1. Project in Laos

Community-based epidemiological studies in two districts in Savannakhet province revealed a high incidence of snakebites between 355 and 1105 snakebites per 100,000 inhabitants per year. On the contrary, hospital-statistics showed that less than 2% of snakebite victims seek medical care in districts or provincial hospitals. After training of medical personnel in the management of snakebite envenoming and supply of antivenom from Queen Saovabha Memorial Institute in Bangkok, Thailand, hospital admissions of snakebite victims significantly increased at the provincial hospital in Savannakhet. The results leave no doubts that the availability of effective, safe, and affordable antivenom together with training of medical personnel are the principal game changers to increase hospital admissions and achieve effective and successful treatment of snakebite envenoming which consequently reduce mortality and cases of disability.

Future work will focus on the epidemiology of snakebites and the responsible venomous snakes in the northern part of Laos, the development and official recognition of guidelines for the management of snakebite envenoming, and studies on long-term disabilities after snakebite. We are working towards ensuring a sustainable supply of appropriate antivenom in provincial and key district hospitals in Lao PDR, which is a “sine qua non” for reducing mortality.

2. Project in Vietnam

Epidemiological surveys in Thua Thien Hue province and Can Tho Municipality showed an incidence of 58 and 48 snakebites per 100,000 inhabitants per year. In Thua Thien Hue the incidence was much higher in the poorer mountainous region (172 per 100,000) compared to the richer lowland coastal region (69 per 100,000) and the City of Hue (10 per 100,000). It confirms again that snakebite envenoming is poverty associated. Green pit vipers and Cobras (Naja species) were responsible for the majority of snakebites in both regions. A liquid formulation of monovalent antivenom against the white-lipped green pit viper (Trimeresurus albolabris) and one against the monocled cobra (Naja kaouthia) is produced at the Institute of Vaccines and Biologicals (IVAC) in Nha Trang.

Antivenom against the Malayan pit viper (Calloselasma rhodostoma), a species found in the Southeast of Vietnam, against the Malayan krait (Bungarus candidus) in the South and against the many-banded krait (Bungarus multicinctus) in the North of Vietnam has to be imported and is mostly not available. However, IVAC has started the development of monovalent antivenom against Malayan pit viper (Calloselasma rhodostoma) and multibanded krait (Bungarus multicinctus), butit will still take a few years until the product is officially registered and ready to use.

3. Project in Ghana

Evaluation of data on snakebite hospital admissions obtained from the District Health Information System of Ghana demonstrated that snakebite incidence is highest in the North of Ghana, particularly in the Upper West region. Therefore, as a first step, a clinical observational study is planned to follow up patients with snakebite envenoming admitted to the regional and municipal hospitals in Wa, Upper West to investigate the efficacy of antivenom, the medically important venomous snakes and clinical outcomes. Particularly the proof of efficacy of the available antivenom products is important. Preliminary inquiries revealed that three different snake antivenom products are used in Ghana, (i) Afriven 10 from VINS Bioproduct limited, (ii) PANAF Premium, from Premium Serums and Vaccines limited and (iii) BEAFRIQUE-10 from Biological E. Limited, all imported from India. Product descriptions indicate that these antivenoms neutralize the venom of 10, 14, and 10 snakes, respectively. However, some of these snakes are not found in Ghana or are rarely responsible for envenoming. There is no evidence that a reasonable dose of these antivenom products is effective against the medically important snakes in Ghana, particularly against venom of Echis ocellatus (West African carpet viper), which is most likely responsible for the majority of cases in Northern Ghana.

4. Project in Gabon

There are very few publications about snakebite envenoming in Gabon. This gap needs to be addressed and therefore a community- and hospital-based study on incidence of snakebites will be conducted in Moyen-Ogooué in the Northwest of Gabon to determine the extent of this largely invisible health problem. Furthermore, the study aims to investigate the health seeking behaviour of snakebite victims and to collect data on available treatments and knowledge about management of snakebite envenoming among health care workers.

5. Project in Malawi