Snake-bite envenoming: a priority neglected tropical disease

Abstract

Last month, WHO reinstated snake-bite envenoming to its list of category A neglected tropical diseases (NTDs), which is an important milestone in disease control. NTD inclusion adds impetus to antivenom development and boosts the likelihood of investor funding for snake-bite prevention and treatment access initiatives. Every year, more than 95 000 people die from snake bite, and a further 300 000 survive but with permanent disability or disfigurement. An estimated 1·8–2·7 million people a year develop serious clinical illness (envenoming) after snake bite. Most victims of snake bite live in the world's poorest communities, with agricultural workers, children, and rural dwellers most at risk. About half of documented deaths from snake bite are in India but data from sub-Saharan Africa are fragmentary, and the burden of disease and the poverty it causes is likely to be underestimated. In Africa, a young farmer bitten by a puff adder might suffer terrible disfigurement rendering him fit only to beg, or the stigmatisation of scars from a spitting cobra bite might lead to a girl being unmarriageable. WHO added snake bite to the list of NTDs in 2009, but it was later removed without explanation. The Bill & Melinda Gates Foundation has so far rejected approaches for funding because snake bite is not infectious and therefore cannot be eradicated by vaccination. Yet snake bite is eminently preventable and treatable through community education to reduce occupational and environmental risk, access to good-quality specific antivenoms, and by training nurses, health workers, dispensers, and doctors. Since WHO's announcement, action has already been taken by the Ministry of Health in Kenya to develop local guidelines on snake-bite management and to engage local and international donor health agencies. Acknowledging the problem in the regions affected is an important start. Momentum is building with the support of the Kofi Annan Foundation, and snake bite is on the World Health Assembly's agenda for the first time next year. Now, surely, the plight of snake-bite victims will be more difficult for the major global health funders to ignore.