Availability Of Antivenom Research Articles

Situation of snakebite, antivenom market and access to antivenoms in ASEAN countries

IntroductionSnakebite envenoming is a neglected tropical disease posing public health challenges globally. The Association of Southeast Asian Nations (ASEAN) countries are among the tropical regions with disproportionately high incidence of...

How beliefs in traditional healers impact on the use of allopathic medicine: In the case of indigenous snakebite in Eswatini.

Snakebite is a major public health problem in Eswatini and serious envenomations can be responsible for considerable morbidity and mortality if not treated correctly. Antivenom should be administered in hospital in case of adverse reactions and any delays due to distance, transport, costs, antivenom availability and cultural beliefs can be critical. Myths and superstition surround snakes, with illness from snakebite considered a supernatural phenomenon best treated by traditional medicine since healers can explore causes through communication with the ancestors. Traditional consultations can cause significant delays and the remedies may cause further complications. Four rural focus group discussions were held in varying geographical regions to establish why people may choose traditional medicine following snakebite. The study revealed four themes, with no apparent gender bias. These were ‘beliefs and traditions’, ‘logistical issues’, ‘lack of knowledge’ and ‘parallel systems’. All snakes are feared, regardless of geographical variations in species distribution. Deep-seated cultural beliefs were the most important reason for choosing traditional medicine, the success of which is largely attributed to the ‘placebo effect’ and positive expectations. Collaboration and integration of the allopathic and traditional systems assisted by the regulation of healers and their methods could improve future treatment success. The plight of victims could be further improved with more education, lower costs and improved allopathic facilities.

The Snake Study: Survey of National Attitudes and Knowledge in Envenomation.

Despite recent reviews of best practice for the treatment of Australian venomous bites and stings, there is controversy about some aspects of care, particularly the use of antivenom. Our aim was to understand current attitudes and practice in the management of suspected snake envenoming. A single-stage, cross-sectional survey of Australian emergency care physicians who had treated snake envenomation in the previous 36 months was conducted. Hospital pharmacists were also invited to complete a survey about antivenom availability, usage, and wastage in Australian hospitals. The survey was available between 5 March and 16 June 2019. A total of 121 snake envenoming cases were reported, and more than a third (44.6%) of patients were not treated with antivenom. For those treated with antivenom (n = 67), 29 patients (43%) received more than one ampoule. Nearly a quarter of respondents (21%) identified that antivenom availability was, or could be, a barrier to manage snake envenoming, while cost was identified as the least important factor. Adverse reactions following antivenom use were described in 11.9% of cases (n = 8). The majority of patients with suspected envenoming did not receive antivenom. We noted variation in dosage, sources of information, beliefs, and approaches to the care of the envenomed patient.

Snakebite envenoming in different national contexts: Costa Rica, Sri Lanka, and Nigeria.

Snakebite envenoming is a neglected tropical disease that predominantly affects impoverished rural communities in sub-Saharan Africa, Asia, and Latin America. The global efforts to reduce the impact of this disease must consider the local national contexts and, therefore, comparative studies on envenomings in different countries are necessary to identify strengths, weaknesses and needs. This work presents a comparative analysis of snakebite envenomings in Costa Rica, Sri Lanka, and Nigeria. The comparison included the following aspects: (a) burden of envenomings, (b) historical background of national efforts to confront envenomings, (c) national health systems, (d) antivenom availability and accessibility including local production, (e) training of physicians and nurses in the diagnosis and management of envenomings, (f) prevention campaigns and community-based work, (g) scientific and technological platforms in these topics, and (h) international cooperation programs. Strengths and weaknesses were identified in the three contexts and several urgent tasks to improve the management of this disease in these countries are highlighted. This comparative analysis could be of benefit for similar studies in other national and regional contexts.

Snake Bite Management: A Scoping Review of the Literature.

Background:Around the world, snake bite envenomation remains an underreported human health hazard. Envenomation can cause local and systemic complications, especially when there is a lack of antivenom availability. Although there are established guidelines regarding snake bite management acute care, there is a paucity of data regarding surgical intervention and the plastic surgeon’s role treating this unique patient population.Methods:A review was conducted identifying relevant published articles involving snake bite management and treatment in PubMed and EMBASE.Results:One hundred ten articles were identified and 77 met inclusion criteria. Snake bite envenomation can result in complications that are dependent upon a variety of variables. The literature has shown the best field treatment to be timely transportation to the nearest medical facility, along with antivenom administration. The cytotoxic, hemotoxic, and neurotoxic effects of venom can cause a variety of local soft tissue and systemic complications. Surgical interventions such as fasciotomies, wound debridements, skin grafts, and tissue flaps may be necessary in these patients to optimize functional and aesthetic outcomes. Disparities in access to care in resource limited settings are discussed.Conclusions:Global health disparities and insufficient antivenom distribution create an inequality of care in snake bite patients. Plastic surgeons have an important role in managing acute and chronic complications of snake bite envenomations that can lead to improved patient outcomes.

Scorpion Stings and Antivenom Use in Arizona

BackgroundArizona's rugged desert landscape harbors many venomous animals, including a small nocturnal scorpion, Centruroides sculpturatus, whose venom can cause severe neuromotor disturbance. An effective antivenom is available at selected health care facilities in the state. MethodsWe analyzed 4398 calls of scorpion stings to the Arizona Poison and Drug Information Center (APDIC) in Tucson over a period of 3 years, from January 2017 to December 2019. ResultsWe followed 1952 (44.4%) of the victims to resolution. We excluded 2253 callers with minimal effects of the sting and 193 victims with possible toxic effects who were lost to follow-up. The most common complaints among callers were pain at the sting site in 88.9% and local numbness in 62.2%. Detailed clinical information was obtained from 593 calls from a health care facility. Neuromotor signs consistent with C. sculpuratus envenomation included nystagmus in 163 (27.5%), hypersalivation in 91 (15.3%), and fasciculations in 88 (14.8%). Antivenom (Anascorp; Rare Disease Therapeutics, Inc., Franklin, Tenn) was administered to 145 patients. Most were children <5 years old (n = 76, or 54.4%); 27 (18.6%) were 5-9 years old and 42 (30.0%) were ≥10 years of age. About half, 79 of 145 (54.5%) victims who received antivenom, met the APDIC recommended use criteria. ConclusionsPatients treated with antivenom exhibited a rapid resolution of symptoms without immediate or delayed hypersensitivity reactions. We recommend broadened availability of antivenom at sites where it is most needed.

Snakebite Envenomation in Rwanda: Patient Demographics, Medical Care, and Antivenom Availability in the Formal Healthcare Sector.

Snakebite envenomation (SBE) is a neglected One Health issue that overwhelmingly affects people living in rural and impoverished regions of Africa and Asia. Information on SBE is scarce in Rwanda; thus, our objectives were to 1) describe the demographics of SBE patients seeking hospital care, 2) evaluate physician adherence to national treatment guidelines, and 3) assess availability of snake antivenom at hospitals in Rwanda. To achieve these goals, we obtained national data on animal bites/stings and visited every district and provincial hospital in Rwanda to obtain physical records of SBE patients treated in 2017 and 2018. Hospital pharmacies were assessed for antivenom availability. We identified snakes as the second leading cause of animal bites, after dogs, among patients who sought hospital care in 2017 and 2018. Of 363 SBE patients, the highest number of cases occurred among children (< 18 years; 32%) and young adults (18-30 years; 33%), females (61%), farmers (82%), and those living in Eastern Province (37%). Overall, physician adherence to treatment guidelines was 63%. Prescriptions of vitamin K and antivenom were low (4% and 13%, respectively), and only 8% of hospital pharmacies had antivenom in stock throughout the study period. The antivenom stocked was an Indian generic suited for Asian snakes. This minimum estimate of hospitalization cases does not include individuals who died in communities or sought care outside the formal sector. Our study highlights the need to map incidence, risk factors, and patient experiences to mitigate human-snake conflicts and improve patient outcomes.

A prospective study on clinico-epidemiological profile and outcome in management of poisonous snake bite

Background: Snake bite is a major health problem in Nepal. According to WHO, annual morbidity due to snake bite is 162 out of 100,000 people in Nepal. Aim of the study is to observe epidemiology, clinical features, and analysis of possible relationship between time delay in administration of anti-snake venom (ASV) and mortality. Methods: This prospective observational study analyses the data of 81 patients admitted to the Lumbini zonal hospital, Butwal, Rupandehi, Nepal with history of snake bite between April to September, 2017.Results: In this study 56% patients were female. Patients of age group (15-30) years were maximum (38.27%). The study showed that 50.61% of snake bites were occurred outside home. Most of patients (84%) were from the Terai region. Average no. of vials used per case was (28±10) vials. Most of victims of snake bite were from rural areas. In most of cases we found that prothrombin time was prolonged. It was found that most of patients 57% reach hospital before 4 hours of snake bite. The mean days of hospital stay was 6±2.86. Most of case of snake bite was unknown (62%). The mortality rate in this study was 6.17%.Conclusions: There is a great need to improve in existing health care conditions for effective management of snake bite; it requires training of the personnel engaged in the emergency health care management, development of national guidelines based on the clinical trials, improving the distribution and easy availability of antivenom.

Situation of public laboratories manufacturing antivenoms in Latin AmericaA situação dos laboratórios públicos produtores de soros antivenenos na América Latina

RESUMENSe analiza la situación de los laboratorios públicos productores de antivenenos en América Latina, con base a los resultados de en un taller coordinado por el Centro Panamericano de Fiebre Aftosa (PANAFTOSA) de la Organización Panamericana de la Salud (OPS). Nueve países en la región poseen doce laboratorios públicos que producen y distribuyen antivenenos contra venenos de diferentes animales ponzoñosos. Se discutió la situación de cada laboratorio, se analizó el escenario actual caracterizado por las crecientes demandas regulatorias y la heterogeneidad de estos en términos de infraestructura y capacidad productiva y se planteó la necesidad de concertar procesos de cooperación regional dirigidos a mejorar la disponibilidad de antivenenos, incluyendo proyectos de investigación y desarrollo para el mejoramiento de los procesos y las tecnologías; estudios del perfil de la capacidad neutralizante de los antivenenos contra diferentes venenos, y programas de capacitación técnica de profesionales y personal técnico. En el contexto actual, en el que la Organización Mundial de la Salud elaboró una estrategia global para la prevención y el control de los envenenamientos ofídicos, el Centro PANAFTOSA de la OPS ha asumido la coordinación de estas acciones en las Américas, mejorar la disponibilidad de antivenenos es prioritaria. Como resultado de ese taller, se creó la Red de Laboratorios Públicos Productores de Antivenenos de América Latina (RELAPA), con el objetivo de fortalecer estos laboratorios y de aumentar la disponibilidad y accesibilidad de antivenenos eficaces y seguros a toda América Latina.

The need for a systemic approach to confront the crisis of antivenom availability and accessibility in Sub-Saharan Africa

The need for a systemic approach to confront the crisis of antivenom availability and accessibility in Sub-Saharan Africa

IgY-based antivenom against Bothrops alternatus: Production and neutralization efficacy

Antivenom for the treatment of bothropic snakebite is a priority for public health institutions from Latin America. An alternative to the conventional antivenom production is based on the use of egg yolk antibodies – IgY-technology – by immunizing laying hens. In this study, we produced, characterized and assessed the efficacy of IgY-based antivenoms against B. alternatus venom. Immunochemical studies (reactivity, avidity and antigen recognition pattern) as well as antivenom efficacy assays were performed. After the 3rd immunization, levels of specific IgY reached a maximum that was maintained throughout the observation period, while avidity indexes of the extracts increased after the successive immunizations. Furthermore, IgY against B. alternatus recognized protein complexes of the venom with high (>40 kDa), medium (20–40 kDa) and low (<20 kDa) molecular weights. IgY antivenoms obtained after 8 immunizations neutralized 35.65 μg of B. alternatus venom per mg of antivenom, while specific activities values ranged from 0.28 to 0.42. In conclusion, we produced and characterized IgY antivenoms capable of neutralizing the lethal activity of B. alternatus venom at a preclinical level. Thus, IgY-technology may allow the production of effective and affordable antivenoms fulfilling the urgent needs of many countries where conventional manufacture is unable to provide enough availability of antivenoms.

Characteristics and relative numbers of lethal snake bite cases in medicolegal practice in central Myanmar – A five year study

Clinical and pathological case files of lethal snakebites were reviewed from the Magway Region General Hospital, Magway, Myanmar, over a five-year period (January 2013 December 2017). A total of 2069 postmortem examinations were performed which included 84 cases of lethal snake bite (4.1%). The annual numbers ranged from 10 out of a total of 268 autopsies in 2013 (3.7%), to 31 out of a total of 501 autopsies in 2016 (6.2%). There were 54 males (64%) and 30 females (36%) (M:F = 1.9:1; age range 5–75yrs, mean 33yrs). The most common time for lethal envenomation was August (16/84–19%), the middle of the monsoon season. 45/84 (54%) had acute renal failure, 27/84 (32%) were shocked, and the remaining 12/84 (14%) had disseminated intravascular coagulation. Twenty cases (24%) died within 24 h after envenomation. Fang marks were identified on the legs (either right or left) in 73/84 cases (87%) and on the arms in five cases (6%). The predominant findings at autopsy were of acute renal injury (82/84–98%), pituitary haemorrhage/necrosis (36/84–43%), and adrenal gland haemorrhage (30/84–36%). Despite the reduction in fatalities over the years snakebite from Russell's viper in particular remains an important contributor to mortality in central Myanmar despite the availability of antivenom.

Inadequate knowledge about snakebite envenoming symptoms and application of harmful first aid methods in the community in high snakebite incidence areas of Myanmar.

IntroductionEvery year millions of people in developing countries suffer from snakebite, causing a large number of deaths and long term complications. Prevention and appropriate first aid could reduce the incidence and improve the health outcomes for those who suffer bites. However, many communities where snakebite is a major issue suffer from a lack of information about prevention and first aid measures that a family or community member could take to prevent severe envenoming, complications and poor outcomes. Myanmar suffers from a high burden of snakebites with a large number of deaths. As part of a health services and community development program, a community survey was conducted to identify communities’ knowledge about snakebite and their sequelae, and knowledge and practice about first aid and health services use.Method4,276 rural residents of Kyaukse and Madaya townships in the Mandalay region were recruited by cluster sampling, involving random selection of 144 villages and random sampling of 30 households from each village. One adult member of each household was interviewed using a structured questionnaire.ResultsThe incidence of snakebite was 116/100,000 people. Respondents reported 15 different types of snakes in the area, with Russell’s Viper, Cobra and Green snakes as the most common. 88% of the people informed that working in the fields and forests was when most of the bites occur. A majority knew about snakebite prevention methods such as wearing long boots. However, only a few people knew about the specific symptoms caused by snakebites. Only 39% knew about the correct methods of first aid. More than 60% mentioned tourniquet as a first aid method, though this may cause significant complications such as ischaemia of the limb. 88% said that they would take a snakebite victim to a government hospital, and 58% mentioned availability of antivenom as the reason for doing this. At the same time, the majority mentioned that traditional methods existed for first aid and treatment and 25% mentioned at least one harmful traditional method as an effective measure that they might use.ConclusionThe community is aware of snakebites as a major public health issue and know how to prevent them. However, the high incidence of snakebites point to lack of application of preventive methods. The community recognise the need for treatment with antivenom. However, inadequate knowledge about appropriate first aid methods, and a reliance on using tourniquets require a targeted education program. Existing knowledge in communities, albeit insufficient, provides a good starting point for mass media educational campaigns.

Clinical and demographic profile of patients with snakebite in a tertiary hospital in Ghana

Background: Snakebite is a public health problem affecting mainly rural populations. Objective: To determine the clinical pro le, manifestation, and outcome of snakebite cases presenting to the Tamale Teaching Hospital in Northern Ghana. Materials and Methods: This is a hospital record-based retrospective descriptive study of all confirmed snakebite cases recorded at the Tamale Teaching Hospital over a 2-year period from January 2016 to December 2017. Relevant demographic and clinical information were extracted from patient folders and analyzed. Results: One hundred and nineteen snakebite cases were recorded. The mean age of the victims was 26.38 years, 69.7% being male. Snakebites were recorded all year round with a slight peak in November. Most bites occurred in the interval between 4:00 PM and 8:00 PM and the lower extremity was the most common site of bite (71.4%). The major symptoms of envenomation included coagulopathies (86.5%) and local swelling/ulceration (78.2%); 68.9% had both coagulopathies and local cytotoxicity. Cellulitis/infected wounds (35.3%) and anemia (21.0%) were the major complications reported. 96.6% of the snakebite cases received antivenom on presentation. There was an average delay of 36.42 h from bite before seeking hospital care. No mortality was recorded. The causative snake species was identified in only 6.7% of cases. Conclusion: Snakebite is a potentially life-threatening disease in developing countries such as Ghana and disproportionately affects rural farmers who are mostly active young males. It occurs all year round. More accurate data on snakebites in Ghana are needed for planning purposes and to ensure the continuous availability of antivenom.

Global Availability of Antivenoms: The Relevance of Public Manufacturing Laboratories.

Snakebite envenoming is a serious global public health problem, and international initiatives, under the coordination of the World Health Organization and its regional offices, are being developed to reduce the impact of this neglected tropical disease. The global availability of safe and effective antivenoms is one of the key aspects in this global strategy. This review discusses the role of public antivenom manufacturing laboratories for ensuring the supply of antivenoms. The difficulties faced by public laboratories are discussed, together with some tasks that need to be implemented for strengthening them. In addition, the concept of ‘redundancy’ in the supply of antivenoms is emphasized, as a way to cope with the risks associated with the provision of antivenoms by few manufacturers. In general, the public sector should play a leading role, in antivenom availability and other aspects as well, within the global struggle to reduce the mortality and morbidity caused by snakebite envenoming.

Vulnerability to snakebite envenoming: a global mapping of hotspots

SummaryBackgroundSnakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed.MethodsWe assembled a list of snake species using WHO guidelines. Where relevant, we obtained expert opinion range (EOR) maps from WHO or the Clinical Toxinology Resources. We also obtained occurrence data for each snake species from a variety of websites, such as VertNet and iNaturalist, using the spocc R package (version 0.7.0). We removed duplicate occurrence data and categorised snakes into three groups: group A (no available EOR map or species occurrence records), group B (EOR map but <5 species occurrence records), and group C (EOR map and ≥5 species occurrence records). For group C species, we did a multivariate environmental similarity analysis using the 2008 WHO EOR maps and newly available evidence. Using these data and the EOR maps, we produced contemporary range maps for medically important venomous snake species at a 5 × 5 km resolution. We subsequently triangulated these data with three health system metrics (antivenom availability, accessibility to urban centres, and the Healthcare Access and Quality [HAQ] Index) to identify the populations most vulnerable to snakebite morbidity and mortality.FindingsWe provide a map showing the ranges of 278 snake species globally. Although about 6·85 billion people worldwide live within range of areas inhabited by snakes, about 146·70 million live within remote areas lacking quality health-care provisioning. Comparing opposite ends of the HAQ Index, 272·91 million individuals (65·25%) of the population within the lowest decile are at risk of exposure to any snake for which no effective therapy exists compared with 519·46 million individuals (27·79%) within the highest HAQ Index decile, showing a disproportionate coverage in reported antivenom availability. Antivenoms were available for 119 (43%) of 278 snake species evaluated by WHO, while globally 750·19 million (10·95%) of those living within snake ranges live more than 1 h from population centres. In total, we identify about 92·66 million people living within these vulnerable geographies, including many sub-Saharan countries, Indonesia, and other parts of southeast Asia.InterpretationIdentifying exact populations vulnerable to the most severe outcomes of snakebite envenoming at a subnational level is important for prioritising new data collection and collation, reinforcing envenoming treatment, existing health-care systems, and deploying currently available and future interventions. These maps can guide future research efforts on snakebite envenoming from both ecological and public health perspectives and better target future estimates of the burden of this neglected tropical disease.FundingBill & Melinda Gates Foundation.

History and perspectives on how to ensure antivenom accessibility in the most remote areas in Brazil

A plan to achieve self-sufficiency in manufacturing biologicals for public health has been structured for the last 40 years in Brazil, in the context of a reform in the health system. Industrial plants of the national public laboratories have been modernized, and a program for reducing morbidity and mortality of venomous snakebite has been created, as part of the National Epidemiological Surveillance System. The epidemiological data are essential to plan for the antivenom production of 400,000 vials of snake antivenoms per year, and the acquisition by the Ministry of Health, which is the exclusive purchaser in the country. Distribution is decentralized to reach hospitals in almost 3000 municipalities, and to provide free of charge antivenom treatment. The National Sanitary Surveillance Agency organized the regulatory environment to implement rules and supervise compliance of GMP procedures, elevating the quality of the biologicals that are produced, as well as reducing the costs in production. Despite all the advances in the health system, antivenom availability and accessibility is not uniform in regards to the most vulnerable parts of the populations, which inhabit remote areas in the Brazilian Amazon region. Better logistics and transportation of liquid form antivenoms is an issue to be addressed and realistic and comprehensive health programs for indigenous groups should be effectively structured, in order to reduce the high morbidity and mortality rates associated with snakebite envenoming.

Epidemiological profile of snakebites cases recorded at the 3rd military hospital laayoune morocco between 2011 and 2017

Snake bites pose a major public health problem worldwide, this pathology is worrying given the mortality, the morbidity it causes and the limited and often discontinuous availability of antivenomserotherapy. The objective of our study is to reveal the epidemiological characteristics, and the elements of management of Ophidian envenomations in the region of Laayoune in Morocco and to follow the practice of an Inoserp® MENA antigen after the production stop of FAVafrique®. This is a retrospective and descriptive study of a series of 23 viperin bite-related cases, which were admitted between January 2011 and December 2017 at the 3rd Military Hospital Laayoune in Morocco. The analysis of inpatient records allowed us to study the circumstances of bite occurrence according to the climatic conditions of the area, biological data, clinical signs, severity criteria and therapeutic treatment. The length of stay in the hospital allowed us to compare two groups; it was lower in the group of patients who received Inoserp®, compared to the group of patients who received the FavAfrique®. This reduction in the length of stay in the intensive care unit, which implies a decrease in the use of other therapies, associated biological and radiological assessments, has saved approximately $ 125 per patient. The availability of antivenoms in first aid units and early management has improved the prognosis.

Shortcomings in snake bite management in rural Cameroon: a case report

BackgroundSnake bites are an important public health problem in developing countries with most bites occurring in rural areas. Severe envenomation often occurs in children and following bites to the face. Prompt administration of potent anti-venom remains the mainstay of management. However in Cameroon, the use of anti-venoms is limited by non-availability, high cost (where available) and poor mastery of treatment guidelines.Case presentationWe present a 10-year-old muslim Cameroonian child from an enclaved rural area, brought to the hospital 12 h after a snake bite to the face, with signs of severe envenomation. Despite the suboptimal anti-venom dose administered to this patient due to a stock out of this medication, supportive therapy was beneficial in ensuring a positive outcome and satisfactory recovery.ConclusionThis highlights snake bites as a public health problem due to the lack of snake anti-venoms in peripheral health facilities, rendering them unable to appropriately manage these cases. National health policies should encourage constant peripheral availability of anti-venoms and the institution of an intervention package for snake bite management, comprising: treatment protocol, staff training, monitoring of compliance and community education to help reduce the mortality and morbidity from snake bites.

Snake Bite as a Public Health Problem: Bangladesh Perspective

Snake bite is an important but often under-recognized public health problem in Bangladesh, with an incidence density one of the highest in the world, which may be 623.4/100,000 person years. The proportion of poisonous snake bites is 10 to 45%, with the reported mortality 0.5 to 22%. Among the 82 species of snakes, 28 are venomous; bites by green pit vipers, cobras and kraits are the most commonly identified ones. High population density, widespread agricultural activities, numerous venomous snake species and lack of functional snake bite control programs favour the high burden of snake bites. Poorer rural populations are the main victims, imposing considerable socioeconomic impact. Treatment of snake bite is largely dominated by traditional snake charmers (Ozha) or ‘Kaviraj’ offering unscientific practices and healers, causing undue delay and precluding standard medical management. Delayed presentation to the hospital, lack of availability of antivenom and modern management facility are the main causes of death. Antivenoms are entirely dependent on import, are expensive, and are not ‘customized’ to local needs. Auxiliary intensive care facilities are not widely available; health care personnel often lack necessary expertise. However, the trend is changing. Public awareness is growing, health care personnel are being trained, and a national guideline for snake bite management has been formulated. Further research, introduction of modern diagnostic facilities, local manufacture of antivenom, and above all, integrated approach on the part of Government, policy-makers and international community can change the outlook of snake bite as a neglected tropical condition in Bangladesh.Birdem Med J 2015; 5(1): 24-29