Journal Article > CommentaryFull Text
BMJ Glob Health. 2021 October 25; Volume 6 (Issue 10); e006913.; DOI:10.1136/bmjgh-2021-006913
Martins D, Ribeiro I, Potet J
BMJ Glob Health. 2021 October 25; Volume 6 (Issue 10); e006913.; DOI:10.1136/bmjgh-2021-006913
SUMMARY POINTS
• Despite inherent differences, Snakebite Envenoming and COVID-19 have much in common in terms of research and development (R&D) challenges and opportunities.
• Both crises require a diversified portfolio of R&D solutions, ranging from diagnostics to treatments, that can effectively work and be accessible in different resource settings.
• Collaborative clinical research and streamlined regulatory pathways are critical to accelerate these candidates in the R&D pipeline.
• Transformative progress is possible with a concerted approach that aligns strong political will, coordinated financing and the needs of the most marginalised communities.
• Despite inherent differences, Snakebite Envenoming and COVID-19 have much in common in terms of research and development (R&D) challenges and opportunities.
• Both crises require a diversified portfolio of R&D solutions, ranging from diagnostics to treatments, that can effectively work and be accessible in different resource settings.
• Collaborative clinical research and streamlined regulatory pathways are critical to accelerate these candidates in the R&D pipeline.
• Transformative progress is possible with a concerted approach that aligns strong political will, coordinated financing and the needs of the most marginalised communities.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2021 February 12; Volume 15 (Issue 2); e0009023.; DOI:10.1371/journal.pntd.0009023
Alcoba G, Ochoa C, Martins SB, Ruiz de Castañeda R, Bolon I, et al.
PLoS Negl Trop Dis. 2021 February 12; Volume 15 (Issue 2); e0009023.; DOI:10.1371/journal.pntd.0009023
BACKGROUND
Worldwide, it is estimated that snakes bite 4.5-5.4 million people annually, 2.7 million of which are envenomed, and 81,000-138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the "Snake-Byte" project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal.
METHODOLOGY/PRINCIPAL FINDINGS
We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility.
CONCLUSIONS/SIGNIFICANCE
This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.
Worldwide, it is estimated that snakes bite 4.5-5.4 million people annually, 2.7 million of which are envenomed, and 81,000-138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the "Snake-Byte" project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal.
METHODOLOGY/PRINCIPAL FINDINGS
We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility.
CONCLUSIONS/SIGNIFICANCE
This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.
Journal Article > ResearchFull Text
Lancet. 2018 July 12; Volume 392 (Issue 10148); DOI:10.1016/S0140-6736(18)31224-8
Longbottom J, Shearer FM, Devine M, Alcoba G, Chappuis F, et al.
Lancet. 2018 July 12; Volume 392 (Issue 10148); DOI:10.1016/S0140-6736(18)31224-8
Snakebite 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.
Conference Material > Abstract
Karl F
Epicentre Scientific Day Paris 2021. 2021 June 10
BACKGROUND
While 2.5 million envenomings and 130,000 deaths occur globally due to snakebites, with 1 million envenomings and 30,000 deaths in sub-Saharan Africa, the accessibility of antivenom for treatment of snakebites remain limited. The Inoserp® Pan-Africa antivenom is being used in many African countries including Cameroon but there is few data on its efficacy or tolerance in those settings. We therefore aim to evaluate the tolerance and efficacy of the Inoserp® Pan-Africa antivenom (AVS) in Cameroon.
METHODS
We performed a Phase IV clinical trial and included participants 5 years and above with snakebites in 14 healthcare centers across 6 of the 10 regions of Cameroon. Participants with envenomation were treated with Inoserp AVS and followed-up for 3 days in the hospital and 15 more days at home. The main study endpoints were complete follow-up to day 15, occurrence of adverse events, including disability or death.
RESULTS
Between October 15, 2019 and April 30, 2021, we included 427 participants with snakebites. Echis ocellatus (43.3%) was the most incriminated. Most frequent signs at admission were pain and edema with 90.9% (388/427) and 75.2% (321/427) respectively. We administered AVS to 81.3% (347/427) of patients with an average dose of 2 doses of AVS. Coagulation disorders was present in 50.4% (215/427) of the participants. We reported 12 deaths (2.7%); none were imputed to the administration of AVS. According to preliminary analysis necessitating confirmation, we observed at least one mild or moderate adverse event in 75 of 347 patients (21.6%), including tachypnea, tachycardia and bradycardia.
CONCLUSIONS
Snakebites are still an important neglected problem. Treatment with the Inoserp® Pan-Africa AVS appeared to be well tolerated in the Cameroonian patients and ongoing analysis will help to better assess its effectiveness.
KEY MESSAGES: Snakebites are neglected and their management is most at times inappropriate. We found the Inoserp® Pan-Africa antivenom to be well tolerated in the Cameroonian population.
This abstract is not to be quoted for publication.
While 2.5 million envenomings and 130,000 deaths occur globally due to snakebites, with 1 million envenomings and 30,000 deaths in sub-Saharan Africa, the accessibility of antivenom for treatment of snakebites remain limited. The Inoserp® Pan-Africa antivenom is being used in many African countries including Cameroon but there is few data on its efficacy or tolerance in those settings. We therefore aim to evaluate the tolerance and efficacy of the Inoserp® Pan-Africa antivenom (AVS) in Cameroon.
METHODS
We performed a Phase IV clinical trial and included participants 5 years and above with snakebites in 14 healthcare centers across 6 of the 10 regions of Cameroon. Participants with envenomation were treated with Inoserp AVS and followed-up for 3 days in the hospital and 15 more days at home. The main study endpoints were complete follow-up to day 15, occurrence of adverse events, including disability or death.
RESULTS
Between October 15, 2019 and April 30, 2021, we included 427 participants with snakebites. Echis ocellatus (43.3%) was the most incriminated. Most frequent signs at admission were pain and edema with 90.9% (388/427) and 75.2% (321/427) respectively. We administered AVS to 81.3% (347/427) of patients with an average dose of 2 doses of AVS. Coagulation disorders was present in 50.4% (215/427) of the participants. We reported 12 deaths (2.7%); none were imputed to the administration of AVS. According to preliminary analysis necessitating confirmation, we observed at least one mild or moderate adverse event in 75 of 347 patients (21.6%), including tachypnea, tachycardia and bradycardia.
CONCLUSIONS
Snakebites are still an important neglected problem. Treatment with the Inoserp® Pan-Africa AVS appeared to be well tolerated in the Cameroonian patients and ongoing analysis will help to better assess its effectiveness.
KEY MESSAGES: Snakebites are neglected and their management is most at times inappropriate. We found the Inoserp® Pan-Africa antivenom to be well tolerated in the Cameroonian population.
This abstract is not to be quoted for publication.
Conference Material > Poster
Steegemans IM, Sisay K, Nshimiyimana E, Gebrewold G, Piening T, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > CommentaryFull Text
South Sudan Med J. 2020 November 1; Volume 13 (Issue 4); 146-152.
Said M, Valdespino E, Baba SP, Lako RL, Malm A, et al.
South Sudan Med J. 2020 November 1; Volume 13 (Issue 4); 146-152.
INTRODUCTION
Snakebite is a neglected tropical disease affecting around five million people, causing more than 100,000 annual deaths, as well as serious disabilities; however, access to antivenom and high-quality programmatic care remain a global challenge
OBJECTIVE
Due to the high burden of snakebite in South Sudan and the serious negative outcomes if left untreated, Médecins Sans Frontières (MSF) integrated snakebite care for the first time among its priorities and consolidated a programme in Agok Hospital.
METHOD
We describe the history, implementation, and challenges of the MSF snakebite programme.
RESULTS
The number of snakebite patients at MSF Agok Hospital has increased each year. From 2013 to 2019, MSF treated 2,005 snakebite patients. In 2019 there were 527 snakebite admissions, 47% presented with severe envenomation, and one death. Puff adders, vipers and various cobras were identified. Agok Hospital gained understanding on the barriers and facilitators for the population to access care after a snakebite. MSF developed “snakebite diagnosis and treatment” algorithms, and provided clinical training, with the validation of national health authorities. Preventive activities were reinforced. Integration of surgical services was an essential programmatic aspect to monitor and treat complications. Challenges for implementation included a lack of easily available antivenoms in the international market. and the need of a strong supply chain and procurement systems.
CONCLUSION
The delivery of healthcare towards snakebite patients can be successfully implemented when prioritized. Global efforts to improve access and quality of antivenoms and snakebite care could help removing Snakebite Envenoming from the Neglected Tropical Diseases list.
Snakebite is a neglected tropical disease affecting around five million people, causing more than 100,000 annual deaths, as well as serious disabilities; however, access to antivenom and high-quality programmatic care remain a global challenge
OBJECTIVE
Due to the high burden of snakebite in South Sudan and the serious negative outcomes if left untreated, Médecins Sans Frontières (MSF) integrated snakebite care for the first time among its priorities and consolidated a programme in Agok Hospital.
METHOD
We describe the history, implementation, and challenges of the MSF snakebite programme.
RESULTS
The number of snakebite patients at MSF Agok Hospital has increased each year. From 2013 to 2019, MSF treated 2,005 snakebite patients. In 2019 there were 527 snakebite admissions, 47% presented with severe envenomation, and one death. Puff adders, vipers and various cobras were identified. Agok Hospital gained understanding on the barriers and facilitators for the population to access care after a snakebite. MSF developed “snakebite diagnosis and treatment” algorithms, and provided clinical training, with the validation of national health authorities. Preventive activities were reinforced. Integration of surgical services was an essential programmatic aspect to monitor and treat complications. Challenges for implementation included a lack of easily available antivenoms in the international market. and the need of a strong supply chain and procurement systems.
CONCLUSION
The delivery of healthcare towards snakebite patients can be successfully implemented when prioritized. Global efforts to improve access and quality of antivenoms and snakebite care could help removing Snakebite Envenoming from the Neglected Tropical Diseases list.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2020 June 25; Volume 14 (Issue 6); e0008334.; DOI:10.1371/journal.pntd.0008334
Alcoba G, Chabloz M, Eyong J, Wanda F, Ochoa C, et al.
PLoS Negl Trop Dis. 2020 June 25; Volume 14 (Issue 6); e0008334.; DOI:10.1371/journal.pntd.0008334
BACKGROUND
Snakebite envenoming causes 81,000-138,000 annual human deaths and pain, terror, or disability in 4.5-5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon.
METHODS
We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportional-to-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated.
FINDINGS
Among the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519-841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (case-fatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%). The two last procedures were also used in health facilities (n = 18). Consulting traditional healers was associated with severity (adjusted-OR: 19.6 (2.5-156), p = 0.005) and complications (aOR: 17.3, 2.4-123, p = 0.004). Long-term disabilities were subjective psychological trauma (n = 47; 71%), finger amputation (n = 1; 2%), ankylosis (n = 1; 2%) and chronic pain (n = 1; 2%).
CONCLUSIONS
We observed alarming levels of snakebite incidence, mortality, antivenom scarcity, and use of traditional medicine. It could represent several thousands of victims at national level. We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals.
Snakebite envenoming causes 81,000-138,000 annual human deaths and pain, terror, or disability in 4.5-5.4 million victims. Accurate community-based epidemiological data is scarce. Our objective was to assess snakebite incidence, mortality, and health-seeking behavior, in an affected health district of Cameroon.
METHODS
We conducted a cross-sectional multicluster household survey in Akonolinga health district, Centre Region, Cameroon, from October to December 2016. Using probability-proportional-to-size, 20 villages were randomly selected, then, all inhabited households were systematically selected. Annual incidence and adjusted odds-ratio for predictors were estimated.
FINDINGS
Among the 9,924 participants, 66 suffered a snakebite during the past year: the resulting incidence is 665 (95%CI: 519-841) per 100,000 inhabitants per year. Victims were aged 5-75y (median: 34y), 53% were male and 57% farmer-cultivators. Two children died (case-fatality rate: 3%); 39 (59%) presented severity signs, including 2 (3%) neurotoxic syndromes, 20 (30%) systemic digestive syndromes, and 17 (26%) severe cytotoxic syndromes. Non-severe cases included 20 (30%) mild cytotoxic syndromes and 7 (11%) dry bites. Only two victims (3%) received antivenom. 59 (89%) used family traditional practices, 25 (38%) traditional healers, and 31 (47%) consulted health facilities. Median delays to these three care-options were 5, 45, and 60 minutes, respectively. Traditional treatments included incisions (n = 57; 86%), tourniquets (n = 51; 77%) and black-stones (n = 44; 67%). The two last procedures were also used in health facilities (n = 18). Consulting traditional healers was associated with severity (adjusted-OR: 19.6 (2.5-156), p = 0.005) and complications (aOR: 17.3, 2.4-123, p = 0.004). Long-term disabilities were subjective psychological trauma (n = 47; 71%), finger amputation (n = 1; 2%), ankylosis (n = 1; 2%) and chronic pain (n = 1; 2%).
CONCLUSIONS
We observed alarming levels of snakebite incidence, mortality, antivenom scarcity, and use of traditional medicine. It could represent several thousands of victims at national level. We suggested conducting a country-wide study, and improving antivenom supply, first-aid training, for traditional healers and health professionals.
Journal Article > ResearchFull Text
PLoS Negl Trop Dis. 2022 August 15; Volume 16 (Issue 8); e0010647.; DOI:10.1371/journal.pntd.0010647
Bolon I, Picek L, Durso AM, Alcoba G, Chappuis F, et al.
PLoS Negl Trop Dis. 2022 August 15; Volume 16 (Issue 8); e0010647.; DOI:10.1371/journal.pntd.0010647
BACKGROUND
Snakebite envenoming is a neglected tropical disease that kills an estimated 81,000 to 138,000 people and disables another 400,000 globally every year. The World Health Organization aims to halve this burden by 2030. To achieve this ambitious goal, we need to close the data gap in snake ecology and snakebite epidemiology and give healthcare providers up-to-date knowledge and access to better diagnostic tools. An essential first step is to improve the capacity to identify biting snakes taxonomically. The existence of AI-based identification tools for other animals offers an innovative opportunity to apply machine learning to snake identification and snakebite envenoming, a life-threatening situation.
METHODOLOGY
We developed an AI model based on Vision Transformer, a recent neural network architecture, and a comprehensive snake photo dataset of 386,006 training photos covering 198 venomous and 574 non-venomous snake species from 188 countries. We gathered photos from online biodiversity platforms (iNaturalist and HerpMapper) and a photo-sharing site (Flickr).
PRINCIPAL FINDINGS
The model macro-averaged F1 score, which reflects the species-wise performance as averaging performance for each species, is 92.2%. The accuracy on a species and genus level is 96.0% and 99.0%, respectively. The average accuracy per country is 94.2%. The model accurately classifies selected venomous and non-venomous lookalike species from Southeast Asia and sub-Saharan Africa.
CONCLUSIONS
To our knowledge, this model’s taxonomic and geographic coverage and performance are unprecedented. This model could provide high-speed and low-cost snake identification to support snakebite victims and healthcare providers in low-resource settings, as well as zoologists, conservationists, and nature lovers from across the world.
Snakebite envenoming is a neglected tropical disease that kills an estimated 81,000 to 138,000 people and disables another 400,000 globally every year. The World Health Organization aims to halve this burden by 2030. To achieve this ambitious goal, we need to close the data gap in snake ecology and snakebite epidemiology and give healthcare providers up-to-date knowledge and access to better diagnostic tools. An essential first step is to improve the capacity to identify biting snakes taxonomically. The existence of AI-based identification tools for other animals offers an innovative opportunity to apply machine learning to snake identification and snakebite envenoming, a life-threatening situation.
METHODOLOGY
We developed an AI model based on Vision Transformer, a recent neural network architecture, and a comprehensive snake photo dataset of 386,006 training photos covering 198 venomous and 574 non-venomous snake species from 188 countries. We gathered photos from online biodiversity platforms (iNaturalist and HerpMapper) and a photo-sharing site (Flickr).
PRINCIPAL FINDINGS
The model macro-averaged F1 score, which reflects the species-wise performance as averaging performance for each species, is 92.2%. The accuracy on a species and genus level is 96.0% and 99.0%, respectively. The average accuracy per country is 94.2%. The model accurately classifies selected venomous and non-venomous lookalike species from Southeast Asia and sub-Saharan Africa.
CONCLUSIONS
To our knowledge, this model’s taxonomic and geographic coverage and performance are unprecedented. This model could provide high-speed and low-cost snake identification to support snakebite victims and healthcare providers in low-resource settings, as well as zoologists, conservationists, and nature lovers from across the world.
Journal Article > ReviewFull Text
Toxicon: X. 2021 October 26; Volume 12; 100086.; DOI:10.1016/j.toxcx.2021.100086
Potet J, Beran D, Ray N, Alcoba G, Habib AG, et al.
Toxicon: X. 2021 October 26; Volume 12; 100086.; DOI:10.1016/j.toxcx.2021.100086
Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming.
Journal Article > CommentaryFull Text
PLoS Negl Trop Dis. 2022 November 17; Volume 16 (Issue 11); e0010897.; DOI:10.1371/journal.pntd.0010897
Gutiérrez JM, Borri J, Giles-Vernick T, Duda R, Habib AG, et al.
PLoS Negl Trop Dis. 2022 November 17; Volume 16 (Issue 11); e0010897.; DOI:10.1371/journal.pntd.0010897