Current challenges for confronting the public health problem of snakebite envenoming in Central America

Abstract

Snakebite envenoming is a serious public health problem in Central America, where approximately 5,500 cases occur every year. Panama has the highest incidence and El Salvador the lowest. The majority, and most severe, cases are inflicted by the pit viper Bothrops asper (family Viperidae), locally known as ‘terciopelo’, ‘barba amarilla’ or ‘equis’. About 1% of the bites are caused by coral snakes of the genus Micrurus (family Elapidae). Despite significant and successful efforts in Central America regarding snakebite envenomings in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, and prevention of snakebites, much remains to be done in order to further reduce the impact of this medical condition. This essay presents seven challenges for improving the confrontation of snakebite envenoming in Central America. Overcoming these challenges demands a coordinated partnership of highly diverse stakeholders though inter-sectorial and inter-programmatic interventions.

Snakebite Epidemiology in Bangladesh—A National Community Based Health and Injury Survey

“…As a result, about 82 different species including 12 species of sea snakes are grossly available all over Bangladesh, of them 28 species are venomous [14]. Countries like Bangladesh and India conduct community based household surveys to identify its magnitude, which is far greater than the hospital based studies [15] [16]. A study conducted in 1999 estimated the incidence of 4.3 snake bites per 100,000 populations per year in Bangladesh, with approximately 2000 deaths [17].…”

Case Report: Hemothorax in Envenomation by the Viperid Snake Bothrops asper

“…In Central and other parts of Latin America, as well as in Asia and Africa, an unknown number of snakebite victims are never treated in medical facilities (being instead managed with traditional medicine) or die without examination and/or official reporting. 5 Envenomations by B. asper in Central America can be severe, with local and systemic manifestations, including tissue necrosis, edema, blistering, coagulopathies, systemic hemorrhage leading to hemodynamic disturbances, and acute kidney injury. 6 The identification of the snake responsible for the bite is often difficult, and a syndromic approach is instead used for diagnosis and management in Central America, whereby patients presenting the described local and systemic manifestations are treated with polyvalent antivenom, which is effective against the venoms of viperid snakes in the region.…”

Biological and molecular properties of yellow venom of the Amazonian coral snake Micrurus surinamensis

“…Additional basic and clinical studies are needed to generate a monovalent serum or venom that includes these species in the pool used to produce commercial antivenom. Snake bites remain a serious public health problem that have generally been neglected by the authorities and the general population 73 . Thus, there are many outstanding challenges and issues that must be addressed to promote snake bite prevention and to develop effective treatments for envenomation.…”