Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study

Suraweera, Wilson; Warrell, David A.; Whitaker, Romulus; Menon, Geetha R; Rodrigues, Rashmi; Fu, Sze Hang; Begum, Rehana; Sati, Prabha; Piyasena, Kapila; Bhatia, Mehak; Brown, Patrick; Jha, Prabhat

doi:10.7554/elife.54076

Cited by 162 publications

(172 citation statements)

References 75 publications

(87 reference statements)

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“…This use, as we have indicated earlier, is known in traditional Indian medicine and in modern research in this country. Based on the shocking, annual number of snakebite cases in this country, and even the more astonishing annual number of fatalities, 58000 in average, 401 it is very understandable why the use of this plant to treat snakebites is very common in India.…”

Section: Discussionmentioning

confidence: 99%

Amaranthaceae plants of Israel and Palestine: Medicinal activities and unique compounds

Azab¹

2020

ECB

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Section: Discussionmentioning

confidence: 99%

Amaranthaceae plants of Israel and Palestine: Medicinal activities and unique compounds

Azab¹

2020

ECB

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“…Snake-bite envenoming (SBE) was re-categorized as a priority neglected tropical disease by the World Health Organization (WHO) in 2017 [1,2]. Worldwide, there are as many as 2.7 million people affected by SBE resulting in an estimated 81,000 to 138,000 deaths per year [3][4][5], the burden of which disproportionately affects the poorest communities [5][6][7]. Antivenom is considered to be one of the most cost effective health interventions [8].…”

Section: Introductionmentioning

confidence: 99%

A Bayesian phase 2 model based adaptive design to optimise antivenom dosing: Application to a dose-finding trial for a novel Russell’s viper antivenom in Myanmar

et al. 2020

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For most antivenoms there is little information from clinical studies to infer the relationship between dose and efficacy or dose and toxicity. Antivenom dose-finding studies usually recruit too few patients (e.g. fewer than 20) relative to clinically significant event rates (e.g. 5%). Model based adaptive dose-finding studies make efficient use of accrued patient data by using information across dosing levels, and converge rapidly to the contextually defined ‘optimal dose’. Adequate sample sizes for adaptive dose-finding trials can be determined by simulation. We propose a model based, Bayesian phase 2 type, adaptive clinical trial design for the characterisation of optimal initial antivenom doses in contexts where both efficacy and toxicity are measured as binary endpoints. This design is illustrated in the context of dose-finding for Daboia siamensis (Eastern Russell’s viper) envenoming in Myanmar. The design formalises the optimal initial dose of antivenom as the dose closest to that giving a pre-specified desired efficacy, but resulting in less than a pre-specified maximum toxicity. For Daboia siamensis envenoming, efficacy is defined as the restoration of blood coagulability within six hours, and toxicity is defined as anaphylaxis. Comprehensive simulation studies compared the expected behaviour of the model based design to a simpler rule based design (a modified ‘3+3’ design). The model based design can identify an optimal dose after fewer patients relative to the rule based design. Open source code for the simulations is made available in order to determine adequate sample sizes for future adaptive snakebite trials. Antivenom dose-finding trials would benefit from using standard model based adaptive designs. Dose-finding trials where rare events (e.g. 5% occurrence) are of clinical importance necessitate larger sample sizes than current practice. We will apply the model based design to determine a safe and efficacious dose for a novel lyophilised antivenom to treat Daboia siamensis envenoming in Myanmar.

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“…Snakebite has been included in the neglected tropical disease category by the World Health Organization (WHO) in 2017 because of the associated mortality and morbidity cases [1]. A nation-wide mortality survey estimated that approximately 1.2 million snakebite deaths occurred from 2000 to 2019 accounting for 58,000 deaths/year in India [2]. The only treatment option available against envenomation is to administer the desired amount of antivenoms at the right time.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Immunological cross-reactivity of Indian polyvalent antivenoms towards the venom of Hypnale hypnale (hump-nosed pit viper) from the Western Ghats

Vanuopadath¹,

Dileepkumar

Nair³

et al. 2020

Preprint

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Hypnale hypnale (hump-nosed pit viper) is a venomous pit viper species found in the Western Ghats of India and Sri Lanka. Due to the severe life-threatening envenomation effects induced by its venom components, Hypnale hypnale has been classified under ″category 1″ of medically important snake species by the World Health Organization. Since there are no specific antivenoms available to combat its envenomation in India, the only option available is to administer Indian polyvalent antivenoms. However, the cross-neutralization potential of the commercially available polyvalent antivenoms on Indian Hypnale hypnale venom has not been explored so far. In the current study, in vitro immunological cross-reactivity of Hypnale hypnale venom towards various Indian polyvalent antivenoms were assessed using end point titration ELISA and Western blotting. A three to four-fold increase in EC50 values were obtained for Hypnale hypnale venom towards all the antivenoms tested. Observation of minimal binding specificities towards low and high molecular mass venom proteins are suggestive of the fact that commercially available polyvalent antivenoms failed to detect and bind to the antigenic epitopes of considerable number of proteins present in Hypnale hypnale venom. This highlights the importance of including Hypnale hypnale venom in the immunization mixture while raising antivenoms.

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Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study

Cited by 162 publications

References 75 publications

Amaranthaceae plants of Israel and Palestine: Medicinal activities and unique compounds

Amaranthaceae plants of Israel and Palestine: Medicinal activities and unique compounds

A Bayesian phase 2 model based adaptive design to optimise antivenom dosing: Application to a dose-finding trial for a novel Russell’s viper antivenom in Myanmar

Evaluating the Immunological cross-reactivity of Indian polyvalent antivenoms towards the venom of Hypnale hypnale (hump-nosed pit viper) from the Western Ghats

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