1. Project in Lao PDR

Cooperation partners

University of Health Science and Setthatirath Hospital, Vientiane, Lao PDR

Objectives

  • Epidemiology of snakebites and venomous snakes in different geographic regions.
  • Training of health personnel in management of snakebite envenoming.
  • Development of national guidelines for management of snakebite envenoming.
  • Support national regulatory authorities for registration and importation of appropriate and effective snake antivenom.
  • Support the distribution of snake antivenom to provincial and district hospitals.
  • Implementation of a consultation service for doctors in provincial and district hospitals in Lao PDR.

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

Cooperation partner

Institute for Community Health Research (ICHR), Hue University of Medicine and Pharmacy, Hue, Vietnam

Objectives

  • Epidemiology of snakebites and venomous snakes in different geographic regions.
  • Training of health personnel in management of snakebite envenoming.
  • Support an update of national guidelines in management of snakebite envenoming.
  • Assessment of availability and need of antivenom in different geographic regions of Vietnam.

Epidemiological surveys in Thua Thien Hue province and Can Tho Municipality indicated an incidence of 58 and 48 snakebites per 100,000 inhabitants per year, respectively. 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). This confirms again that snakebite envenoming and poverty are closely linked. Green pit vipers and Cobras (Naja species) were responsible for the majority of snakebites in both regions.

Preliminary assessment of knowledge about management of snakebites at four provincial hospitals, in Thua Thien Hue, in Central Vietnam, Can Tho, in the Mekong Delta and Dak Lak and Gia Lai Provinces in the Central Highlands revealed that there is a need for training. Treatment guidelines were developed in 2015 by the Ministry of Health in Hanoi to ensure state-of-the-art treatment of snakebite envenoming and need to be updated.

Antivenom supply for Vietnam from a local producer is limited and only two liquid formulations, one monovalent Antivenom against Trimeresurus albolabris (white-lipped pit viper) and one against Naja kaouthia (monocled cobra) are available from the Institute of Vaccines and Biologicals (IVAC) in Nha Trang. Antivenom against Calloselasma rhodostoma (Malayan pit viper), a species found in the Southeast of Vietnam, against Bungarus candidus (Malayan krait) in the South and Bungarus multicinctus (many-banded krait) in the North of Vietnam has to be imported and is mostly not available. However, IVAC has started production of monovalent antivenom against Malayan pit viper (Calloselasma rhodostoma) and many-banded krait (Bungarus multicinctus), but it will take time until the product is officially registered and ready to use.

3. Project in Ghana

Cooperation partners

Kumasi Center for Collaborative Research (KCCR), Kumasi, Ghana

Upper West Regional Hospital (UWRH), Wa, Ghana

Objectives

  • Observational study of snakebite patients admitted to Wa Regional and City Hospital, Upper West Region, Ghana.
  • Training of health personnel in management of snakebite envenoming.

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

Cooperation partner

Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon

Objectives

  • Epidemiology and burden of snakebites in Moyen Ogooué, Gabon.
  • Assessment of antivenom need in the region.

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

Cooperation partner

Neno District Hospital, Malawi

Objectives

  • Observational study of snakebite patients admitted to Neno District Hospital.
  • Training of health personnel in management of snakebite envenoming.

Even though Malawi is home to 66 different snake species, of which 11 are considered medically important and snakebite envenoming has been acknowledged by the Ministry of Health in its Neglected Tropical Diseases Master Plan development (2021-2025), there have been no documented studies on the incidence of snakebites or the clinical course of snakebite envenoming in Malawi yet. The first study is currently in review, and found that most health care workers are not confident in treating snakebite patients, do not know the WHO guidelines on snakebite management and have little experience in using antivenom. Therefore, one of the main objectives is to improve the management of snakebite envenoming. Similar to the project in Ghana, we are planning a clinical observational study to follow up patients with snakebite envenoming admitted to Neno District Hospital 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.