Overview - our focus in research

Snakebite envenoming is one of the most neglected diseases, particularly in low- and middle-income countries with tropical climate and a rich snake fauna, such as Lao PDR, Vietnam and Ghana. Worldwide snakebite envenoming affects as many as 2.7 million people every year with an annual mortality of 81,000 to 138,000. Many surviving victims suffer permanent disability which significantly affects their working ability.

In June 2017 the World Health Organization added snakebite envenoming to their list of neglected tropical diseases and in May 2018 the World Health Assembly (WHA) adopted a resolution, which urges member states (i) to assess the burden of snakebites, (ii) promote community awareness of snakebite envenoming in support of early treatment and prevention, (iii) to provide training to relevant health workers on diagnosis and management of snakebite envenoming, (iv) improve the availability, accessibility and affordability of antivenoms to population at risk, and (v) intensify and support research on snakebite envenoming. These interventions are supposed to reduce snakebite mortality and disability by 50% until 2030.

The main objectives of the research group snakebite envenoming are studies on epidemiology of snakebites and venomous snakes in different geographic regions in the target countries, clinical studies, availability of appropriate and effective antivenom, training of healthcare personnel in management of snakebites, and development of national guidelines.

1. Project Laos

Objectives:

  • Epidemiology of snakebites and venomous snakes in different geographic regions.  
  • Training of health personnel in management of snakebite envenoming.
  • Development of national guidelines in management of snakebite envenoming.
  • Registration of Thai snake antivenom products at the Lao Ministry of Health.
  • Import regulation and distribution of snake antivenom to provincial and district hospitals.
  • Implementation of a consultation service for snakebite envenoming.
     

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. In contrary hospital statistics showed that less than 2% of snakebite victims seek medical care in districts or provincal hospitals. After training of medical personnel in 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. It clearly shows, that the availability of effective, safe and affordable antivenom together with training of medical personnel and development of treatment guidelines are the game changer to increase hospital admissions and achieve effective and successful treatment of snakebite envenoming.

Future work will focus on epidemiology of snakebites and the responsible venomous snakes in the northern part of Laos, development and recognition of guidelines for management of snakebite envenoming and studies on long-term disabilities after snakebite. Furthermore, we work towards ensuring a sustainable supply of antivenom in provincial and at least certain district hospitals in Lao PDR.

 

2. Project Vietnam

Objectives

  • Epidemiology of snakebites and venomous snakes in different geographic regions.
  • Training of health personnel in management of snakebite envenoming.
  • Development of national guidelines in management of snakebite envenoming.
  • Support to extend antivenom production in Vietnam
     

Epidemiological surveys in Thua Thien Hue province and Can Tho Municipality show 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. Antivenom against Trimeresurus albolabris and Naja kaouthia is produced at 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 often not available. Preliminary assessment of knowledge about management of snakebites at four provincial hospitals revealed that there is a need for training and development of national treatment guidelines in order to ensure state of the art treatment of snakebite envenoming.

 

3. Project 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 showed 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 antivenom used is important. There are different snake antivenom products used in Ghana, such as Afriven 10 from VINS Bioproduct limited, PANAF Premium, from Premium Serums and Vaccines limited and BEAFRIQUE-10 from Biological E. Limited. Most of them are imported from India. They are supposed to neutralize the venom of up to 14 snakes. Some of these snakes are even not found in Ghana or are rarely responsible for envenoming. Evidence is poor that a reasonable dose of these antivenom products is effective against the medically important snakes in Ghana, particularly against venom of Echis ocellatus, which is most likely responsible for the majority of cases in Northern Ghana.

 

4. Project 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 performed in Moyen-Ogooué in the Northwest of Gabon to determine the extent of this largely invisible health problem. Furthermore, the study aims to investigate health seeking behavior of snakebite victims and to collect data on available treatments and knowledge about management of snakebite envenoming among health care workers.