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Geoffrey K Isbister - One of the best experts on this subject based on the ideXlab platform.
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evaluating temporal patterns of Snakebite in sri lanka the potential for higher Snakebite burdens with climate change
International Journal of Epidemiology, 2018Co-Authors: D S Ediriweera, Peter J Diggle, Anuradhani Kasturiratne, A Pathmeswaran, N K Gunawardena, Shaluka Jayamanne, Geoffrey K Isbister, Andrew H DawsonAbstract:Background Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to Snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. Methods A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165 665 individuals living in 44 136 households and recorded all recalled Snakebite events that had occurred during the preceding year. Log-linear models were fitted to describe the expected number of Snakebites occurring in each month, taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and of recall bias amongst survey respondents. Results Snakebite events showed a clear seasonal variation. Typically, Snakebite incidence is highest during November–December followed by March–May and August, but this can vary between years due to variations in relative humidity, which is also a risk factor. Low relative-humidity levels are associated with high Snakebite incidence. If current climate-change projections are correct, this could lead to an increase in the annual Snakebite burden of 31.3% (95% confidence interval: 10.7–55.7) during the next 25–50 years. Conclusions Snakebite in Sri Lanka shows seasonal variation. Additionally, more Snakebites can be expected during periods of lower-than-expected humidity. Global climate change is likely to increase the incidence of Snakebite in Sri Lanka.
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the australian Snakebite project 2005 2015 asp 20
The Medical Journal of Australia, 2017Co-Authors: Chris Johnston, Margaret A Oleary, Nicole M Ryan, Colin B Page, Nicholas A Buckley, Simon G A Brown, Geoffrey K IsbisterAbstract:To describe the epidemiology, treatment and adverse events after Snakebite in Australia.Prospective, multicentre study of data on patients with Snakebites recruited to the Australian Snakebite Project (2005-2015) and data from the National Coronial Information System. Setting, participants: Patients presenting to Australian hospitals with suspected or confirmed Snakebites from July 2005 to June 2015 and consenting to participation.Demographic data, circumstances of bites, clinical effects of envenoming, results of laboratory investigations and snake venom detection kit (SVDK) testing, antivenom treatment and adverse reactions, time to discharge, deaths.1548 patients with suspected Snakebites were enrolled, including 835 envenomed patients (median, 87 per year), for 718 of which the snake type was definitively established, most frequently brown snakes (41%), tiger snakes (17%) and red-bellied black snakes (16%). Clinical effects included venom-induced consumption coagulopathy (73%), myotoxicity (17%), and acute kidney injury (12%); severe complications included cardiac arrest (25 cases; 2.9%) and major haemorrhage (13 cases; 1.6%). There were 23 deaths (median, two per year), attributed to brown (17), tiger (four) and unknown (two) snakes; ten followed out-of-hospital cardiac arrests and six followed intracranial haemorrhages. Of 597 SVDK test results for envenomed patients with confirmed snake type, 29 (4.9%) were incorrect; 133 of 364 SVDK test results for non-envenomed patients (36%) were false positives. 755 patients received antivenom, including 49 non-envenomed patients; 178 (24%), including ten non-envenomed patients, had systemic hypersensitivity reactions, of which 45 (6%) were severe (hypotension, hypoxaemia). Median total antivenom dose declined from four vials to one, but median time to first antivenom was unchanged (4.3 hours; IQR, 2.7-6.3 hours).Snake envenoming is uncommon in Australia, but is often severe. SVDKs were unreliable for determining snake type. The median antivenom dose has declined without harming patients. Improved early diagnostic strategies are needed to reduce the frequently long delays before antivenom administration.
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mapping the risk of Snakebite in sri lanka a national survey with geospatial analysis
PLOS Neglected Tropical Diseases, 2016Co-Authors: D S Ediriweera, Anuradhani Kasturiratne, A Pathmeswaran, N K Gunawardena, Shaluka Jayamanne, Geoffrey K Isbister, Andrew H Dawson, Buddhika Asiri WijayawickramaAbstract:Background There is a paucity of robust epidemiological data on Snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of Snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of Snakebite in Sri Lanka. Methodology/Principal Findings The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of Snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop Snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country’s population) were surveyed. The crude overall community incidence of Snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and Snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. Conclusions/Significance This study provides community based incidence rates of Snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region. Author Summary Snakebite is a neglected tropical disease which mainly affects the rural poor in tropical countries. There is little reliable data on Snakebite, which makes it difficult to estimate the true disease burden. Hospital statistics underestimate numbers of Snakebites because a significant proportion of victims in tropical countries seek traditional treatments. On the other hand, time limited or localized surveys may be inaccurate as they may underestimate or overestimate numbers depending on when and where they are performed. To get a truer picture of the situation in Sri Lanka, where Snakebites are an important cause of hospital admission, we undertook an island-wide community survey to determine the number of bites, envenomings and deaths due to Snakebite in the previous 12 months. We found that there were more than 80,000 bites, 30,000 envenomings and 400 deaths due to Snakebite, much more than claimed by official statistics. There was variation in numbers of bites and envenomings in different parts of the country and, using the data from our survey, we were able develop Snakebite risk maps to identify Snakebite hotspots and cold spots in the country. These maps would be useful for healthcare decision makers to allocate resources to manage Snakebite in the country. We used free and open source software and replicable methods, which we believe can be adopted to other regions where Snakebite is a public health problem.
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Snakebite in australia a practical approach to diagnosis and treatment
The Medical Journal of Australia, 2013Co-Authors: Geoffrey K Isbister, Colin B Page, Nicholas A Buckley, Simon G A Brown, David Mccoubrie, Shaun L GreeneAbstract:Snakebite is a potential medical emergency and must receive high-priority assessment and treatment, even in patients who initially appear well. Patients should be treated in hospitals with onsite laboratory facilities, appropriate antivenom stocks and a clinician capable of treating complications such as anaphylaxis. All patients with suspected Snakebite should be admitted to a suitable clinical unit, such as an emergency short-stay unit, for at least 12 hours after the bite. Serial blood testing (activated partial thromboplastin time, international normalised ratio and creatine kinase level) and neurological examinations should be done for all patients. Most Snakebites will not result in significant envenoming and do not require antivenom. Antivenom should be administered as soon as there is evidence of envenoming. Evidence of systemic envenoming includes venom-induced consumption coagulopathy, sudden collapse, myotoxicity, neurotoxicity, thrombotic microangiopathy and renal impairment. Venomous snake groups each cause a characteristic clinical syndrome, which can be used in combination with local geographical distribution information to determine the probable snake involved and appropriate antivenom to use. The Snake Venom Detection Kit may assist in regions where the range of possible snakes is too broad to allow the use of monovalent antivenoms. When the snake identification remains unclear, two monovalent antivenoms (eg, brown snake and tiger snake antivenom) that cover possible snakes, or a polyvalent antivenom, can be used. One vial of the relevant antivenom is sufficient to bind all circulating venom. However, recovery may be delayed as many clinical and laboratory effects of venom are not immediately reversible. For expert advice on envenoming, contact the National Poisons Information Centre on 13 11 26. Language: en
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a pharmacological approach to first aid treatment for Snakebite
Nature Medicine, 2011Co-Authors: Megan Saul, Geoffrey K Isbister, Paul Thomas, Peter J Dosen, Margaret A Oleary, Ian M Whyte, Sally A Mcfadden, Dirk F Van HeldenAbstract:Snakebite toxins need to be transported through the lymphatic system before gaining access to the blood. By interfering with lymphatic system function, Megan Saul et al. found that nitric oxide donors delay the fatal effects of snake venom in rats. By giving Snakebite victims more time to obtain medical care, this approach may be useful for the first-aid treatment of Snakebites.
Andrew H Dawson - One of the best experts on this subject based on the ideXlab platform.
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evaluating temporal patterns of Snakebite in sri lanka the potential for higher Snakebite burdens with climate change
International Journal of Epidemiology, 2018Co-Authors: D S Ediriweera, Peter J Diggle, Anuradhani Kasturiratne, A Pathmeswaran, N K Gunawardena, Shaluka Jayamanne, Geoffrey K Isbister, Andrew H DawsonAbstract:Background Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to Snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. Methods A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165 665 individuals living in 44 136 households and recorded all recalled Snakebite events that had occurred during the preceding year. Log-linear models were fitted to describe the expected number of Snakebites occurring in each month, taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and of recall bias amongst survey respondents. Results Snakebite events showed a clear seasonal variation. Typically, Snakebite incidence is highest during November–December followed by March–May and August, but this can vary between years due to variations in relative humidity, which is also a risk factor. Low relative-humidity levels are associated with high Snakebite incidence. If current climate-change projections are correct, this could lead to an increase in the annual Snakebite burden of 31.3% (95% confidence interval: 10.7–55.7) during the next 25–50 years. Conclusions Snakebite in Sri Lanka shows seasonal variation. Additionally, more Snakebites can be expected during periods of lower-than-expected humidity. Global climate change is likely to increase the incidence of Snakebite in Sri Lanka.
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mapping the risk of Snakebite in sri lanka a national survey with geospatial analysis
PLOS Neglected Tropical Diseases, 2016Co-Authors: D S Ediriweera, Anuradhani Kasturiratne, A Pathmeswaran, N K Gunawardena, Shaluka Jayamanne, Geoffrey K Isbister, Andrew H Dawson, Buddhika Asiri WijayawickramaAbstract:Background There is a paucity of robust epidemiological data on Snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of Snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of Snakebite in Sri Lanka. Methodology/Principal Findings The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of Snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop Snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country’s population) were surveyed. The crude overall community incidence of Snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and Snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. Conclusions/Significance This study provides community based incidence rates of Snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region. Author Summary Snakebite is a neglected tropical disease which mainly affects the rural poor in tropical countries. There is little reliable data on Snakebite, which makes it difficult to estimate the true disease burden. Hospital statistics underestimate numbers of Snakebites because a significant proportion of victims in tropical countries seek traditional treatments. On the other hand, time limited or localized surveys may be inaccurate as they may underestimate or overestimate numbers depending on when and where they are performed. To get a truer picture of the situation in Sri Lanka, where Snakebites are an important cause of hospital admission, we undertook an island-wide community survey to determine the number of bites, envenomings and deaths due to Snakebite in the previous 12 months. We found that there were more than 80,000 bites, 30,000 envenomings and 400 deaths due to Snakebite, much more than claimed by official statistics. There was variation in numbers of bites and envenomings in different parts of the country and, using the data from our survey, we were able develop Snakebite risk maps to identify Snakebite hotspots and cold spots in the country. These maps would be useful for healthcare decision makers to allocate resources to manage Snakebite in the country. We used free and open source software and replicable methods, which we believe can be adopted to other regions where Snakebite is a public health problem.
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Delayed Psychological Morbidity Associated with Snakebite Envenoming
PLOS Neglected Tropical Diseases, 2011Co-Authors: Shehan Williams, Shaluka Jayamanne, Andrew H Dawson, David G Lalloo, Nicholas A Buckley, Chamara A. Wijesinghe, H. Janaka De SilvaAbstract:Introduction The psychological impact of Snakebite on its victims, especially possible late effects, has not been systematically studied. Objectives To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among Snakebite victims. Methods The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following Snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of Snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among Snakebite victims explored common somatic symptoms attributed to envenoming. Results Previous Snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p
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delayed psychological morbidity associated with Snakebite envenoming
PLOS Neglected Tropical Diseases, 2011Co-Authors: S S Williams, Shaluka Jayamanne, Andrew H Dawson, David G Lalloo, Nicholas A Buckley, Chamara A. Wijesinghe, Janaka H De SilvaAbstract:Introduction The psychological impact of Snakebite on its victims, especially possible late effects, has not been systematically studied. Objectives To assess delayed somatic symptoms, depressive disorder, post-traumatic stress disorder (PTSD), and impairment in functioning, among Snakebite victims. Methods The study had qualitative and quantitative arms. In the quantitative arm, 88 persons who had systemic envenoming following Snakebite from the North Central Province of Sri Lanka were randomly identified from an established research database and interviewed 12 to 48 months (mean 30) after the incident. Persons with no history of Snakebite, matched for age, sex, geograpical location and occupation, acted as controls. A modified version of the Beck Depression Inventory, Post-Traumatic Stress Symptom Scale, Hopkins Somatic Symptoms Checklist, Sheehan Disability Inventory and a structured questionnaire were administered. In the qualitative arm, focus group discussions among Snakebite victims explored common somatic symptoms attributed to envenoming. Results Previous Snakebite victims (cases) had more symptoms than controls as measured by the modified Beck Depression Scale (mean 19.1 Vs 14.4; p<0.001) and Hopkins Symptoms Checklist (38.9 vs. 28.2; p<0.001). 48 (54%) cases met criteria for depressive disorder compared to 13 (15%) controls. 19 (21.6%) cases also met criteria for PTSD. 24 (27%) claimed that the Snakebite caused a negative change in their employment; nine (10.2%) had stopped working and 15 (17%) claimed residual physical disability. The themes identified in the qualitative arm included blindness, tooth decay, body aches, headaches, tiredness and weakness. Conclusions Snakebite causes significant ongoing psychological morbidity, a complication not previously documented. The economic and social impacts of this problem need further investigation.
Jose Maria Gutierrez - One of the best experts on this subject based on the ideXlab platform.
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Snakebite envenoming in children a neglected tropical disease in a costa rican pediatric tertiary care center
Acta Tropica, 2019Co-Authors: Helena Breneschacon, Jose Maria Gutierrez, Kattia Camachobadilla, Alejandra Sorianofallas, Rolando Ulloagutierrez, Kathia Valverdemunoz, Maria L AvilaagueroAbstract:Abstract Background Introduced in June 2017 by the World Health Organization (WHO) as a Neglected Tropical Diseases, Snakebite envenoming is a global health problem. In Costa Rica, an incidence of 15 per 100,000 inhabitants and a mortality rate of 0.15 per 100,000 inhabitants per year were reported from 2005–2012. Children are also affected and prone to complications. Methods Retrospective descriptive 14-year study of children with envenomings by Viperidae Snakebites managed at the tertiary pediatric hospital in Costa Rica. Findings 80 patients (pts) were included and classified as having mild (17 pts, 29.3%), moderate (58 pts, 72.5%) or severe (5 pts, 6.2%) envenoming. 52/80 (65%) patients received treatment within the first four hours, three (3.75%) between 5–8 h, three between 9–12 h, four (4%) between 13–16 h, two (2.5%) between 17–20 h, and seven (8.75%) after 20 h. Edema was documented in 76/80 (95%), pain in 58 (72.5%), local bleeding in 23 (28.8%), emesis in 10 (12.5%), bullae formation in 8 (10%), and tissue necrosis in three (3.8%) pts. Complications presented according with degree of envenoming, being more common in severe cases: wound infection occurred in 14/58 (24.1%) with moderate envenoming and 5/5 pts with severe envenoming (p
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from fangs to pharmacology the future of Snakebite envenoming therapy
Current Pharmaceutical Design, 2016Co-Authors: Andreas Hougaard Laustsen, Jose Maria Gutierrez, Mikael Engmark, Christina Milbo, Jonas Johannesen, Bruno Lomonte, Brian LohseAbstract:The snake is the symbol of medicine due to its association with Asclepius, the Greek God of medicine, and so with good reasons. More than 725 species of venomous snakes have toxins specifically evolved to exert potent bioactivity in prey or victims, and Snakebites constitute a public health hazard of high impact in Asia, Africa, Latin America, and parts of Oceania. Parenteral administration of antivenoms is the mainstay in Snakebite envenoming therapy. However, despite well-demonstrated efficacy and safety of many antivenoms worldwide, they are still being produced by traditional animal immunization procedures, and therefore present a number of drawbacks. Technological advances within biopharmaceutical development and medicinal chemistry could pave the way for rational drug design approaches against snake toxins. This could minimize the use of animals and bring forward more effective therapies for Snakebite envenomings. In this review, current stateof- the-art in biopharmaceutical antitoxin development is presented together with an overview of available bioinformatics and structural data on snake venom toxins. This growing body of scientific and technological tools could define the basis for introducing a rational drug design approach into the field of Snakebite envenoming therapy.
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a call for incorporating social research in the global struggle against Snakebite
PLOS Neglected Tropical Diseases, 2015Co-Authors: Jose Maria Gutierrez, David A Warrell, Thierry Burnouf, Robert A Harrison, Juan J Calvete, Nick Brown, S Jensen, David J WilliamsAbstract:In Africa, Asia, Latin America, and parts of Oceania, envenoming after Snakebite is a serious public health problem [1]. Conservative data suggest that between 1.2 and 5.5 million people suffer Snakebites every year, resulting in 25,000 to 125,000 deaths and leaving approximately 400,000 victims with permanent sequelae [2,3]. Despite its significant impact on human health, this disease remains largely neglected by national and international health authorities, funding agencies, pharmaceutical companies, patients’ organizations, and health advocacy groups [1,2]. Most initiatives aiming to study snakes, snake venoms, and Snakebite envenoming and its treatment approach the problem from a biomedical and technological perspective. Notwithstanding the substantial scientific and clinical legacy generated through this view, significant gaps remain in our understanding of other highly relevant aspects of this problem and its solutions. The emerging field of global health has brought about a more holistic approach to health issues by incorporating a “biosocial approach” to the understanding of diseases and the circumstances behind their occurrence [4]. The centrepiece of this approach is the integration of biomedical aspects—including etiology, pathophysiology, diagnosis, and therapy—with the analysis of the social, economic, psychological, cultural, and political contexts in which diseases occur. Snakebite envenoming is predominantly a disease of the poor [5], with the highest incidence and severity seen in regions facing complex and interrelated social and economic problems. Understanding how this interplay of variables influences both the circumstances leading to Snakebite injury and its consequences is crucial to developing successful strategies to mitigate the problem. A comprehensive multidisciplinary approach incorporating social research into the study of Snakebite envenoming is needed. Hereby, we aim to increase awareness of the following areas where reinvigorated social research would be highly beneficial.
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current challenges for confronting the public health problem of Snakebite envenoming in central america
Journal of Venomous Animals and Toxins Including Tropical Diseases, 2014Co-Authors: Jose Maria GutierrezAbstract:Snakebite envenoming is a serious public health problem in Central America, where approximately 5,500 cases occur every year. Panama has the highest incidence and El Salvador the lowest. The majority, and most severe, cases are inflicted by the pit viper Bothrops asper (family Viperidae), locally known as ‘terciopelo’, ‘barba amarilla’ or ‘equis’. About 1% of the bites are caused by coral snakes of the genus Micrurus (family Elapidae). Despite significant and successful efforts in Central America regarding Snakebite envenomings in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, and prevention of Snakebites, much remains to be done in order to further reduce the impact of this medical condition. This essay presents seven challenges for improving the confrontation of Snakebite envenoming in Central America. Overcoming these challenges demands a coordinated partnership of highly diverse stakeholders though inter-sectorial and inter-programmatic interventions.
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antivenom for Snakebite envenoming in sri lanka the need for geographically specific antivenom and improved efficacy
Toxicon, 2013Co-Authors: Daniel E Keyler, Jose Maria Gutierrez, Indika Gawarammana, K H Sellahewa, Kimberly Mcwhorter, Roy MalleappahAbstract:Sri Lanka is a tropical developing island nation that endures significant economic and medical burden as a result of Snakebite envenomation, having not only a high prevalence of envenomations, but also one of the highest incidence rates (200 Snakebites/ 100,000 people/year) of venomous Snakebite in the world (Kasturiratne et al., 2005). Ironically, the very snakes responsible for this human morbidity and mortality are a valuable biomedical and ecological national resource, despite the medical and economic consequences of envenomation. Currently, no snake antivenom is produced using venoms from native Sri Lankan snakes as immunogens, and there is a true need for an efficacious Sri Lanka, poly-specific snake antivenom. An approach to fulfilling this need via combining the scientific, technological and economical resources from Costa Rica and the United States with the knowledge and talent of Sri Lankan official governmental agencies, legal counsels, environmental, medical and veterinary academic institutions, and religious and cultural leaders has been initiated, coordinated and funded by Animal Venom Research International (AVRI), a nonprofit charity. This bridging of nations and the cooperative pooling of their resources represents a potential avenue for antivenom development in a developing country that suffers the consequences of few specific resources for the medical management of venomous Snakebite. The desired final outcome of such an endeavor for Sri Lanka is, most importantly, improved medical outcomes for Snakebite patients, with enhanced and expanded science and technology relating to snake venoms and anti- venoms, and the collateral benefits of reduced economic cost for the country.
D S Ediriweera - One of the best experts on this subject based on the ideXlab platform.
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evaluating temporal patterns of Snakebite in sri lanka the potential for higher Snakebite burdens with climate change
International Journal of Epidemiology, 2018Co-Authors: D S Ediriweera, Peter J Diggle, Anuradhani Kasturiratne, A Pathmeswaran, N K Gunawardena, Shaluka Jayamanne, Geoffrey K Isbister, Andrew H DawsonAbstract:Background Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to Snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. Methods A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165 665 individuals living in 44 136 households and recorded all recalled Snakebite events that had occurred during the preceding year. Log-linear models were fitted to describe the expected number of Snakebites occurring in each month, taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and of recall bias amongst survey respondents. Results Snakebite events showed a clear seasonal variation. Typically, Snakebite incidence is highest during November–December followed by March–May and August, but this can vary between years due to variations in relative humidity, which is also a risk factor. Low relative-humidity levels are associated with high Snakebite incidence. If current climate-change projections are correct, this could lead to an increase in the annual Snakebite burden of 31.3% (95% confidence interval: 10.7–55.7) during the next 25–50 years. Conclusions Snakebite in Sri Lanka shows seasonal variation. Additionally, more Snakebites can be expected during periods of lower-than-expected humidity. Global climate change is likely to increase the incidence of Snakebite in Sri Lanka.
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mapping the risk of Snakebite in sri lanka a national survey with geospatial analysis
PLOS Neglected Tropical Diseases, 2016Co-Authors: D S Ediriweera, Anuradhani Kasturiratne, A Pathmeswaran, N K Gunawardena, Shaluka Jayamanne, Geoffrey K Isbister, Andrew H Dawson, Buddhika Asiri WijayawickramaAbstract:Background There is a paucity of robust epidemiological data on Snakebite, and data available from hospitals and localized or time-limited surveys have major limitations. No study has investigated the incidence of Snakebite across a whole country. We undertook a community-based national survey and model based geostatistics to determine incidence, envenoming, mortality and geographical pattern of Snakebite in Sri Lanka. Methodology/Principal Findings The survey was designed to sample a population distributed equally among the nine provinces of the country. The number of data collection clusters was divided among districts in proportion to their population. Within districts clusters were randomly selected. Population based incidence of Snakebite and significant envenoming were estimated. Model-based geostatistics was used to develop Snakebite risk maps for Sri Lanka. 1118 of the total of 14022 GN divisions with a population of 165665 (0.8%of the country’s population) were surveyed. The crude overall community incidence of Snakebite, envenoming and mortality were 398 (95% CI: 356–441), 151 (130–173) and 2.3 (0.2–4.4) per 100000 population, respectively. Risk maps showed wide variation in incidence within the country, and Snakebite hotspots and cold spots were determined by considering the probability of exceeding the national incidence. Conclusions/Significance This study provides community based incidence rates of Snakebite and envenoming for Sri Lanka. The within-country spatial variation of bites can inform healthcare decision making and highlights the limitations associated with estimates of incidence from hospital data or localized surveys. Our methods are replicable, and these models can be adapted to other geographic regions after re-estimating spatial covariance parameters for the particular region. Author Summary Snakebite is a neglected tropical disease which mainly affects the rural poor in tropical countries. There is little reliable data on Snakebite, which makes it difficult to estimate the true disease burden. Hospital statistics underestimate numbers of Snakebites because a significant proportion of victims in tropical countries seek traditional treatments. On the other hand, time limited or localized surveys may be inaccurate as they may underestimate or overestimate numbers depending on when and where they are performed. To get a truer picture of the situation in Sri Lanka, where Snakebites are an important cause of hospital admission, we undertook an island-wide community survey to determine the number of bites, envenomings and deaths due to Snakebite in the previous 12 months. We found that there were more than 80,000 bites, 30,000 envenomings and 400 deaths due to Snakebite, much more than claimed by official statistics. There was variation in numbers of bites and envenomings in different parts of the country and, using the data from our survey, we were able develop Snakebite risk maps to identify Snakebite hotspots and cold spots in the country. These maps would be useful for healthcare decision makers to allocate resources to manage Snakebite in the country. We used free and open source software and replicable methods, which we believe can be adopted to other regions where Snakebite is a public health problem.
Jean-philippe Chippaux - One of the best experts on this subject based on the ideXlab platform.
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Snakebite envenomation turns again into a neglected tropical disease
Journal of Venomous Animals and Toxins Including Tropical Diseases, 2017Co-Authors: Jean-philippe ChippauxAbstract:On June 9th, 2017 WHO categorized Snakebite envenomation into the Category A of the Neglected Tropical Diseases. This new situation will allow access to new funding, paving the way for wider and deeper researches. It should also expand the accessibility of antivenoms. Let us hope that it also leads to cooperation among stakeholders, aiming at improving the management of Snakebites in developing countries.
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incidence and mortality due to Snakebite in the americas
PLOS Neglected Tropical Diseases, 2017Co-Authors: Jean-philippe ChippauxAbstract:Background Better knowledge of the epidemiological characteristics of Snakebites could help to take measures to improve their management. The incidence and mortality of Snakebites in the Americas are most often estimated from medical and scientific literature, which generally lack precision and representativeness. Methodology/Principal findings Authors used the notifications of Snakebites treated in health centers collected by the Ministries of Health of the American countries to estimate their incidence and mortality. Data were obtained from official reports available on-line at government sites, including those of the Ministry of Health in each country and was sustained by recent literature obtained from PubMed. The average annual incidence is about 57,500 snake bites (6.2 per 100,000 population) and mortality is close to 370 deaths (0.04 per 100,000 population), that is, between one third and half of the previous estimates. The incidence of Snakebites is influenced by the abundance of snakes, which is related to (i) climate and altitude, (ii) specific preferences of the snake for environments suitable for their development, and (iii) human population density. Recent literature allowed to notice that the severity of the bites depends mainly on (i) the snake responsible for the bite (species and size) and (ii) accessibility of health care, including availability of antivenoms. Conclusions/Significances The main limitation of this study could be the reliability and accuracy of the notifications by national health services. However, the data seemed consistent considering the similarity of the incidences on each side of national boundaries while the sources are distinct. However, Snakebite incidence could be underestimated due to the use of traditional medicine by the patients who escaped the reporting of cases. However, gathered data corresponded to the actual use of the health facilities, and therefore to the actual demand for antivenoms, which should make it possible to improve their management.
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Appraisal of Snakebite incidence and mortality in Bolivia
Toxicon, 2014Co-Authors: Jean-philippe Chippaux, Jorge PostigoAbstract:Abstract No information has been yet published on Snakebite in Bolivia. The country includes very different ecological situations leading to various epidemiological risks. A study has been carried out to evaluate the incidence and location of Snakebite, particularly in relation with altitude, in order to improve management. Investigations on Snakebite epidemiology were based on a) cases treated in health facilities as reported by health authorities and b) household surveys carried out in areas with high variations of altitude, in various regions of Bolivia. An average of 700 bites was treated each year in Bolivia (national annual incidence = 8 bites per 100,000 people) with a great disparity between districts. Household surveys showed annual incidences ranged from 30 to 110 bites per 100,000 inhabitants depending on location. Annual mortality ranged 0.1–3.9 per 100,000 people. A significant and constant inverse correlation was shown between Snakebite incidence and altitude, which may be explained by both snake and human distributions and activities. Notification of Snakebite is useful for improving patient management and informing antivenom distribution. It should also involve the report of deaths and clinical details of envenomation.
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Epidemiology of Snakebite and use of antivenom in Argentina
Transactions of The Royal Society of Tropical Medicine and Hygiene, 2014Co-Authors: Jorge A Dolab, Adolfo Rafael De Roodt, Ernesto Horacio De Titto, Susana Isabel García, Raúl F Funes, Oscar D. Salomon, Jean-philippe ChippauxAbstract:Results: A total of 8083 completed questionnaires was collected between 1978 and 1998. The annual incidence of Snakebite was 1.8 bites per 100 000 inhabitants, with a high geographical heterogeneity; in the northern provinces of the country, the incidence can exceed 150 Snakebites per 100 000 people per year. Bothrops (pit viper) bites predominated, accounting for 96.6% (6720/6957) of envenomations; bites from Crotalus (rattlesnake) accounted for 2.8% (195/6957), and bites from Micrurus (coral snake) for 0.6% (42/6957). Most patients were young men, who were generally bitten during agricultural activities, i.e. while working in the fields. Most Snakebites (78.9%, 5852/7419) were to the lower limb, including 58.3% (4322/7419) to the foot. The case fatality rate was ,0.04% (3/8083). Most envenomations (90%, 7275/8083) were treated with specific antivenom during the first 4 h after the bite. The median dose of antivenom was two vials for viper bites (Bothrops and Crotalus) and three vials for Micrurus bites. Conclusion: These preliminary results should enable manufacturers to increase the availability of appropriate antivenom and health authorities to improve the management of Snakebites where they are most common.
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Epidemiology of Snakebites in Europe: a systematic review of the literature.
Toxicon, 2011Co-Authors: Jean-philippe ChippauxAbstract:Abstract Snakebites are rare medical emergency cases in Europe but may sometimes be severe and lead to complications. A better knowledge of Snakebite epidemiology may help health authorities to better understand therapeutic requirements, especially concerning antivenoms, and thus improve treatment of Snakebite. An extensive literature search for studies and articles published between 1970 and 2010 was performed. Both indexed and non-indexed articles were examined, the analysis of which took into account the heterogeneity between the studies and weighted the studies according to size of the study population covered. Most of the articles involved hospitalized patients who represented more than 90% of Snakebites. Incidence, mortality and population at risk were estimated after stratification into three regions (northern, central and southern Europe) based both on viper species distribution and climatic characteristics. There was no significant variation in incidence from the north to the south of Europe. In the whole of Europe, including European Russia and Turkey, the annual number of Snakebite cases was estimated at 7992 [CI 95% = 6860–9178] bites, out of which approximately 15% were considered severe (grade 3). These bites usually occurred between May and September, with a more dispersed distribution in southern Europe. The average number of deaths per annum was 4 [0.7–7.7]. Children and male victims are more affected, contrary to what one would expect given their respective proportion in the entire population. Both upper and lower limb bites were recorded at an equal frequency while the bites in other parts of the body were very rare. Immunotherapy was prescribed in one out of three Snakebites in Europe, with a very high geographical variability, in spite of excellent tolerance, at least considering highly-purified immunoglobulin fragments. Snakebites are uncommon in Europe but can cause life-threatening envenomation. Fragments of highly-purified immunoglobulins are now very well tolerated and dramatically reduce both severity and mortality of Snakebites when used in treatment.
