Why in news?

The Union Health Ministry has urged states to classify snakebites as a notifiable disease, requiring both private and public hospitals to report cases.

Diseases likely to cause outbreaks, result in fatalities, or require immediate public health action are classified as notifiable. Common examples include tuberculosis, HIV, cholera, malaria, dengue, and hepatitis.

What’s in today’s article?

• Snakebites in India
• Why Make Snakebites Notifiable?
• Challenges of treating snakebites

Snakebites in India

• Statistics
  • Snakebites pose a significant public health challenge in India, with 3-4 million cases and an estimated 58,000 deaths annually, according to the 2020 Indian Million Death Study.
• National action plan
  • To address this, the government launched the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE) earlier this year, aiming to halve snakebite deaths by 2030.
  • NAPSE recommends making snakebites a notifiable disease.
• Bites of which snakes can be fatal
  • India has over 310 snake species, 66 venomous and 42 mildly venomous.
  • Of these, 23 species are medically significant, with the majority of bites caused by the “Big Four”:
    • Indian cobra
    • Common krait
    • Russell’s viper
    • Saw-scaled viper
  • Commercial polyvalent antivenom is effective against bites from these four species and covers 80% of snakebites.
• Snakebite - a ‘Disease’
  • Snakebites can lead to acute medical emergencies that require immediate care.
  • They can cause severe paralysis that can prevent breathing, can lead to a fatal hemorrhage, and damage different tissues.
  • Snakebites need to be treated with antivenom to prevent death and severe symptoms.

Why Make Snakebites Notifiable?

• Classifying snakebites as notifiable could improve surveillance and provide precise data on cases and deaths.
• This information would help allocate antivenoms and train healthcare workers in high-risk areas.
• In a letter to state health secretaries, Union Health Secretary emphasized mandatory notification to strengthen snakebite surveillance and improve clinical management.
• High-risk states include Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh, Telangana, Rajasthan, and Gujarat.

Challenges of treating snakebites

• The challenges are mainly on three fronts:
• Treatment
  • Delayed or No Healthcare Access: Victims often do not reach healthcare centers in time or rely on faith-based healers.
  • Lack of Training: Healthcare staff often lack adequate training to treat snakebites.
  • Testing Gaps: Tests to confirm snakebites are unavailable.
• Antivenoms
  • Development of the antivenom
    • Almost all the venom that is used to develop the antivenom in the country comes from snakes caught by the Irula tribe, who live in the states of Tamil Nadu, Karnataka, and Kerala.
    • This is a major challenge, as the biochemical constituents and the effect of the venom from the same snake species may differ based on geography.
  • Venom potency changes with snake's age
    • For instance, neonatal Russell’s viper venom is more toxic than that of adults.
  • Other challenges related to antivenoms
    • Antivenoms themselves cause various reactions.
    • There are also local snake species — such as the banded krait, monocled cobra, and green pit viper in the Northeast — against which the commercially available antivenom does not work.
  • Artificial interventions
    • Due to these limitations of antivenoms, researchers are now developing artificially produced antibodies that can help neutralise the toxins across various snake species. They are also looking at artificially designed peptides to fight the toxin.
• Venom collection
  • Experts recommend creating zonal venom collection banks to account for regional venom differences.
  • However, the Wild Life (Protection) Act, 1972 restricts access to snakes, complicating efforts to establish these banks.