in the presence of snake venom metalloproteases and serine proteases. The developed equipment-free assay can detect and discriminate viper venom from that of elapids and scorpions. The low-end detection limit of the sensor is ∼3.0 ng for the saw-scaled viper Echis carinatus, while the same for Russell's viper Daboia russelii is ∼6.0 ng. The performance of the sensor remains unaltered for different batches of GMG nanoparticles. Altogether, this finding establishes the role of nanotechnology and paper microfluidics in the rapid and accurate detection of viper venom.
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Affiliation(s)
- Lakshmi Narashimhan Ramana
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India.
| | - Santosh S Mathapati
- Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India
| | - Nitin Salvi
- Premium Serums and Vaccines Pvt. Ltd, Maharashtra, 410504, India
| | - M V Khadilkar
- Premium Serums and Vaccines Pvt. Ltd, Maharashtra, 410504, India
| | - Anita Malhotra
- School of Natural sciences, College of Environment sciences and Engineering, Bangor University, Bangor LL57 2UW, UK
| | - Vishal Santra
- Society for Nature Conservation, Research and Community Engagement (CONCERN), Nalikul, Hooghly, 712407, West Bengal, India
- Captive and Field Herpetology, 13 Hirfron, Anglesey, LL65 1YU, Wales, UK
| | - Tarun Kumar Sharma
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research Group, Translational Health Science and Technology Institute (THSTI), Faridabad, Haryana 121001, India.
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Martín G, Yáñez-Arenas C, Rangel-Camacho R, Murray KA, Goldstein E, Iwamura T, Chiappa-Carrara X. Implications of global environmental change for the burden of snakebite. Toxicon X 2021; 9-10:100069. [PMID: 34258577 PMCID: PMC8254007 DOI: 10.1016/j.toxcx.2021.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 11/21/2022] Open
Abstract
Snakebite envenoming is a set of intoxication diseases that disproportionately affect people of poor socioeconomic backgrounds in tropical countries. As it is highly dependent on the environment its burden is expected to shift spatially with global anthropogenic environmental (climate, land use) and demographic change. The mechanisms underlying the changes to snakebite epidemiology are related to factors of snakes and humans. The distribution and abundance of snakes are expected to change with global warming via their thermal tolerance, while rainfall may affect the timing of key activities like feeding and reproduction. Human population growth is the primary cause of land-use change, which may impact snakes at smaller spatial scales than climate via habitat and biodiversity loss (e.g. prey availability). Human populations, on the other hand, could experience novel patterns and morbidity of snakebite envenoming, both as a result of snake responses to environmental change and due to the development of agricultural adaptations to climate change, socioeconomic and cultural changes, development and availability of better antivenoms, personal protective equipment, and mechanization of agriculture that mediate risk of encounters with snakes and their outcomes. The likely global effects of environmental and demographic change are thus context-dependent and could encompass both increasing and or snakebite burden (incidence, number of cases or morbidity), exposing new populations to snakes in temperate areas due to “tropicalization”, or by land use change-induced snake biodiversity loss, respectively. Tackling global change requires drastic measures to ensure large-scale ecosystem functionality. However, as ecosystems represent the main source of venomous snakes their conservation should be accompanied by comprehensive public health campaigns. The challenges associated with the joint efforts of biodiversity conservation and public health professionals should be considered in the global sustainability agenda in a wider context that applies to neglected tropical and zoonotic and emerging diseases. Distribution and abundance of snakes are expected to be affected by climate change. Land-use change may also impact snakes but at smaller spatial scales than climate. Human populations could experience novel patterns and morbidity of snakebite. Reducing snakebite should be accompanied by actions that protect snake diversity.
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Affiliation(s)
- Gerardo Martín
- Departamento de Sistemas y Procesos Naturales, Escuela Nacional de Estudios Superiores Unidad Mérida, Universidad Nacional Autónoma de México, Yucatán, Mexico
| | - Carlos Yáñez-Arenas
- Laboratorio de Ecología Geográfica, Unidad de Conservación de La Biodiversidad, UMDI-Sisal, Facultad de Ciencias, Universidad Nacional Autónoma de México, Sierra Papacal, Yucatán, 97302, Mexico
| | - Rodrigo Rangel-Camacho
- Laboratorio de Ecología Geográfica, Unidad de Conservación de La Biodiversidad, UMDI-Sisal, Facultad de Ciencias, Universidad Nacional Autónoma de México, Sierra Papacal, Yucatán, 97302, Mexico
| | - Kris A Murray
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK.,MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Gambia
| | - Eyal Goldstein
- School of Zoology, Faculty of Life Sciences, Tel Aviv University, Israel
| | - Takuya Iwamura
- Deparment of Forest Ecosystems and Society, College of Forestry, Oregon State University, Corvallis, OR, USA 97330
| | - Xavier Chiappa-Carrara
- Departamento de Sistemas y Procesos Naturales, Escuela Nacional de Estudios Superiores Unidad Mérida, Universidad Nacional Autónoma de México, Yucatán, Mexico
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