Antivenoms

India is infamously considered the ‘snakebite capital’ of the world with over 58000 snakebite related deaths occurring annually.

• As per the Central Bureau of Health Investigation (CBHI) reports (2016-2020), the average annual frequency of snakebite cases in India is around 3 lakhs and about 2000 deaths occur due to snakebite envenoming.

About Snakebite Envenoming

• Snakebite envenoming is a potentially life-threatening disease following the bite of a venomous snake resulting in medical issues which can lead to death or permanent impairment if timely and appropriate treatment is not given.
• Cocktail of Toxic Proteins: Snake Venom is a cocktail of toxins immobilising the human body by releasing,
  • Haemotoxins: It destroys blood cells and disrupts clotting. 
  • Neurotoxins: It blocks nerve signals and paralyzes.
  • Cytotoxins: It dissolves tissue at the bite site. 

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• WHO Guidelines: It  has categorised ‘snakebite envenoming’, as a Neglected Tropical Disease (NTD) globally and has issued certain guidelines for effective management of snakebite cases,
  • Remove anything tight from around the bitten part of the body to avoid harm if swelling occurs.
  • Immobilize the person completely, splint the limb to keep it still and transport the person to a health facility as soon as possible
  • Applying pressure at the bite site with a pressure pad may be suitable in some cases.
  • Avoid traditional first aid methods or herbal medicines like wound incision or excision, suction, or application of “black stones” 
  • Place the person on their left side with head down in the recovery position so as to not choke if vomiting occurs
  • Closely monitor airway and breathing and be ready to resuscitate if necessary
  • Health facilities should treat all snakebite cases as emergencies and give priority to assessing these patients and instituting treatment without delay.
• Symptoms: Bleeding disorders, Kidney failure, Paralysis, Tissue damage, and Amputation. 
• Treatment: Making Safe and effective antivenoms widely available and accessible is the most effective treatment against snakebite envenoming.
• • Antivenoms are included in the WHO List of essential medicines and should be part of any primary health care package where snake bites occur.

India- The Snakebite Capital of World

• India is home to more than 300 species of snakes, of which more than 60 are venomous, ranging from mild to high. 
• Statistics: A 2020 study has estimated that between 2001 and 2014, approximately,  1.2 million snakebite deaths and three-times as many cases of permanent disability occurred in India. 
  • The study also said one in 250 Indians were at risk of dying from snakebite before the age of 70.
• Causes: 
  • Rural: Agricultural workers, Farmers, Tribals ect are the most vulnerable to snake bites particularly during the monsoon, when snakes become more active. 
  • Urban: Rapid, often unplanned urbanisation, poor garbage management, and urban floods have increased encounters between humans and snakes, making even city-dwellers vulnerable.
• Reasons for high Snake Bite related Mortality:
  • Not easily accessible: Timely medical care in remote areas is a significant challenge as people often have to undertake long journeys to reach a healthcare facility equipped with antivenoms.
  • Not Inclusive: The present method of treatment ie. Polyvalent antivenoms (PVAs) is not effective on the venom of other less known but venomous snakes like,
    • king cobra, monocled cobra, banded krait, Sochurek’s saw-scaled viper, hump-nosed viper, and several species of pit vipers.
  • Logistical Issues: Antivenoms often need to be transported in cold storage and India’s rural parts lack the supporting infrastructure and power supply.
  • Delay in Treatment: Superstitious beliefs, cultural practices and using traditional medicine as the first line of treatment  leads to delay in  proper treatment..
  • Inadequate Facilities: Lack of supporting infrastructure or proper handling of the antivenoms can cause them to degrade in storage and become ineffective.
  • Unequal Access: The high cost of manufacturing antivenom limits accessibility for the economically-disadvantaged. 

About Antivenoms

• Antivenoms are life-saving medicines used to treat snakebites. India is the world’s largest producer and consumer of antivenoms in the world.
  • The Antivenoms work by specifically binding to the venom toxins to render them ineffective, allowing the body’s natural defence systems to clear them safely over time. 
• Production Process: The first Antivenom was produced by French physician Albert Calmette in the 1890s using horses
  • Antivenoms are produced by injecting small amounts of snake venom into horses, which then produce antibodies as part of their immune response.
  • These antibodies are extracted from the horse’s blood and purified and formulated as antivenoms.

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• The Irula tribe of Tamil Nadu are experts in milking the snake and collecting its venom which is then supplied to Pharma companies to produce Antivenoms.
  • Several companies in India, including Bharat Serums and Vaccines, Haffkine Bio-pharmaceutical Corporation, and ViNS Bioproducts, produce antivenom this way.
• Current Status in India: Polyvalent antivenoms (PVAs) are currently used in India as it targets the Big Four accounting for most snakebite deaths.
  • The Big Four: The venom extracted from Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell’s viper (Daboia russelii), and the saw-scaled viper (genus Echis)  is used to produce PVAs in India.
• Future Research in Antivenom Development:
  • Synthetic Antivenoms: Recombinant DNA technology is being used to produce lab-engineered, synthetic antivenoms that are free from animal-derived proteins and offer greater safety and efficacy. 
    • Example: A research led by 2024 Nobel laureate David Baker, reported successfully using Artificial Intelligence (AI) to design synthetic antivenoms. 
  • Region-Specific Antivenoms: Researching on the cross-species and geographic variability in venoms, scientist are developing Region-Specific Antivenoms.
  • Tailored Antivenoms: By mapping the toxins’ compositions, scientists are attempting to create tailored antivenoms, holding the promise for more precise treatments.