Abstract
Millions of people are bitten by venomous snakes annually, causing high mortality and disability, but the true burden of this neglected health issue remains unknown. Since 2015, Médecins Sans Frontières has been treating snakebite patients in a field hospital in north-west Ethiopia. Due to the poor market situation for effective and safe antivenoms for Sub-Saharan Africa, preferred antivenom was not always available, forcing changes in choice of antivenom used. This study describes treatment outcomes and the effectiveness and safety of different antivenoms used. This retrospective observational study included 781 snakebite patients presenting at the field hospital between 2015 and 2019. Adjusted odds ratios, 95%-CI and p-values were used to compare the treatment outcome of patients treated with Fav-Afrique (n = 149), VacSera (n = 164), and EchiTAb-PLUS-ICP (n = 156) antivenom, and to identify the risk of adverse reactions for each antivenom. Whereas only incidental snakebite cases presented before 2015, after treatment was made available, cases rapidly increased to 1,431 in 2019. Envenomation was mainly attributed to North East African saw-scaled viper (Echis pyramidum) and puff adder (Bitis arietans). Patients treated with VacSera antivenom showed lower chance of uncomplicated treatment outcome (74.4%) compared to Fav-Afrique (93.2%) and EchiTAb-PLUS-ICP (90.4%). VacSera and EchiTAb-PLUS-ICP were associated with 16- and 6-fold adjusted odds of treatment reaction compared to Fav-Afrique, respectively, and VacSera was weakly associated with higher odds of death. Snakebite frequency is grossly underreported unless treatment options are available. Although EchiTAb-PLUS-ICP showed favorable outcomes in this retrospective analysis, prospective randomized trials are needed to evaluate the effectiveness and safety of the most promising antivenoms for Sub-Saharan Africa. Structural investment in sustained production and supply of antivenom is urgently needed.
Highlights
This study explores the effectiveness of three different antivenoms, Fav-Afrique, VacSera and EchiTAb-PLUSICP, and provides insights in factors that might influence the outcome of the snakebite treatment
This research fulfills the exemption criteria set by the Medecins Sans Frontières Ethics Review Board (MSF ERB) for a posteriori analysis of routinely collected clinical data and does not require MSF ERB review
The frequency of reported snakebites in the Abdurafi field hospital from 2015 to 2019 shows a seasonal pattern (Fig 1), peaking between June and November, which coincides with the agricultural season and presence of migrant workers
Summary
Around 5.5 million people worldwide are bitten by snakes, causing approximately 100,000 deaths and leaving 400,000 people disabled [1,2]. Antivenoms are the only effective treatment against envenomation when someone is bitten by a venomous snake [4] They can prevent or reverse most toxic effects that occur during snakebite envenoming and they play a significant role in limiting the morbidity and mortality. At this moment antivenoms are mainly equine immunoglobulins, which are snakespecific and can cause serious adverse events; when an unsuitable product is used which has not been developed to neutralize venoms of relevant endemic snake species, it is ineffective [13,14]. Millions of people are bitten by venomous snakes annually, causing high mortality and disability, but the true burden of this neglected health issue remains unknown. This study describes treatment outcomes and the effectiveness and safety of different antivenoms used
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