Guwahati: Snakebite in India is a severe problem as it causes a mortality rate of 58,000 and a disability rate of 140,000 every year which is the highest among any other country. Antivenom is the primary therapy for snakebite, and its manufacturing techniques have essentially stayed unaltered for over a century.
Indian polyvalent antivenom, a scientifically validated medicine for treating the toxic effects of snakebites, is available only against the venom of the so-called Big Four snakes namely Spectacled cobra (Naja naja), Saw-scaled viper (Echis carinatus), Russell’s viper (Daboia russelli) and the Common krait (Bungarus caeruleus), responsible for majority of the deaths in India.
Scientific institutions have now joined hands for making an improved Anti Snake Venom(ASV) which can treat snakebite cases in Northeast India.
“The antivenom generated from these Big Four snakes is not effective in neutralizing many venoms of NE snakes and hence there is a dire need for a region-specific anti-snake venom,” says Dr H T Lalremsanga of Mizoram University who is working on a DST project on preparation of an improved antivenom against other than Big Four venomous snakes of NE.
Lalremsenga says since Indian polyvalent antivenom is inefficient in reversing the envenomation-mediated pathologies from most NE venomous snakebites, there is high demand on the need for a suitable antivenom generated from specific venomous snake species for the treatment of NE Indian venomous snake bite patients.
The university is collaborating with the Institute of Advanced Study in Science and Technology, Guwahati, Aaranyak, Amrita Vishwa Vidyapeetham and Premium Serums and Vaccines, Pune on the preparation of an improved antivenom against other than Big Four venomous snakes of NE.
Some other components of the project like “Bioactive screening and therapeutic evaluation of herbal extracts as potential sources of antivenom and proteomics of medically important snakes of North East India and “Development of diagnostic assays for the identification of snakebite at a species level” are being looked by the Indian Council of Medical Research.
Firoz Ahmed from Aaranyak says NE India has about 29 species of venomous snakes and none of its venom is used to produce antivenom. “Thus snakebite treatment in this region is a concern given that appropriate antivenom is not available. Producing such antivenom is the need of the hour to save lives and improve the living conditions of victims,” he said.
Due to rich vegetation and optimal climatic conditions, India is home to about 300 species of snakes, out of which about 60 are identified to be venomous.
According to the White paper on Venomous Snakebite in India by Indian Council Of Medical Research, Snakebite was re-designated as a neglected tropical disease (NTD) in 2017, which was removed from the list in 2013, re-considering the problem of snakebite in developing and tropical countries, which contributes 95 per cent of the total snakebites of the world, it was re-designated as a Category A of the NTD by the WHO with the hope that this declaration would provide an ample opportunity to attract investment and research funding for further improvement of snakebite management in developing countries. One of the major reasons cited for snakebite being removed from the NTD list was that there was not enough data from developing countries like India.
So far 110 species of snake have been recorded from NE and other than the Big Four, and there are 20+ species in NE which are venomous.
According to a study published in the Assam Journal of Internal Medicine, snakebite is a common occurrence in the Northeast, with an estimated 10,000 cases reported annually. The majority of these cases occur in remote areas where access to healthcare is limited. The lack of awareness and inadequate healthcare infrastructure exacerbate the problem, leading to delayed treatment and poor outcomes.
“The development of region-specific ASV and increased awareness and education about snakebites are crucial steps toward reducing the burden of snakebites in India. It is essential that policymakers, healthcare providers, and the general public work together to address this neglected tropical disease,” the study says.
One of the lesser-known groups of venomous snakes in northeastern India is the “green pit viper”. They belong to the Trimeresurus complex of Asiatic pit vipers and possess a bamboo-green-coloured body. The Indian green pit vipers are distributed across the northern and north-eastern states of India spreading to Sundarbans and Andaman & Nicobar-island.
Studies have shown bites of green pit viper to cause haematological abnormalities in patients resulting in significant morbidity and imposing a substantial socio-economic burden on patients. Green pit viper venom is reported to be haemotoxic in nature, causing extensive swelling of the bite site spreading considerably in severe cases, mild dyspnoea, nausea, bleeding and significant pain.
A study on “Indian green pit vipers: A lesser-known snake group of north-east India” by Dr H T Lalremsanga and others say the inefficacy of Indian polyvalent antivenom has been reinforced by regional envenomation reports from Demow Community Health Centre, Sivasagar, which confirms severe clinical conditions such as coagulopathy with incoagulable blood persisting 10 days post green pit viper bite even after administration of antivenom.
“The retrospective data obtained from the Demow health centre establishes that Indian polyvalent antivenoms available in hospitals are inefficient to reverse the envenomation-mediated pathology caused by green pit viper bites in northern and north-eastern India. The standard treatment protocol published in 2016 by the Directorate General of Health Services, Government of India advises against the use of antivenom for the treatment of envenomation featured by prolonged swelling and incoagulable blood, which are the characteristics of a typical green pit viper bite,” the study says.
Lalremsanga says persistent belief of victims in faith healers and insufficient knowledge regarding snakebite management protocols among the health care workers of most hospitals marks a crucial problem.
“Additionally, the absence of a green pit viper-specific monovalent anti venom in the region further complicates the situation. The patient at any cost needs a prolonged stay in the hospital till normalization of blood coagulation causing a socio-economic burden to the victims and their families. Thus, there is an urgent need to develop an alternative approach for snakebite therapy specific for north and north-eastern India,” he says.
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