Snake Antivenom Research Articles

A Study of Clinical Profile of Patients with Snake Bite Attending a Tertiary Care Hospital in the North Bank of the Brahmaputra

Background: Snake bite envenomation is a neglected tropical disease which needs urgent medical attention and anti-snake venom (ASV) infusion but is often overlooked and under-reported owing to the age-old tradition of local aid by quacks, poor transportation facilities, and lack of public awareness. This leads to delays in hospitalization and causes increased morbidity and mortality. WHO’s global target is to reduce the number of snake bite deaths to half by 2030 and India needs to play an important role in achieving the target. Aims and Objectives: (a) To study the clinical profile of patients, 12 years of age or above, presenting with snake bites, attending OPD and Emergency in the Department of Medicine, TMCH. (b) To study the effectiveness of ASV and adverse effects following its use. Materials and Methods: (a) Study design—hospital based cross-sectional study. (b) Duration—1st January 2020 to 30th June 2022. (c) Number of cases—221. Results: Out of 221 cases, non-venomous bites and venomous bites were 88.2% and 11.7%, respectively. Out of the venomous cases, 61.5% were hemotoxic and 38.4% were neurotoxic. A total of three patients died during our study and all of these were from neurotoxic bites. Conclusion: Snake bite is an important rural and occupational hazard. Delay in hospitalization following snake bite creates a hindrance in timely administration of ASV leading to deleterious effects which may prove fatal. In the present study neurotoxic bites proved to be more fatal in comparison to hemotoxic bites.

Clinic-epidemiological profile and acute kidney injury among pediatric snake bite cases admitted in a tertiary care center of South India

Background: Snake bite is a neglected public health problem in the tropical countries, particularly in rural areas. Snake bite is more common in children and young adults. This study intends to bring out the burden of the issue in rural children of South India. Aims and Objectives: The objectives of the study are as follows: (1) To study the epidemiological profile, the clinical profile, complications, and outcome of pediatric snake bite cases and (2) to study the incidence, predictors, and outcome of acute kidney injury (AKI). Materials and Methods: A prospective and observational study carried out for 1½ years among 0–12-year-old snake bite children. The epidemiological details, details related to snake bite event, pre hospital events, clinical and laboratory parameters on admission, outcome, complications, incidence of AKI, and their possible predictive factors among the snake bite children are analyzed. Statistical analysis was done using SPSS software (IBM, USA) version 20. Results: Male children above 5 years of age in rural areas during outdoor activities are more commonly affected during the monsoon period and during night hours. Hemotoxic snake bites are more common. Incidence of AKI following snake bite is 10%. Possible predictive factors are long bite to admission interval, tender lymph nodes, anemia, increased total count, elevated serum bilirubin on admission, and increased requirement of Anti Snake Venom. Conclusion: This study proves the burden of snake bite among rural children and their morbidity and mortality following snake bite-induced AKI. A high index of suspicion should be kept in mind based on possible predictive factors for development of AKI in snake bite children.

Reversible Brain Death

Snakebite is a serious public health problem and one of the priorities in WHO's list of neglected tropical diseases. It significantly increases morbidity and mortality associated with envenomation in India. A neurotoxic snakebite can present in the form of symptoms ranging from asymptomatic presentation, ptosis, and complete external and internal ophthalmoplegia to complete respiratory failure. This is a case report of a 22-year-old male, who presented with bilateral ptosis and impending respiratory failure. He soon became deeply comatose, with absent brain stem reflexes (mute plantar, fixed pupils, and the absence of the doll's eye reflex) which were suggestive of brain death. He was treated with polyvalent anti-snake venom, anticholinesterases, and supportive therapy and recovered completely with an excellent outcome.

Ischemic cerebrovascular event amidst coagulopathy in snake venom envenomation: A case report

This case report highlights the necessity to have in consideration about the ischemic complications post snake envenomation along with the traditional hemmorhagic events. We report a case of 28-year-old male who developed ischemic cerebral vascular accident post snake envenomation. The manifestations of snakebite may cause severe and sometimes fatal thrombotic or hemorrhagic sequelae. Some of these venom constituents and the mechanisms by which cerebral infarction have been discussed here. Physicians should also take into consideration that snake bite may cause both procoagulant and anticoagulant state. Complications can be prevented by prior identification of the snake bite and early administration of anti-snake venom.

In vitro Detoxifying Effects of Catunaregam nilotica(STAPF) Root Extracts against Naja nigricollis Phospholipase A2 (PLA2) Enzyme

Snakebite is a severe public health problem across the globe, especially in sub-Saharan Africa where most victims live in rural areas where their livelihood depends on farming and rearing animals. Catuneragamniloticahas been used in ethnomedicine to treat snakebites, and diarrhea among others. The study aims to evaluate the phospholipase A2 inhibition potential of C. niloitca using in vitro model. The plant was collected, authenticated, and sequentially extracted using solvents of increasing polarity starting from n-hexane, ethyl acetate, and methanol. The extracts were screened in vitro for their inhibitory activity against N. nigricollisvenom using PLA2 assay, and polyvalent serum-base antivenin was used as a standard. The phytochemical screening conducted using standard procedures revealed the presence of flavonoids, alkaloids, saponins, polyphenols, tannins, terpenoids, cardiac glycosides, anthraquinones, and steroids which varies in the extracts. The extracts of the plant have demonstrated significant (p<0.05) and concentration-dependent antisnake venom activity by combating the hydrolytic actions of N. nigricollisPLA2 enzyme; methanol extract was the most active with PLA2 inhibition of 83.01 to 63.01% at1.0mg/mL to 0.125mg/mL respectively while hexane extract was the least active with percentage inhibition of 45.04 to 30.00% at 1.0mg/mL to 0.125mg/mL. In conclusion, the plant C. niloticahas demonstrated good antisnake venom activity and could be studied further for development as safe and affordable antivenom by subjecting it to bioassay-guided isolation and purification of bioactive compound(s) responsible for the observed activity.

Therapeutic management of marine toad toxicities with snake bite in a German shepherd dog; a case report

Although toad intoxication and snake envenomations are two common toxicities reported in animals, the incidence of having exposed to both the toxic insults simultaneously is unusual and rarely reported. A 6 years old German shepherd dog was presented with a complaint of frothy salivation, vomiting, bloody urination along with the history of both viper snake envenomation and marine toad intoxication. Physical examination revealed ulcers on the tongue epithelium, fang marks on the left forepaw, hyperaemic oral and conjunctival mucus membrane. Clotting time was increased and ventricular tachycardia was evidenced in ECG. Alterations in haemato-biochemical parameters like haemoconcentration, leucocytosis, neutrophilia, increased hepatic and renal enzymes along with hyperkalemia were found. The oral cavity of the dog was lavaged with normal saline and then treated with polyvalent anti-snake venom along with 5% DNS, tetanus toxoid, dexamethasone, chlorpheniramine maleate and enrofloxacin parenterally. Propranolol was also administered to alleviate ventricular arrhythmia. ECG was monitored continuously which was found normal on the second day of treatment. After 7 days of treatment, the symptoms were alleviated with all the parameters within the reference range. Such type of toxicitys should be considered as critical where early recognition and appropriate therapeutic regimen will contribute to the successful recovery of the patient.

Clinical profile and outcome of AKI in snake bite in a tertiary care hospital, India

Introduction: Acute kidney injury (AKI) is one of the complications of envenomation that is frequently fatal. Aim: To evaluate the clinical profile and outcome of AKI in snake bite patients and to identify the predictors of mortality in these patients. Methods: All patients admitted with history of envenomation and AKI were included in the study. A detailed history was obtained from all the patients about the time of antisnake venom administration and time interval between the event and admission in hospital, and then hematological and biochemical investigations were performed. Results: A total of 202 patients were diagnosed with snake bite induced AKI, of which 8.6% had died. Majority of patients were males (82.7%). The dialysis requirement was significantly higher in patients who died as compared to those who survived (100% vs. 72.6%, p = 0.013). The disseminated intravascular coagulation was found to be higher in patients who died due to snake bite (p < 0.001). The median (range) length of hospitalization was shorter for the nonsurvivors than the survivors (3.0 [1.0–4.0] days vs. 8.0 [3.0–27.0] days; p < 0.001). Compared to patients who survived, the total leukocyte count and serum urea were significantly higher among patients who died due to snake bite induced AKI. Conclusion: The present study revealed that higher dialysis requirement, high complication rate, and lower duration of hospital stay were the risk factors associated with patients who died due to snake bite induced AKI.

Digital Potency Measurement: A New Approach Methodology for Antisera Effective Dose Assessments

Polyvalent antivenom potency tested for every batch and at four different stages of production is a regulatory requirement to be followed by the industry. Antivenom manufacturers have been following the gold standard test methodology for estimating median effective dose in mice for ages. Here, we report a non-animal New Approach Methodology that aligns with 3Rs in animal testing agenda, leveraging in vitro human stem cell technology for recreating microphysiological system complemented with process automation, Artificial Intelligence and Machine Learning digital workers’ effective utilization in the assay system to measure Naja naja snake antivenom potency. In vitro neutralization performed on specially configured human Microphysiological System acquired phenotype data sets at 20X magnification were analyzed against benchmark panels in the trained prediction model while the Artificial Intelligence predicted median effective dose value of venom-antivenom mixture was 3.9μL, showing a potency value of 2.04 mg recorded as the readout. This method adopted in the antivenom producer’s workflow will reduce reliance on mice-based testing and showcases potential for acceptance of robust alternative strategy to traditionally practiced protocols.

Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia.

Millions of snake bites occur worldwide each year. Clinical practice guidelines generally do not recommend the use of prophylactic antibiotics. To determine the sociodemographic, clinical, and pharmacological variables and the use of antibiotics in a group of patients with snake bites in Colombia. A retrospective cross-sectional study was carried out. Patients affiliated with a Colombian health insurer who presented with snake bites between 2015 and 2022 were included. The cases were identified from the National Public Health Surveillance System. Sociodemographic, clinical and pharmacological variables were identified. Descriptive and bivariate analyses were performed. A total of 643 patients were analyzed, with a median age of 30.8 years, and 74.7% were men. The most frequently identified genus of snake was Bothrops (88.8%), and most incidents were classified as mild ophidian accidents (61.6%). A total of 59.7% of patients received snake antivenom. A total of 13.8% and 2.2% of the patients had cellulitis or abscesses, respectively. A total of 63.5% received antibiotics (50.6% for prophylaxis and 12.9% for treatment), especially cephalexin (25.9%), and most of the antibiotic management was considered inappropriate (91.7%). Most patients with snake bites received antibiotics, especially for prophylactic purposes, a clinical behavior that goes against current evidence. The use of antibiotics with an unsuitable spectrum for the microorganisms that are usually found in the wounds of these patients is frequent. The development of local clinical practice guidelines is required to help reduce the overprescription of antibiotics, as the excessive use of antimicrobials is the main determinant of antimicrobial resistance.

Snakebites in Northeastern Brazil: accessing clinical-epidemiological profile as a strategy to deal with Neglected Tropical Diseases.

Brazil ranks first in the number of snakebites in South America. A detailed analysis of these cases is required to improve the public health planning. In this study, we retrospectively examined the clinical and epidemiological profiles of snakebites in Maranhão between January 2009 and December 2019. Data were obtained from the compulsory notification forms provided by the Health Department of Maranhão. A total of 17,658 cases were recorded during the study period. Most of the bites were from snakes belonging to the genus Bothrops. Medical care was mostly within three hours after the bite. Most cases were classified as mild and most victims recovered; however, 139 deaths were recorded. Most bites occurred among people aged 20-39 years, mainly among rural workers. The most frequent local clinical manifestations were pain, edema, and ecchymosis. The most common systemic clinical manifestations include neuroparalysis, vagal syndrome, and myolysis. Most snakebites occurred between January and March. The municipalities with the highest number of notifications were Buriticupu (936 cases), Arame (705 cases), and Grajaú (627 cases). The clinical profile of snakebites in Maranhão is similar to that observed in other states of Northeast Brazil. However, we found that some systemic manifestations are not compatible with the etiology of snakebites, which leads us to believe that the problem could be the lack of knowledge of the health professionals at the site of envenomation, who may not be ready for attendance, and an important lack of health centers with snake antivenom to treat snakebites.

Assessment of snakebite management practices at Meserani Juu in Monduli District, Northern Tanzania.

Snakebite envenoming represents a tragically neglected tropical disease mostly affecting poor people living in remote areas of developing countries, primarily in sub-Saharan Africa. Anti-snake venom (ASV) is the only approved specific treatment for systemic envenoming from snakebite, but it remains largely unavailable in many parts of developing countries. There is paucity of data on snakebite management practice in Tanzania. This study aimed at assessing the community management practices of snakebite and availability of anti-snake venom in the public health facilities in Monduli District, Northern Tanzania. A cross sectional study was carried out between May and June, 2018 involving 67 victims, 147 other household members, and 35 public health facilities. A structured questionnaire, respondent interview, and health facility report/document review were considered during data collection. Clean data were analyzed using SPSS version 20. Sixty-seven snakebite victims and 147 other household members were interviewed during a household survey. All snakebite cases reported to having visited a health facility after snakebite with the majority 55/67 (82.1%) reporting the use, prior attendance to medical care, of some form of local treatment such as tourniquets 13 (19.4%), local incision 11 (16.4%), and snakestone 7 (10.4%). None of the public health facilities in Monduli District attended a snakebite case and had never stocked anti-snake venom products. In this area, 45 snakebite cases were reported to be managed at Meserani snake park clinic where anti-snake venom products were available and provided for free in the period between January 2017 and December 2017. Majority of the snakebite cases at Meserani Juu relied on local methods for the management of snake bites of which most are of unknown efficacy and safety. Furthermore, none of the primary public health facilities in Monduli District stocked antivenom despite being a habitat for different kinds of venomous snakes. The government and local non-government organizations should collaborate so as to improve the anti-snake venom availability and the provision of snakebite preventive and management awareness programs, especially to the rural communities.

Antibodies against a single fraction of Micrurus dumerilii venom neutralize the lethal effect of whole venom

The coralsnake Micrurus dumerilii (Elapidae) is reported to cause envenomings of medical importance. Previous studies characterized the protein composition of its venom, with phospholipase A2 (PLA2) proteins the most abundant. However, it is unknown which venom components are responsible for its lethal toxicity. Fractionation of M. dumerilii venom from Colombia was carried out using RP-HPLC and each fraction was screened for lethal effect in mice at a dose of 20 μg by intraperitoneal route. Results showed that only one fraction, F9, was lethal. This fraction displayed PLA2 activity, induced indirect hemolysis in vitro, as well as edema and myotoxicity in vivo. SDS-PAGE of unreduced F9 evidenced two bands of 8 and 15 kDa, respectively, consistent with the detection of proteins with masses of 13,217.77 Da, 7144.06 Da, and 7665.55 Da. Tryptic digestion of F9 followed by nESI-MS/MS revealed peptide sequences matching proteins of the three-finger toxin (3FTx) and PLA2 families. Immunization of a rabbit with F9 proteins elicited antibody titers up to 1:10,000 by ELISA. After serum fractionation with caprylic acid, the obtained IgG was able to neutralize the lethal effect of the complete venom of M. dumerilii using a challenge of 2 ×LD50 at the IgG/venom ratio of 50:1 (w/w). In conclusion, present results show that the lethal effect of M. dumerilii venom in mice is mainly driven by one fraction which contains 3FTx and PLA2 proteins. The antibodies produced against this fraction cross-recognized other PLA2s and neutralized the lethal effect of whole M. dumerilii venom, pointing out to the potential usefulness of F9 as a relevant antigen for improving current coral snake antivenoms.

Anti-diabetic Activity of Brucine in Streptozotocin-Induced Rats: In Silico, In Vitro, and In Vivo Studies.

Diabetes mellitus (DM) is a complex and multiple group of disorders, and understanding the molecular mechanisms is a key role in identifying various markers involved in the diagnosis of the disease. Brucine is derived from the seeds of Strychnos nux-vomica L. (Loganiaceae), which has been used in traditional medicine to cure a variety of ailments, such as chronic rheumatism, nervous system diseases, dyspepsia, gonorrhea, anemia, and bronchitis, and has analgesic, anti-inflammatory, anti-oxidant, anti-snake venom, and anti-diabetic properties. The anti-diabetic potential of brucine was studied utilizing in vitro, in silico, in vivo, and molecular methods, including streptozotocin-induced diabetic rat models, α-glucosidase and α-amylase inhibitory assays, and via Auto-DocVina software. Brucine exhibits binding affinities of -5.0 to -10.1 Kcal/mol against chosen protein targets, according to an in silico investigation. In vitro studies revealed that brucine inhibited the enzymes α-amylase and α-glucosidase, and brucine (20 mg/kg) reduced blood glucose levels, oral glucose tolerance overload, body weight, glycosylated hemoglobin levels, total cholesterol, triglycerides, low-density lipoprotein, alanine transaminase, aspartate aminotransferase, total bilirubin, and alkaline phosphatase and elevated high-density lipoprotein levels in in vivo studies. The brucine binding energy against certain protein targets ranges from -5.0 to -10.1 Kcal/mol. It has anti-diabetic, anti-hyperlipidemic, hepatoprotective, anti-oxidant, and anti-inflammatory properties, which are mediated via inhibition of α-glucosidase and α-amylase.

Experience of using expired lyophilized snake antivenom during a medical emergency situation in Lao People's Democratic Republic--A possible untapped resource to tackle antivenom shortage in Southeast Asia.

To evaluate the safety and efficacy of expired lyophilized snake antivenom of Thai origin during a medical emergency in 2020/2021 in Lao People's Democratic Republic. Observational case series of patients with potentially life-threatening envenoming who consented to the administration of expired antivenom between August 2020 and May 2022. A total of 31 patients received the expired antivenom. Malayan pit vipers (Calloselasma rhodostoma) were responsible for 26 (84%) cases and green pit vipers (Trimeresurus species) for two cases (6%). In three patients (10%) the responsible snake could not be identified. Of these, two presented with signs of neurotoxicity and one with coagulopathy. A total of 124 vials of expired antivenom were administered. Fifty-nine vials had expired 2-18 months earlier, 56 vials 19-36 months and nine vials 37-60 months before. Adverse effects of variable severity were observed in seven (23%) patients. All 31 patients fully recovered from systemic envenoming. Under closely controlled conditions and monitoring the use of expired snake antivenom proved to be effective and safe. Discarding this precious medication is an unnecessary waste, and it could be a valuable resource in ameliorating the current shortage of antivenom. Emergency use authorization granted by health authorities and preclinical testing of expired antivenoms could provide the support and legal basis for such an approach.

Venom-induced consumptive coagulopathy leading to thrombotic microangiopathy following Echis carinatus sochureki bite: is snake antivenom effective?

The incidence of thrombotic microangiopathy (TMA) following snake bite is reported to be ranging from 3.6 to 15%. We report a 10-year-old boy who developed TMA and due to venom-induced consumptive coagulopathy (VICC) despite receiving adequate and timely doses of snake antivenom following a bite of saw-scaled viper (Echis carinatus sochureki). VICC was managed by plasmapheresis. Though snake bite envenomation-associated renal complications are not uncommon, possibility of TMA should be considered early during management. Our patient developed TMA with subsequent acute cortical necrosis after saw-scaled viper bite despite an adequate and timely dose of snake antivenom which emphasizes the ineffectiveness of antivenom against the venom of given snake species leading to long-term complications.

Role of noninvasive ventilation for acute respiratory failure due to snakebite

Introduction: Noninvasive ventilation (NIV) has revolutionised the management of diverse forms of respiratory failure.1 Case report: An 18 year old male patient presented to the emergency department with a history of an Indian krait snake bite on his left upper limb about seven hours ago. He had signs and symptoms of local and systemic envenomation, left upper limb cellulitis and suspected acute tubular necrosis of the kidneys. He was administered anti-snake venom and given supportive care. He was shifted to the intensive care unit where a noninvasive ventilator was used for supporting his respiratory system via a full face mask. He received NIV for thirteen days intermittently alternating with 60 percent oxygen via a Venturi mask. Progressively, he showed significant improvement and was weaned off NIV. He was discharged from hospital with no neurological sequelae. Conclusion: NIV can be used in selected patients with acute neuromuscular respiratory failure while awaiting improvement from specific therapies.

Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases.

Snakebites are a common cause of morbidity and mortality, especially in tropical countries. Snakebites in any community are managed based on the clinical features and intravenous administration of antisnake venom (ASV). The administration of ASV is either deficient or given in excess based on clinical decisions and whole blood clotting test results. The present study is designed to analyze the level of snake venom component in the blood of snakebite in association with the clinical features. Blood samples were collected from the patients admitted to Karnataka Institute of Medical (KIMS) hospital with a history of snakebite considering the inclusion criteria. Serum was collected from the blood of snakebite patients before and after ASV and used to assess the level of venom-specific phospholipase A2 (PLA2) enzyme using the enzyme-linked immunosorbent assay (ELISA) method. Quantitative ELISA results revealed that the snake venom-specific PLA2 in the victim's blood was in the range of 0.3-1.27 mg/mL before the administration of ASV. However, the concentration of PLA2 after 24 hours of ASV administration was decreased in most of the patients. Further, it was observed that envenomation complications were directly proportional to the amount of snake venom-specific PLA2 found in the blood of the snakebite patient. The study concludes that snake venom-specific PLA2 in the blood of snakebite patients could be used as a reliable venom marker, which helps in determination of appropriate ASV dosage in snakebite patients. Kaulgud RS, Hasan T, Vanti GL, Veeresh S, Uppar AP, Kurjogi MM. Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases. Indian J Crit Care Med 2022;26(12):1259-1266.

Case Study: Snakebite Envenomation in Toddler and Acute Abdomen

Abstract: The Child aged 10 year was bought to the Emergency Department of Chhatrapati Subharti Hospital with the chief complaints of no body movement which was diagnosed as the case of cardiac arrest as per the evidences suggested by recordings of vital parameters. History taken from the father revealed the toddler boy had a snake bite in middle finger of the left hand. After wards child complained of severe abdominal pain and the entire body got collapsed and they rushed to hospital as a lifesaving attempt, where CPR was initiated in hospital first which was followed by the emergency treatment in the form of administration of Anti snake venom Anti serum and after wards the child was admitted in paediatric ICU and was on the medical treatment for 10 days and on after which the boy was shifted to general ward and 15th day he got discharged.

Health care workers' knowledge on identification, management and treatment of snakebite cases in rural Malawi: A descriptive study.

Snakebite envenoming remains a public health threat in many African countries, including Malawi. However, there is a shortage of literature on the knowledge of Health Care Workers (HCWs) and the prevalence of snakebite cases in Malawi. We interviewed HCWs in Neno District to assess their knowledge of snake identification and management of snakebites. We further reviewed patient registers from 2018 to 2021 in all 15 health facilities in the district. We used descriptive statistics to characterize the survey population, knowledge, snake antivenom (SAV) administration, and snake identification. Using "shapefiles" from Open Street Maps, we mapped villages with snakebite cases. Of the 105 HCWs interviewed, 58% were males, and 60% had worked for less than five years. The majority (n = 93, 89%) reported that snakebite envenoming was a problem in the district. Among the clinicians, 42% said they had prescribed SAV previously, while among nurses, only 26% had ever administered SAV. There were discrepancies among clinicians regarding the dosing of snake antivenom. Significant gaps in knowledge also existed regarding snake identification. While two-thirds of HCWs could correctly name and identify venomous snake species, most (> 90%) failed for non-venomous snakes. Most (n = 100, 95%) reported that snakebite victims visit traditional healers more than the hospital. Between 2018 and 2021, the Neno District registered 185 snakebites with a yearly average of 36 cases per 100,000 population. Fifty-two percent (n = 97) were treated as an inpatient; of these cases, 72% were discharged in less than three days, and two died. More snakebite cases were recorded in the eastern part of the district. Significant knowledge gaps exist among HCWs in Neno regarding prescription and administration of SAV and snake identification, which likely challenges the quality of services offered to snakebite victims.

Potential economic and clinical implications of improving access to snake antivenom in five ASEAN countries: A cost-effectiveness analysis.

Despite domestic production of antivenoms in the Association of Southeast Asian Nations (ASEAN) countries, not all victims with snakebite envenomings indicated for antivenom received the appropriate or adequate effective dose of antivenom due to insufficient supply and inadequate access to antivenoms. We aimed to conduct a cost-effectiveness analysis to project the potential economic and clinical impact of improving access to antivenoms when all snakebite envenomings in ASEAN countries were hypothetically treated with geographically appropriate antivenoms. Using a decision analytic model with input parameters from published literature, local data, and expert opinion, we projected the impact of "full access" (100%) to antivenom, compared to "current access" in five most impacted ASEAN countries, including Indonesia (10%), Philippines (26%), Vietnam (37%), Lao PDR (4%), and Myanmar (64%), from a societal perspective with a lifetime time horizon. Sensitivity analyses were performed. In base-case analyses, full access compared to current access to snake antivenom in the five countries resulted in a total of 9,362 deaths averted (-59%), 230,075 disability-adjusted life years (DALYs) averted (-59%), and cost savings of 1.3 billion USD (-53%). Incremental cost-effectiveness ratios (ICERs) of improving access to antivenom found higher outcomes but lower costs in all countries. Probabilistic sensitivity analyses of 1,000 iterations found that 98.1-100% of ICERs were cost-saving. Improving access to snake antivenom will result in cost-saving for ASEAN countries. Our findings emphasized the importance of further strengthening regional cooperation, investment, and funding to improve the situation of snakebite victims in ASEAN countries.