Abstract
BackgroundSnakebite envenoming kills more than more than 20,000 people in Sub-Saharan Africa every year. Poorly regulated markets have been inundated with low-price, low-quality antivenoms. This review aimed to systematically collect and analyse the clinical data on all antivenom products now available in markets of sub-Saharan Africa.Methodology/Principal findingsOur market analysis identified 12 polyspecific and 4 monospecific antivenom products in African markets. Our search strategy was first based on a systematic search of publication databases, followed by manual searches and discussions with experts. All types of data, including programmatic data, were eligible. All types of publications were eligible, including grey literature. Cohorts of less than 10 patients were excluded. 26 publications met the inclusion criteria. Many publications had to be excluded because clinical outcomes were not clearly linked to a specific product. Our narrative summaries present product-specific clinical data in terms of safety and effectiveness against the different species and envenoming syndromes. Three products (EchiTabPlus, EchiTabG, SAIMR-Echis-monovalent) were found to have been tested in robust clinical studies and found effective against envenoming caused by the West African carpet viper (Echis ocellatus). Four products (Inoserp-Panafricain, Fav-Afrique, SAIMR-Polyvalent, Antivipmyn-Africa) were found to have been evaluated only in observational single-arm studies, with varying results. For nine other products, there are either no data in the public domain, or only negative data suggesting a lack of effectiveness.Conclusions/SignificanceClinical data vary among the different antivenom products currently in African markets. Some products are available commercially although they have been found to lack effectiveness. The World Health Organization should strengthen its capacity to assess antivenom products, support antivenom manufacturers, and assist African countries and international aid organizations in selecting appropriate quality antivenoms.
Highlights
More than 100,000 people die from snakebite envenoming every year, associating this neglected tropical medical condition with one of the highest burdens of mortality of all neglected tropical diseases (NTDs)
While six different clinical syndromes are described by the World Health Organization (WHO) [2], field organisations in sub-Saharan Africa, such as Medecins Sans Frontières / Doctors without Borders (MSF), distinguish three major syndromes requiring antivenom therapy: neurotoxic, haematotoxic and cytotoxic
A minority of the antivenoms included in this review were supported by robust clinical data prior to their registration and commercialization in African countries
Summary
More than 100,000 people die from snakebite envenoming every year, associating this neglected tropical medical condition with one of the highest burdens of mortality of all neglected tropical diseases (NTDs). In sub-Saharan Africa alone, snakebites are estimated to cause between 435,000 and 580,000 envenomings, and between 20,000 and 32,000 deaths every year [1]. While six different clinical syndromes are described by the World Health Organization (WHO) [2], field organisations in sub-Saharan Africa, such as Medecins Sans Frontières / Doctors without Borders (MSF), distinguish three major syndromes requiring antivenom therapy: neurotoxic, haematotoxic and cytotoxic (see Table 1). Snakebite envenoming kills more than more than 20,000 people in Sub-Saharan Africa every year.
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