Epidemiological profile and management of snakebite cases – A cross sectional study from Himachal Pradesh, India

Abstract

Background/objectivesSnakebite envenomings are an important but neglected public health problem. Our objectives were to describe the clinico-epidemiological profile and management practices of snakebite cases in Himachal Pradesh, India. MethodsWe did a cross-sectional analysis of data extracted from the records of snakebite cases (2008–2012) in Zonal Hospital, Solan, Himachal Pradesh. We estimated time trends, age/sex distribution of cases, and distribution of bites by colour of snake. We categorised the clinical manifestations into syndromes. Cases with locally toxic, haemotoxic or neurotoxic manifestations were classified as poisonous bites. Amongst the poisonous cases, we analysed trends in use of vials of antisnake venom (ASV) and its clinical outcomes and financial implications. ResultsOf the total 497 snakebites reported during 5 years, cases increased from 77/55,784 (0.14%) total hospital admissions in 2008 to 110/68,770 (0.16%) in 2012, 73% occurred in rainy season (July–September), and 266 (54%) amongst females. Colour of snake was recorded in 159 (32%) of which 122 (77%) were green. In all, 171 (34%) were poisonous out of which 96 (56%) were haemotoxic. Cases of poisonous bites decreased from 42 (2008) to 17 (2012). Out of 25 referred envenomings, 2 (8%) were given ASV at peripheral institutes. Use of ASV vials decreased from 747 (2008) to 71 (2012), with a corresponding reduction of 73% in the expenditure on ASV per cured patient. Cure rate remained above 70%. Five (3%) poisonous snakebite cases died. ConclusionsEffective management of snakebites would include appropriate ASV use and production of monovalent antitoxin as per predominance of specific species of snakes.