Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Issue 10385 (22nd April 2023)

• Record Type: Journal Article
• Authors: Warrell, David A; Williams, David J
• Is Part Of: Lancet. Volume 401:Issue 10385(2023)
• Page Start: 1382
• Page End: 1398
• Publication Date: 2023-04-22
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(23)00002-8
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: There is increasing recognition of the public health importance of snakebite envenoming. Worldwide annual incidence is likely to be 5 million bites, with mortality exceeding 150 000 deaths, and the resulting physical and psychological morbidity leads to substantial social and economic repercussions. Prevention through community education by trained health workers is the most effective and economically viable strategy for reducing risk of bites and envenoming. Clinical challenges to effective treatment are most substantial in rural areas of low-resource settings, where snakebites are most common. Classic skills of history taking, physical examination, and use of affordable point-of-care tests should be followed by monitoring of evolving local and systemic envenoming. Despite the profusion of new ideas for interventions, hyperimmune equine or ovine plasma-derived antivenoms remain the only specific treatment for snakebite envenoming. The enormous interspecies and intraspecies complexity and diversity of snake venoms, revealed by modern venomics, demands a radical redesign of many current antivenoms.