India, on average, witnesses over 90 deaths a month (or about three a day) due to snake bites, going by conservative estimates. However, despite the efforts by authorities to treat snake bites, factors like cost and storage of antivenom prove to be a challenge. Now, a team of researchers from India and the United States of America has developed a new antivenom that addresses these factors.
Additionally, this new antivenom can be used against bites of several species, unlike the present antivenoms that can be used properly only in cases of bites of species like Russell’s viper, saw-scaled viper, Indian cobra and common krait.
“The present antivenom solutions are made by injecting horses with snake venom and using their blood serum. But the problem with this approach is that the serum is not very stable and also it is specific to the snake venom used,” Professor Anurag S Rathore of the department of chemical engineering of the Indian Institute of Technology, Delhi told Mongabay-India. “In contrast, once developed we hope that our peptide can be used for several kinds of snake bites compared to the present ones including Russell’s viper, saw-scaled viper, Indian cobra and common krait.”
The Lethal Toxin Neutralising Factor-based treatment, currently under testing, has been developed by a team of researchers from IIT Delhi (India), which was led by Rathore and from the San Jose State University in the United States of America.
It took around two years to develop, which Rathore said “is not that long in the business of making medicine”. The work was carried out on a budget of less than Rs 7 million (Rs 70 lakh) and could have the potential to substitute currently available antivenoms. The new antivenom is expected to cost around Rs. 100 per dose, which is considerably less than the current cost of a vial.
Of more than 2,000 species of snakes in the world, around 300 species are found in India and of those, 52 are considered venomous. As per India’s Ministry of Health and Family Welfare , snakebite is a preventable public health hazard often faced by rural populations in tropical and subtropical countries with heavy rainfall and humid climate.
For instance, as per government data, kraits are active during night hours, often biting a person sleeping on a floor bed, while maximum viper and cobra bites occur during the day or early darkness, when people are watering their plantation or walking barefoot in grown grass or soybean crops.
Varying data on snake bites and deaths in India
According to the World Health Organisation , about 5.4 million snake bites occur each year globally, resulting in 1.8 to 2.7 million cases of envenomings (a life-threatening disease due to the bite of a venomous snake). It is estimated these result in the deaths of 81,000–138,000 people a year and leaves another 400,000 with permanent disabilities.
In India alone, as per WHO, it is estimated that every year about 2.8 million people are bitten by snakes and 46,900 people die from snakebite which means about 50% of the global bite cases and deaths are from India.
However, there is a vast difference between estimates of cases of snakebites and deaths from various sources.
In the draft standard treatment guidelines prepared for the management of snakebite by the Ministry of Health and Family Welfare, it is noted that “there is a huge gap between the number of snakebite deaths reported from the direct survey and official data”. It notes that there are about 1,300-50,000 annual deaths from snakebites in India.
In March 2016, India’s Minister of Health and Family Welfare JP Nadda told Parliament that there were 3,252 deaths in three years (2013-2015) across India due to snake bites. Of those, 483 deaths were reported from West Bengal alone.
There is no consensus on the number of cases of snake bites either. In another document, the Ministry of Health and Family Welfare notes that the estimated snakebite cases per year are 250,000. But, in a reply to Parliament in March 2015, Nadda had revealed that there were 126,431 and 132,615 cases of snake bite in 2013 and 2014 respectively.
According to WHO, most victims of snake bites are poor rural dwellers and many are women and children, who are prone to suffer more severe effects due to their smaller body mass. Bites by venomous snakes can cause acute medical emergencies like severe paralysis, bleeding disorders that can lead to fatal haemorrhage, irreversible kidney failure, and severe local tissue destruction which can cause permanent disability and amputation.
New anti venom addresses cost and storage challenges
Snakebite was included in the list of neglected tropical diseases by WHO in 2009. Recently, in May in Geneva, the 71st World Health Assembly adopted a resolution formally providing the WHO with a strong mandate to “develop a comprehensive plan to support countries in implementing measures for increased access to effective treatment to people who get bitten by venomous snakes”.
The WHO has also set up a working group to prepare a strategic plan to assess and address the global burden of snakebite envenoming, especially in mid- to low-income countries. The plan, being developed by the 28-member working group of experts, is expected by the end of 2018.
According to WHO, the effective treatment of snakebite envenoming is currently unavailable in many countries and wherever treatment is available its cost can be prohibitive.
Rathore, while explaining the main advantages of the new antivenom, said that two factors that will work in its favour is easy storage and cost.
“It is in the testing phase right now and if it works then it will change the way snakebites are treated in the country. There are two main problems with the existing solutions. Stability is one of them and that’s a huge issue because almost all the incidents are going to happen in rural areas, smaller cities or jungles. When a person is bitten in such areas it takes many hours to reach a medical centre or hospital and by then a lot of damage is already done,” he said.
“But our peptide-based antivenom, on the other hand, is a lot more stable and it can be simply in the form of a powder. So it can be kept at home and once needed one can just break the vial, dissolve it and inject it. This way everyone in villages can keep it with them,” Rathore added.
The IIT professor emphasised that cost is another major factor because of which antivenom is not something a poor man can buy and keep in advance.
“A dose for treating snakebite right now costs several thousand rupees but our antivenom will cost less than Rs 100 per dose. So once it is commercially developed people in such areas can purchase and keep it with them,” he said.
Rathore said that they are in the middle of testing it on rats at present and is hoping that within a month or two all rat tests will be done.
“If results are good we can go to the next step. We are also talking to collaborate with companies who are in this business for further commercialisation. It will be a year or at most two before it hits the market,” he informed.
This article has first appeared on Mongabay.