Hello! My name is Holly, and I am a student at Whitman College in Walla Walla, Washington. I have lived in Oregon and Washington for most of my life, and when starting research for the Asclepius Snakebite Foundation I had no clue that venomous snake bites were of such global significance . Where I live in Oregon snake bites are not an issue that comes up often, so I was surprised to find out how much of a problem snake bites are worldwide.

There is a large disparity in this global problem that can be seen by looking at snakebite statistics worldwide: in the US, there are roughly 8,000 venomous snake bites annually, resulting in five deaths each year (Venomous Snakes). Similarly in Australia, an average of 2 people die each year from an annual total of 3000 venomous snake bites (Zdenek). These numbers are shockingly different from the numbers of deaths in Africa and Asia. In Africa there are roughly 20,000-32,000 deaths each year, although the prevalence of traditional medicine as a treatment means these reported numbers may be far lower than the actual number of mortalities each year. India has the highest reported snake bite fatalities each year, with approximately 64,000 deaths annually (Bhaumik). This means that although India represents only 17.7% of the world’s population, it has 80% of the world’s snake bite mortalities each year. This is a much greater proportion of deaths than we would expect to see in India, given its proportion of world population, and illustrates how the burden of snake bite mortalities is much higher in India than in other areas.

These numbers are shocking and beg the question, why such a huge disparity? The number of venomous snakes in an area seems like a possible answer to this question, but when comparing numbers of venomous snakes we see that both Australia and Africa have fairly similar numbers of venomous species. The below figure shows the prevalence of venomous, medically important snake species worldwide. As can be seen in the figure Africa, Asia, South America, and Australia have the highest number of these species of snakes.

Vulnerability to snakebite envenoming: a global mapping of hotspots. (https://www.sciencedirect.com/science/article/pii/S0140673618312248)

Another interesting figure, below, shows the twenty most venomous snakes in the world. If we look at the distribution of these snakes we see five of the twenty can be found in Australia, four can be found in various places in Africa, and only one out of the twenty is found in the US. Although a large proportion of the most venomous snakes in the world are found in Australia, there are very few deaths from snake bites. In lower income areas, like Africa, there are similar numbers of venomous snakes, but many more deaths from snake bites each year. This clearly shows that the cause of the disparity is not the distribution of venomous snakes.

We can see ultimately that the major predictor of snake bite mortality is whether the country is a high or low income country. The difference between low and high income countries in their responses to snake bites is reflected in availability of treatment, travel time to access antivenom, and manufacturing of antivenom. These factors vastly affect how snake bites are treated, which has huge implications for the outcome of the snake bites.

In Australia and the US, snake bites are treated with hospitalization and antivenom (Venomous Snake Bites: Symptoms & First Aid). The very few deaths that do occur often come from not seeking proper care or in those with underlying medical conditions. Most treatments require a patient to remain in the hospital for 24 hours after a snakebite for monitoring, and while antivenom stops the process of local tissue injury, it is not proven yet whether antivenom has effects on long duration limb impairment. Many adults take more than 2-4 weeks to recover from a snakebite through antivenom treatment and resume normal daily activity, but 25% of adults can take one to nine months to fully recover from snake bite envenomation (Snake Bite: Symptoms, Causes, Diagnosis & Treatment). This full recovery entails a return to normal life and activities, and this rehabilitation can be delayed by pain and swelling at the site of the bite, as well as disabilities caused by snake bite.

In Africa, patients face a completely different story. A recent study found that in Africa, 59% of snake bites are treated exclusively by traditional medicine, while only 16% of snake bites are treated in health centers (Farooq). A major obstacle is the difficulty in obtaining antivenom. While in the US and Australia antivenom is not difficult to obtain, in Sub-Saharan Africa, it costs an average of $125 US dollars per vial, and most snake bites require 6-15 vials to be properly treated. Because so few people seek out professional help for snake bites or are able to afford the antivenom, antivenom is often stored long past its shelf life and may not be effective when it is actually used. When antivenoms are actually used and are effective there is additional danger because lower quality antivenoms are more likely to trigger anaphylaxis. This occurs much more frequently in low income countries dealing with antivenom administration, because corners are cut in the manufacturing process to keep costs down. The ineffectiveness of antivenoms and increased anaphylactic reactions lead to a stronger distrust of professional healthcare for snake bites, which compounds the issue. There is little likelihood of significant recovery when a venomous snake bite is treated by traditional medicine, therefore leading to the high prevalence of deaths from snake bites in low income areas.

Another difference between wealthy regions and their poorer counterparts lies in the outcomes of snakebites. Recovery from snake bite envenomation is a very difficult process in lower income countries and often leads to lifelong disabilities. While in the US and Australia it can take time to return to normal daily life after a venomous snake bite, in Africa returning to normal is less likely because of mortalities or disabilities. In these low income areas, this means that a snake bite more often entails loss of income source or even loss of life.

Travel time to receive care for snakebite envenomation also differs globally. We can see in the figure below that in locations marked in red it can take 24 hours or longer to obtain proper treatment for snakebite envenomation. We see this being an issue in hot spots of snake envenomations like Africa and South America, and, interestingly, in largely uninhabited Western Australia.

Average travel time to nearest major city for populations living within snake ranges. https://www.sciencedirect.com/science/article/pii/S0140673618312248

The disparity in the availability of treatment centers for snake bites is a major concern in low income areas. In sub-saharan Africa for example, there are rarely more than one or two treatment centers for snake bites in each country. In Kenya there are two more permanent places to seek treatment, while Sierra Leone and Guinea each have one. In contrast, the Democratic Republic of the Congo and the Republic of Congo have none. This is a significant factor in the disparity seen in snake bite mortality, as it often is difficult to access snake bite treatment centers that provide antivenom. In remote villages, like Kindia in Guinea, this can mean a trip of 3-12 hours to reach a facility that has antivenom, greatly adding to the risk of mortality or disability from snake bites.

The following figure shows both concentration of medically important snakes and the presence or lack of antivenom production centers in this country. Looking at the figure, we can see there is very low prevalence of antivenom production in sub-saharan Africa, which is an area of great antivenom need. From this figure it becomes obvious that antivenom manufacture is not occurring in the areas with the greatest need for antivenom, which is problematic for antivenom accessibility, because of the difficulties of antivenom transport. Antivenom must be kept cold during transport, which becomes very hard to do in remote areas. Local manufacture could solve these problems, because the antivenom would be available in places where it is most needed, without having to worry about transportation.

Regional burden of SBE, national abundance of medically important snake species and national antivenom manufacturing capacity https://www.sciencedirect.com/science/article/pii/S2590171021000229

As evidenced by the low snake bite mortality rates in countries like the US and Australia, this is a problem that can be solved. The Asclepius Snakebite Foundation’s goal is to alleviate the disparity of snake bite mortalities in Sub-Saharan Africa (The Asclepius Foundation). ASF does this by providing better access to professional medical treatment and cutting down on travel time to access antivenom in Sub-Saharan Africa. ASF increases access to professional medical treatment by establishing snake bite treatment clinics in low income areas, which also cuts down on travel time necessary to access antivenom in these areas. ASF also works to train motorcycle taxi drivers in basic snake bite first aid and incentivize them to transport snake bite victims to treatment centers from remote areas, and this also helps to cut down on travel time from snake bite to antivenom access in remote areas. Addressing these two factors can drastically change snake bite outcomes in Sub-Saharan Africa. ASF also has the goal of expanding their reach to other low income areas that are disproportionately affected by snake bites. With your help, the Asclepius Snakebite Foundation can help these communities that lack the resources to effectively deal with snake bites, and they can save lives!

If you found this article helpful, please consider donating to ASF today. Every donation is tax-deductible and directly impacts the outcomes for snakebite victims worldwide.

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References

Joshua Longbottom, Freya M Shearer, Maria Devine, Gabriel Alcoba, Francois Chappuis, Daniel J Weiss, Sarah E Ray, Nicolas Ray, David A Warrell, Rafael Ruiz de Castañeda, David J Williams, Simon I Hay, David M Pigott, Vulnerability to snakebite envenoming: a global mapping of hotspots, The Lancet, Volume 392, Issue 10148, 2018, Pages 673-684, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(18)31224-8. (https://www.sciencedirect.com/science/article/pii/S0140673618312248 )

Bryan, M. (2024, July 15). Most venomous snakes. Facts.net. https://facts.net/most-venomous-snake/

Potet, J., Beran, D., Ray, N., Alcoba, G., Habib, A. G., Iliyasu, G., Waldmann, B., Ralph, R., Faiz, M. A., Monteiro, W. M., de Almeida Gonçalves Sachett, J., di Fabio, J. L., Cortés, M. de, Brown, N. I., & Williams, D. J. (2021). Access to antivenoms in the developing world: A multidisciplinary analysis. Toxicon: X, 12, 100086. https://doi.org/10.1016/j.toxcx.2021.100086

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