Call for region-specific antivenoms to save snakebite victims

The Hindu

19 hours ago

Herpetologists and health experts have called for region-specific antivenoms to increase the chances of saving lives in areas where the 'Big Four' snakes are not dominant.
Snakebite victims in India are administered a polyvalent antivenom derived from the venom of four serpents that cause the majority of deaths. These four are the Indian cobra (Naja naja), common krait (Bungarus caeruleus), Russell's viper (Daboia russelii), and saw-scaled viper (Echis carinatus).
However, the polyvalent serum developed against these four snakes has limited or no efficacy in most parts of Northeastern India, where snakebite deaths are more commonly caused by the monocled cobra (Naja kaouthia), kraits (Bungarus sp.), green pit vipers (Trimeresurus sp.), and other medically significant snakes.
'There is an urgent need to establish a Regional Venom Centre and a serpentarium (a place where snakes are housed for exhibition or research) at a strategic place in the northeast to address the region's unique snakebite challenges and improve patient outcomes,' herpetologist Jayaditya Purkayastha said.
He heads Help Earth, a Guwahati-based biodiversity conservation organisation, which partnered the Assam State Biodiversity Board, Assam Forest Department, and the Madras Crocodile Bank Trust (MCBT) to organise the first-ever Assam Snake Symposium a fortnight ago. The event brought together more than 80 snake rescuers from across Assam, alongside national and international experts, researchers, educators, and policymakers.
'Without region-specific antivenom, many envenomation cases result in delayed recovery, long-term complications, or even fatalities, despite the administration of standard treatment. A regional venom centre would serve as a hub for the systematic collection of venom from the medically important species native to the northeast, enabling the development of geographically appropriate antivenom,' Dr Purkayastha said.
'Such a centre, coupled with a serpentarium, can help maintain, milk, and study live specimens ethically. This facility would also support research on venom variability, toxin composition, and clinical manifestations specific to local snake species,' he said.
High-burden States
A 2020 study on trends in snakebite deaths in India from 2000 to 2019, published in eLife, said the World Health Organisation's call to halve global snakebite deaths by 2030 would require substantial progress in India. It also cited the WHO's estimation that 81,000-138,000 people die annually from snakebites worldwide, and thrice the number survive with amputations and permanent disabilities.
The researchers of the study, including Romulus Whitaker, Wilson Suraweera, Geetha Menon, and Prabhat Jha, analysed 2,833 snakebite deaths from 611,483 verbal autopsies in the nationally representative Indian Million Death Study from 2001 to 2014, and conducted a systematic literature review from 2000 to 2019 covering 87,590 snakebites.
The team estimated 1.2 million snakebite deaths (average 58,000 per year) across India from 2000 to 2019, nearly half of them occurring at ages 30-69 years and over a quarter in children under 15 years. Most of these deaths occurred at home in rural areas.
The study found that about 70% occurred in eight higher-burden States with 55% of India's population, and half during the rainy season and at low altitude. These States are Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh (before the creation of Telangana), Rajasthan, and Gujarat.
'The risk of an Indian dying from snakebite before age 70 is about 1 in 250, but notably higher in some areas. More crudely, we estimate 1.11-1.77 million bites in 2015, of which 70% showed symptoms of envenomation,' the study said, noting that prevention and treatment strategies might substantially reduce snakebite mortality in India.
Overlooked health issue
According to the National Crime Records Bureau's report on accidental deaths in 2022, deaths due to 'snakebite' dropped by 3.6% from 10,450 in 2021 to 10,085 the following year. Deaths due to 'killed by animals' and 'animal/reptiles/insects bite' increased by 16.5% and 16.7% during this period, respectively. Despite the 'encouraging' trend in snakebite deaths, reptile specialists pointed out that snakebite envenoming remains a major but often overlooked public health issue in India, which accounts for nearly half of the global snakebite deaths each year.
'India is the world's most affected nation in terms of mortality. The burden is particularly high in rural and agrarian communities, where people frequently work barefoot in fields and lack access to timely medical care,' MCBT's Gnaneswar Ch. said.
He said that the snakebite crisis is worsened by several challenges, with many cases going unreported due to reliance on traditional healers, lack of transportation, and limited awareness.
'Delays in reaching health facilities, along with improper first-aid practices, often lead to severe complications or death. Furthermore, there is a shortage of trained personnel and adequate supplies of antivenom in remote areas. The quality and regional suitability of antivenom is another concern, as it may not be effective against locally prevalent snake species outside the Big Four,' he said.
In response to this public health emergency, India launched the National Action Plan for Prevention and Control of Snakebite Envenoming in 2024, aligning with the WHO's 2030 target to halve snakebite deaths.
The experts agreed that despite such efforts, major gaps remain in public awareness, community preparedness, and healthcare infrastructure. They sought greater emphasis on region-specific research, education campaigns at the village level, and strengthening rural healthcare systems to ensure early and appropriate treatment.
Snakebite mitigation
Acknowledging the challenges in saving lives in a region where the polyvalent serum is less effective, Assam's forest minister, Chandra Mohan Patowary said a State-Level Steering Committee on Snakebite Mitigation would be formed.
He proposed the establishment of a serpentarium in Assam to facilitate advanced research on snake venom and address the region-specific challenges of envenomation and treatment.
Subsequently, the Assam State Biodiversity Board signed a memorandum of understanding with Help Earth to work jointly on snakebite awareness and mitigation programmes at the Biodiversity Management Committee level.
The experts favoured a State Snakebite Mitigation Action Plan toward setting up a Regional Venom Centre and facilitating collaborations with institutions across India for venomics research and antivenom standardisation.
They also suggested an app or digital platform for the timely and ethical handling of snake-human encounters, increasing due to habitat encroachment, urbanisation, and seasonal flooding. Such an app is envisaged to serve as a life-saving tool for both humans and snakes by reducing panic and delays during snake sightings or bite incidents.
'Beyond rescue logistics, the app can act as a centralised repository of real-time data on snake rescue, release locations, species involved, and conflict zones. This valuable information can be used to identify hotspots, monitor trends, and guide policy-level decisions for snake conservation, land-use planning, and public health interventions,' Dr Purkayastha said.
'Moreover, this digital platform can be integrated with hospitals, forest departments, and wildlife boards to streamline responses, improve awareness, and encourage coexistence,' he said.
'Snakebite deaths in India are largely preventable, and with coordinated action across health, forest, and community sectors, the country can move closer to eliminating avoidable snakebite fatalities,' Assam's chief wildlife warden, Vinay Gupta, said.