tag:theconversation.com,2011:/ca/topics/snakebite-33165/articlessnakebite – The Conversation2024-03-17T08:37:05Ztag:theconversation.com,2011:article/2244112024-03-17T08:37:05Z2024-03-17T08:37:05ZSnakebites: we thought we’d created a winning new antivenom but then it flopped. Why that turned out to be a good thing<figure><img src="https://images.theconversation.com/files/579144/original/file-20240301-30-2x5qov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A _Bothrops asper_ is prepared for its venom to be milked to use in making antivenom.</span> <span class="attribution"><span class="source">Jon G. Fuller/VWPics/Universal Images Group</span></span></figcaption></figure><p>Snakebites kill <a href="https://www.nature.com/articles/nrdp201763">over 100,000 people each year</a>, and hundreds of thousands of survivors are left with long-term disabilities such as amputations.</p>
<p>Africa, Asia and Latin America are <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009073">the regions most heavily affected</a>. The most venomous snakes in Africa are the <a href="https://theconversation.com/why-knowing-what-black-mamba-venom-does-to-the-human-body-is-crucial-121386">black mamba</a>, cobras and saw-scaled and carpet vipers. In Asia, the Indian cobra, Russel’s viper, saw-scaled viper and common krait are the most venomous.</p>
<p>In the Central America and northern South America regions, the <a href="https://www.britannica.com/animal/viper-snake">venomous pit viper</a> <em>Bothrops asper</em> <a href="https://pubmed.ncbi.nlm.nih.gov/22146491/">is responsible for most of the fatal and harmful bites</a>.</p>
<p>We are venom and antivenom specialists who spent four years developing a therapeutic antibody to mitigate the effects of the pit viper’s bites. We were certain that we’d met all the standards for an effective, safe and efficacious antivenom. But, at the last hurdle, <a href="https://www.nature.com/articles/s41467-023-42624-5">we realised</a> the antibody didn’t neutralise the snake’s toxins: it enhanced them, worsening the venom’s effects.</p>
<p>Initially this was, of course, very disappointing. But it was also a valuable lesson. By reporting this new way that future antivenoms can fail, we have highlighted a problem with the <a href="https://iris.who.int/bitstream/handle/10665/255657/9789241210133-eng.pdf#page=217">current recommendations for testing antivenoms</a> that was hidden until now.</p>
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<a href="https://theconversation.com/mozambique-had-no-data-about-snakebites-our-new-study-filled-the-gap-and-the-results-are-scary-192106">Mozambique had no data about snakebites. Our new study filled the gap -- and the results are scary</a>
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<p>Our lesson is likely to have a much larger impact on the development of snakebite treatments than if the antibody had been a success, because the discovery will help antivenom researchers focus their efforts so they don’t fail at the last hurdle as we did. </p>
<h2>Developing our antivenom</h2>
<p>A large percentage of <em>B. asper’s</em> venom consists of potent muscle-damaging molecules called phospholipases A₂ (PLA₂s) and PLA₂-like toxins. These have <a href="https://pubmed.ncbi.nlm.nih.gov/36632869/">severe effects</a>, often leading to irreversible damage and disability. </p>
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Read more:
<a href="https://theconversation.com/finally-snakebite-is-getting-more-attention-as-a-tropical-health-issue-131016">Finally, snakebite is getting more attention as a tropical health issue</a>
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<p>Myotoxin II, a formidable PLA₂-like toxin within <em>B. asper’s</em> arsenal, is particularly significant. The precise mechanisms that underlie myotoxin II’s action aren’t fully understood. It is known to exert its effects locally, binding to muscle fibres and triggering muscle damage. This localised action poses a challenge for traditional antivenom treatments.</p>
<p>We have attempted to develop human monoclonal antibodies that target and neutralise this membrane-disrupting myotoxin II. For the first four years of our research project, the antibodies we discovered kept showing impressive effects in neutralising myotoxin II. </p>
<p>Even when tested in living mice, using the current gold standard for antivenom testing, the antibodies continuously showed impressive neutralisation. However, for our most promising antibody, we wanted to go a step further and carry out an experiment that more closely resembled a human envenoming, in which the antibody is injected after injection of the venom. </p>
<p>The results of this additional experiment were equal parts disappointing and surprising. Our most promising antibody in this last experiment changed its toxin-neutralising effect to toxin-enhancing instead, as we’ve <a href="https://www.nature.com/articles/s41467-023-42624-5">documented in a research paper</a>. </p>
<p>The results were so surprising that we decided to immediately repeat the experiment. We thought something must’ve gone wrong, like the antibody or other materials having gone bad. However, the results remained the same.</p>
<p>This curious phenomenon, which we termed “antibody-dependent enhancement of toxicity”, represents a novel discovery in toxin immunology. Similar phenomena have been observed in other contexts, such as with <a href="https://pubmed.ncbi.nlm.nih.gov/19307220/">poisonous mushrooms</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/3188055/">bacterial toxins</a>, but never before with toxins from the animal kingdom. </p>
<p>Additional studies will be needed to fully understand what causes antibody-dependent enhancement of toxicity. </p>
<h2>Reassessing preclinical models</h2>
<p>There’s good news about this failure. It’s a chance for antivenom researchers all over the world, no matter what snake species they’re working with, to reassess their preclinical models (like the <a href="https://iris.who.int/bitstream/handle/10665/255657/9789241210133-eng.pdf#page=217">current gold standard model</a>).</p>
<p>We also think antivenom researchers should consider incorporating more sophisticated experiments like the ones used in our study, which more closely resemble a real-life envenoming case. By doing so, the antivenom research community can streamline the drug discovery process. This will expedite the identification and development of safer and more effective snakebite treatments.</p><img src="https://counter.theconversation.com/content/224411/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andreas Hougaard Laustsen receives funding from Wellcome, the European Research Council, the Villum Foundation, and Innovation Fund Denmark. </span></em></p><p class="fine-print"><em><span>Bruno Lomonte receives funding from Vicerrectoría de Investigación, Universidad de Costa Rica, Costa Rica.</span></em></p><p class="fine-print"><em><span>Julián Fernández receives funding from Vicerrectoría de Investigación, Universidad de Costa Rica, Costa Rica. </span></em></p><p class="fine-print"><em><span>Christoffer Vinther Sørensen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>By reporting this new way that future antivenoms can fail, the research has highlighted a problem with current antivenom testing recommendations.Christoffer Vinther Sørensen, Postdoctoral researcher, Department of Biotechnology and Biomedicine, Center for Antibody Technologies, Technical University of DenmarkAndreas Hougaard Laustsen, Professor & Center Director at the Department of Biotechnology and Biomedicine, Technical University of DenmarkBruno Lomonte, Emeritus Professor, Instituto Clodomiro Picado, Universidad de Costa RicaJulián Fernández, Researcher at Instituto Clodomiro Picado, Universidad de Costa RicaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2246642024-03-05T16:05:39Z2024-03-05T16:05:39ZWe’re a step closer to having a universal antivenom for snake bites – new study<p>If you’re bitten by a venomous snake, the medicine you need is antivenom. Unfortunately, antivenoms are species specific, meaning you need to have the right antivenom for the snake that bit you. Most of the time, people have no idea what species of snake has bitten them. And for some snakes, antivenoms are simply not available. </p>
<p><a href="https://www.science.org/doi/full/10.1126/scitranslmed.adk1867">New research</a> my colleagues and I conducted provides a significant step forward in enabling the development of an antivenom that will neutralise the effects of venom from any venomous snake: a so-called “universal antivenom”. </p>
<p>In our paper, published in Science Translational Medicine, we describe the discovery and development of a laboratory-made antibody that can neutralise a neurotoxin (a toxin that acts on the nervous system) found in the venom of many types of snake around the world.</p>
<p>Venomous snakes kill as many as <a href="https://www.who.int/news-room/fact-sheets/detail/snakebite-envenoming#:%7E:text=An%20estimated%205.4%20million%20people,are%20caused%20by%20snakebites%20annually.">138,000 people</a> each year, with many more survivors suffering from life-changing injuries and mental trauma. Children and farmers make up the bulk of the victims. </p>
<p>The active ingredients in antivenoms are anti-toxin antibodies. They are made by injecting horses with small quantities of snake venom and harvesting the antibodies. This method of making antivenom has remained the same for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9634357/#b0005">over a century</a> – and it has substantial drawbacks. </p>
<p>In addition to antivenoms being species specific, they are also not very potent, so you need lots of antivenom to neutralise the venom from a bite. </p>
<p>Also, because antivenoms are made in horses, you are highly likely to experience severe side-effects when administered, as your body’s immune system will detect and react to the “foreign” horse antibodies circulating in your bloodstream. </p>
<p>Antibodies that are made in the laboratory using genetically modified cells are routinely used in humans to treat <a href="https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/monoclonal-antibodies#how-do-monoclonal-antibodies-work-against-cancer">cancers</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775886/">immune disorders</a>. A long-held hope is that the technology used to produce these antibodies can be used to make antivenom and eventually replace traditional antivenoms, thereby solving many of the issues current antivenoms face.</p>
<p>The antibodies in lab-made antivenoms could be “humanised”, a process that tricks your immune system into thinking foreign antibodies are your own antibodies. This might reduce the rate of severe side-effects that are commonly encountered with horse-derived antivenoms. </p>
<h2>Paralysis and death avoided</h2>
<p>One of the most important families of toxins in snake venoms are neurotoxins. </p>
<p>These toxins prevent nerve signals from travelling from your brain to your muscles, paralysing them. This includes paralysing the muscles that inflate and deflate your lungs, so prey and human victims quickly stop breathing and die. </p>
<p>These neurotoxins are in the venoms of some of the world’s most deadly snakes, including the African black mamba, the Asian monocled cobra and king Cobra, and the deadly kraits of the Indian subcontinent. </p>
<p>In our research, we describe the discovery and development of a lab-made humanised antibody that can neutralise key venom neurotoxins from diverse snakes from diverse regions. </p>
<p>The lab-made antibody is called 95Mat5 and was discovered after examining 50 billion unique antibodies to find ones capable of not only recognising the neurotoxin in the venoms of many species but also able to neutralise its deadly effects. </p>
<p>When injected into mice that had received lethal doses of venom, 95Mat5 was able to prevent paralysis and death in all the venoms tested. </p>
<p>These results are particularly exciting as they show that generating lab-made antibodies that can broadly neutralise the effects of venoms from many species is feasible, making the development of a universal antivenom a realistic prospect. </p>
<p>However, 95Mat5 is a single antibody that only works against neurotoxins. As we said earlier, to make a universal antivenom you will require a handful of antibodies. This is because snake venoms don’t just consist of neurotoxins. </p>
<p>Some snake venoms have haemotoxins, which make you bleed, and some have cytotoxins, which destroy skin and bone. To create a universal antivenom, capable of treating any bite from any snake, we still need to identify additional antibodies that can broadly and potently neutralise the other toxin types, in the same manner as 95Mat5. </p>
<p>We hope that once identified, these antibodies can be mixed with 95Mat5 to make an antivenom that is capable of neutralising the venom of any snake, no matter what toxin types it possesses. </p>
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<img alt="Person milking a snake" src="https://images.theconversation.com/files/579412/original/file-20240303-24-3b1s50.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579412/original/file-20240303-24-3b1s50.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579412/original/file-20240303-24-3b1s50.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579412/original/file-20240303-24-3b1s50.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579412/original/file-20240303-24-3b1s50.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579412/original/file-20240303-24-3b1s50.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579412/original/file-20240303-24-3b1s50.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A universal antivenom would make milking snakes a thing of the past.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/milking-cobra-snake-venom-thailand-1580384338">Ali _Cobanoglu/Shutterstock</a></span>
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<p>The requirement for antibodies for other venom toxins and also the need to ensure any new lab-made antivenom for effectiveness and safety in human trials means it will still take many years for a universal antivenom to become available to snakebite victims. </p>
<p>Other hurdles need to be overcome. These new antivenoms will probably need to be stored in a fridge to prevent loss of effectiveness, so it will need to be shown that they can be distributed in often warm regions of the world that don’t have reliable electricity for refrigeration. </p>
<p>Lab-made antibodies are some of the most expensive drugs on the planet. While we are hopeful, it remains to be seen if lab-made antivenoms will be affordable for most snakebite victims, who are usually some of the poorest people in the world.</p><img src="https://counter.theconversation.com/content/224664/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stuart Ainsworth receives funding from United Kingdom Research and Innovation and the National Centre for the Replacement, Reduction and Refinement of Animals in Research. </span></em></p><p class="fine-print"><em><span>Camille Abada receives funding from the Medical Research Council, UK.</span></em></p>We’re still using century-old technology to make snake antivenom. A method fit for the 21st century is on the horizon.Stuart Ainsworth, Senior Lecture and UKRI Future Leader Fellow, University of LiverpoolCamille Abada, PhD Candidate, Antibodies, Liverpool School of Tropical MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2171112023-11-08T13:53:13Z2023-11-08T13:53:13ZDo you like snakes, lizards and frogs? Why herpetology might be the career for you<figure><img src="https://images.theconversation.com/files/557734/original/file-20231106-23-lkg44h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The author handling a boomslang as part of her work with a conservation organisation.</span> <span class="attribution"><span class="source">Chris Cooke</span>, <span class="license">Author provided</span></span></figcaption></figure><p>We are so fortunate to share the world with a huge diversity of creatures. For me, some of the most fascinating are reptiles and amphibians. Collectively called <a href="https://www.dec.ny.gov/docs/administration_pdf/0220c4kherps.pdf">herpetofauna</a>, reptiles and amphibians are ectotherms; they rely on external sources to regulate their body temperature.</p>
<p>A person like me who works with these groups of animals is called a herpetologist. Among the reptiles and amphibians, my special interest is in snakes. I’ve always been interested in reptiles, from the days when I would chase common flat lizards in the Motobo Hills in Zimbabwe, where I grew up, and interact with snakes and other animals at our local rehabilitation centre. </p>
<p>Still, if somebody had told my teenage self that my job would entail working with snakes and encouraging other people to appreciate them, I never would have believed them. I didn’t even know you could make a career out of working with reptiles. Today, I’m studying towards my PhD in herpetology (which is technically a degree in ecology and conservation) while also working with a snake conservation organisation in South Africa.</p>
<h2>Learning about snakes</h2>
<p>Most people will be familiar with zoology, the branch of biology that focuses on the study of all animals. Some animals have their own speciality within the discipline of zoology. Herps (a slang term for herpetofauna) are one example.</p>
<p>There are <a href="http://www.reptile-database.org/db-info/SpeciesStat.html">over 4,000 species</a> of snakes around the world. Each species has a unique adaptation to its own environment. Some snakes, like <a href="https://theconversation.com/the-ultimate-in-stealth-puff-adders-employ-camouflage-at-every-level-53316">puff adders</a>, are scentless as a way to camouflage themselves from predators. Others, like southern African pythons, <a href="https://theconversation.com/new-insights-into-how-southern-african-pythons-look-after-their-babies-91276">show maternal care</a>, which is very unusual for snakes and much more common in mammals and birds. </p>
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<a href="https://theconversation.com/the-ultimate-in-stealth-puff-adders-employ-camouflage-at-every-level-53316">The ultimate in stealth, puff adders employ camouflage at every level</a>
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<p>These unique adaptations have allowed snakes to thrive in different environments. This makes them a great model in science: herpetologists can ask questions about their physiology, evolution, ecology and biology.</p>
<p>For anyone looking to become a herpetologist, a basic zoology degree will get you started. Most universities will have someone who specialises in teaching herpetology or someone who can point you in the right direction. Volunteering at institutions that have reptiles, like zoos, is also a great way to get some experience working with them. Once you get to postgraduate level, you can specialise in one of many different topics in herpetology and apply different techniques to answer questions that you are curious about. </p>
<p>As a specialist in reptiles and amphibians, you can merge that interest with other disciplines like photography, law or conservation, and this can open up many job opportunities. You can also pursue further research at a university, become a lecturer or school teacher, work at a zoo or become a museum curator. There are many options to explore. </p>
<h2>My research</h2>
<p>I completed my MSc in 2017 and my research focused on the evolution of diet in a group of snakes called <a href="https://wiredspace.wits.ac.za/items/2d772155-77f6-4f7c-94db-b3e59fb0b22a">lamprophiids</a>. I loved learning about how diverse snakes are in the food they eat. For my PhD, I wanted my research to have a real-world application, so I waited until 2021 to start after getting some work experience in conservation. </p>
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<a href="https://theconversation.com/new-insights-into-how-southern-african-pythons-look-after-their-babies-91276">New insights into how southern African pythons look after their babies</a>
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<p><a href="https://hiralnaik.wordpress.com/contact-info/publications/">My current research</a> focuses on the way that snakes behave (behavioural ecology) to answer some of the bigger question of what leads snakes to bite people. Another year and I will have some answers for you on this. </p>
<p>Snakebite is a <a href="https://www.who.int/health-topics/snakebite">neglected tropical disease</a> according to the World Health Organization and affects millions of people around the world. When natural spaces are transformed and destroyed, many animals, like snakes, go looking for food and shelter – often in people’s homes. Many people are afraid of snakes, so encounters often lead to conflict as people try to kill the animals and get bitten in the process. </p>
<p>I am also fortunate to work for a non-profit organisation, <a href="https://savethesnakes.org/">Save The Snakes</a>, which allows me to educate people about snakes and do my part to conserve them by applying my research. My job includes researching information on snakes that live in different parts of South Africa and assessing threats to them, like habitat transformation, learning more about the relationship between humans and snakes, conducting fieldwork and running experiments to understand more about the behaviour and ecology of snakes.</p>
<h2>The circle of life</h2>
<p>I’m also passionate about education.</p>
<p>Learning about the world of snakes has allowed me to appreciate the natural world in a unique way. <a href="https://youtu.be/ltQcE0gapIo">As predators and prey</a>, snakes are an emblem of the circle of life. One of my favourite activities is going out at night looking for them (called “herping”) and watching them display different behaviours. After the summer rains, frogs and insects come out and the snake predators follow. When I take these moments to observe the world around me I feel fortunate to appreciate these animals in a way most people don’t. This is the feeling I like to share in my education efforts.</p>
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<p>Some of my favourite moments in my current job have involved seeing the change in people’s perceptions about snakes. Snakes have been feared for many generations because of misinformation. Most snakes are harmless. They don’t chase people, and they stay hidden much of the time. By sharing the correct information about snakes, we show that fear can be changed to curiosity and that creates more motivation to learn about them.</p><img src="https://counter.theconversation.com/content/217111/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hiral Naik has received funding from the National Research Foundation. She is affiliated with Save The Snakes.</span></em></p>Learning about snakes offers unique insights into the natural world.Hiral Naik, PhD candidate: School of Animal, Plant and Environmental Sciences, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921062022-10-12T14:08:31Z2022-10-12T14:08:31ZMozambique had no data about snakebites. Our new study filled the gap – and the results are scary<figure><img src="https://images.theconversation.com/files/488755/original/file-20221007-7785-4xd2be.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Stiletto Snake is one of the species found in Mozambique. </span> <span class="attribution"><span class="source">extinctorshy.org - Ali Puruleia</span></span></figcaption></figure><p>Every year between 20,000 and 32,000 people in sub-Saharan Africa die after being <a href="https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/snakebite">bitten by snakes</a>. That’s more than five times the number of deaths caused by <a href="https://www.nationalgeographic.com/animals/article/hippos-flooding-fishing-covid-collide-kenya">hippos</a>, <a href="http://www.crocodile-attack.info/">crocodiles</a>, <a href="https://www.statista.com/statistics/448169/deadliest-creatures-in-the-world-by-number-of-human-deaths/">elephants, lions and buffalo</a> combined. </p>
<p>At least, that’s what the available data suggests. But, the World Health Organization (WHO) <a href="https://apps.who.int/iris/bitstream/handle/10665/324838/9789241515641-eng.pdf#page=17">acknowledges</a>, that statistics – as well as figures related to non-fatal injury and disability caused by snakebites – are incomplete. Not all snakebite victims are treated in hospitals, especially in poorer countries and communities. Some may be treated by traditional doctors. Others may die before receiving any treatment.</p>
<p>But without accurate data, it is difficult to see how the WHO will meet its <a href="https://apps.who.int/iris/bitstream/handle/10665/324838/9789241515641-eng.pdf">global target</a> of reducing death and disability from snakebites by 50% by 2030. Without it, it’s difficult to prioritise which countries or regions require financial resources or antivenom, for instance.</p>
<p>We wanted to find a different way to quantify snakebites. So my colleagues and I from Mozambique’s Lúrio University embarked on <a href="https://www.sciencedirect.com/science/article/pii/S004101012200277X">a household survey</a> across nine rural villages in Cabo Delgado Northern Mozambique. Before this, the only existing snakebite data for Mozambique was extrapolated from incidents in other countries in sub-Saharan Africa. This <a href="https://www.sciencedirect.com/science/article/abs/pii/S0041010118311802">suggested</a> there were 6996 snakebite cases and 319 deaths annually in Mozambique.</p>
<p>Our results offer a very different and extremely worrying picture. From our data we extrapolated snakebite figures for the entire area and for Mozambique as a whole. Despite being an underestimation (since we favoured a conservative approach) they increase snakebite incidence levels ten-fold and the number of deaths by 30-fold. </p>
<p>Urgent and widespread surveys are needed to further assess the full extent of snakebites in sub-Saharan Africa, explore regional patterns and develop mitigation plans. Obtaining this sort of data is critical: the WHO has placed snakebite in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31751-8/fulltext">category A</a> (the most severe or urgent) of neglected tropical diseases. Its 2030 target underscores that this is a priority area. But how can this metric be checked without accurate data?</p>
<h2>Gathering data</h2>
<p>We gathered data from 1037 households. We asked about snakebite incidents in people’s own homes and among their neighbours, as well as details about the species of snake, the symptoms, and what sort of treatment the victim received, if any. </p>
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<a href="https://theconversation.com/snakebites-still-exact-a-high-toll-in-africa-a-shortage-of-antivenoms-is-to-blame-80982">Snakebites still exact a high toll in Africa. A shortage of antivenoms is to blame</a>
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<p>There were 296 reported snakebites and most (60%) were treated exclusively by traditional doctors; 15% went to hospitals for treatment and 25% died before reaching any doctor. </p>
<p>Using a conservative estimation where we assume our results to be extrapolatable for the whole of rural Mozambique, but considering snakebites in urban areas to be inexistent, we propose that every year in Cabo Delgado, at least 6124 people are victims of snakebites. Of these at least 791 result in deaths. </p>
<p>In Mozambique, we extrapolated that every year at least 69,261 people are victims of snakebite; at least 8950 result in death, meaning that one in eight snakebites is fatal. <a href="https://www.statista.com/statistics/1268021/main-causes-of-deaths-in-mozambique/">For comparison</a>, 37,000 people die in Mozambique (which is home to more than 30 million people) each year because of respiratory infections and tuberculosis while 21,000 die from malaria.</p>
<p><a href="https://www.resakss.org/sites/default/files/pdfs/MozSAKSS_ATOR_2010.pdf">Most</a> (68%) of the population live in rural areas and practice subsistence farming for a living. This means that millions of people are exposed to snakebites. The country is home to at least <a href="https://link.springer.com/article/10.1186/s13002-021-00493-6">14 snake species of medical importance</a> – those whose bites can kill or lead to limb amputation. This is a fairly standard number of such snakes for the continent’s less tropical regions.</p>
<p>The number of medically important snakes in the country, the percentage of people living in rural areas, and the total absence of snakebite incidence data, make Mozambique a good place to focus on when trying to quantify and model snakebite data.</p>
<h2>Who gets bitten and where</h2>
<p>Some of our other key findings included:</p>
<ul>
<li><p>Most bites occurred on farms and during the rainy season (December to April).</p></li>
<li><p>The type of snake was important when people were choosing between hospitals or traditional doctors. Those bitten by dangerous species such as the <a href="https://www.africansnakebiteinstitute.com/snake/puff-adder/">Puff Adder</a> were usually taken to hospitals. Bites from less dangerous species like the <a href="https://www.africansnakebiteinstitute.com/articles/beware-of-the-stiletto-snake/">Stiletto Snake</a> were taken to traditional doctors. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/finally-snakebite-is-getting-more-attention-as-a-tropical-health-issue-131016">Finally, snakebite is getting more attention as a tropical health issue</a>
</strong>
</em>
</p>
<hr>
<p>One exception was made for victims of <a href="https://www.sanbi.org/animal-of-the-week/black-mamba/">Black Mambas</a>. This deadly snake has extremely fast-acting venom: its bite can kill in less than an hour. In the communities we surveyed, Black Mamba victims were usually taken to traditional doctors close to home, to avoid long trips to hospitals up to 20km away and queues at the facilities. </p>
<h2>Figures may be higher</h2>
<p>It is possible that our figures are too low. That’s because we took a conservative approach when extrapolating data – and because we assumed that every interviewee had 100% recall, as well as assuming a 0% snakebite incidence in urban areas, which make up 30% of the country.</p>
<p>So, the figures for snakebite incidence are very likely still an underestimation of the true incidence in both Cabo Delgado and Mozambique more broadly. </p>
<p>Local universities should consider using our approach to engage with communities and retrieve household data. This will help researchers and health authorities to assess the full extent of snakebites in sub-Saharan Africa, explore regional patterns and develop mitigation plans.</p>
<p>Such mitigation might include training both traditional doctors and hospital staff in snakebite treatment; public education campaigns to encourage people to use hospitals for treating snakebites; and making antivenom widely available. It may also be useful to generate local literature to guide snake identification and share first-aid measures.</p><img src="https://counter.theconversation.com/content/192106/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harith Omar Morgadinho Farooq does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even by conservative estimates, Mozambique’s snakebite figures are far higher than previously thought.Harith Omar Morgadinho Farooq, Post-doc, University of CopenhagenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1774392022-03-02T19:07:11Z2022-03-02T19:07:11ZNo, you cannot ‘devaccinate’ yourself with snake venom kits, bleach or cupping<figure><img src="https://images.theconversation.com/files/449381/original/file-20220302-13-rbog2.jpg?ixlib=rb-1.1.0&rect=1%2C7%2C997%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/buren-netherlands-march-25-2020-sawyer-1694029711">Shutterstock</a></span></figcaption></figure><p>Claims you can “devaccinate” yourself have been <a href="https://www.businessinsider.com.au/bleach-among-grim-devaccination-procudres-hyped-conspiracy-theorists-2021-11">circulating on social media</a>, another example of extreme and dangerous misinformation about COVID vaccines.</p>
<p>Methods said to remove COVID vaccines from the body include using snake venom extractors or a type of traditional therapy known as “wet cupping”.</p>
<p>If you encounter claims like this online, you need to ask yourself four questions, to figure out whether these claims really are too good to be true.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-want-to-use-bleach-and-antiseptic-for-covid-and-are-calling-us-for-advice-168660">People want to use bleach and antiseptic for COVID and are calling us for advice</a>
</strong>
</em>
</p>
<hr>
<h2>Cupping</h2>
<p>Misinformation circulating on Instagram and other social media includes a video of someone using cupping therapy, suggesting this removes or sucks out the COVID vaccine.</p>
<p>The video shows someone cutting the skin, before applying a cup over the cuts to create suction – a type of therapy known as “wet cupping”. </p>
<p>Cupping has been used for thousands of years, mostly in traditional Chinese medicine. Practitioners believe this eases pain or promotes healing by drawing fluid towards the treated area and improve the flow of energy. However, there are few high-quality studies to support its effectiveness.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cups on someone's back as part of cupping therapy" src="https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/449383/original/file-20220302-17-qxgdh3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cupping therapy is said to ease pain or promote healing by drawing fluid towards the treated area.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/detail-woman-therapist-hands-giving-cupping-1551105344">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why this doesn’t remove vaccine</h2>
<p>Cupping usually affects only the superficial layers of the skin. COVID vaccines are generally deeper, <a href="https://theconversation.com/why-do-we-get-shots-in-the-arm-its-all-about-the-muscle-161259">injected into muscle</a>. </p>
<p>After injection, vaccines train the body’s immune system to fight SARS-CoV-2, the virus that causes COVID. <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/approved-vaccines/how-they-work">They do this</a> by either presenting a weakened or inactivated part of the virus (the spike protein antigen) to the immune system, or by delivering the instructions for the body to make these antigens.</p>
<p>It’s important to note, this period of “training” is very short, and once the body has learnt how to respond, the vaccines are cleared from your body in mere days or weeks. </p>
<p>That’s because after the vaccine has primed the immune system, the body <a href="https://theconversation.com/no-covid-vaccines-dont-stay-in-your-body-for-years-169247">breaks down these components naturally</a>, just as it does with other genetic fragments, proteins and fats.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-covid-vaccines-dont-stay-in-your-body-for-years-169247">No, COVID vaccines don't stay in your body for years</a>
</strong>
</em>
</p>
<hr>
<h2>Snake venom kits</h2>
<p>Others have tried to devaccinate using venom extraction kits. These kits include a plunger-type device you place over a snakebite, which is supposed to suck out venom. </p>
<p>Again, venom extractors will not remove the antigen in COVID vaccines, for the same reasons we’ve already described.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/447467/original/file-20220221-27-1rcl22b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447467/original/file-20220221-27-1rcl22b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447467/original/file-20220221-27-1rcl22b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447467/original/file-20220221-27-1rcl22b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447467/original/file-20220221-27-1rcl22b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447467/original/file-20220221-27-1rcl22b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447467/original/file-20220221-27-1rcl22b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Venom extractors don’t remove enough snake venom, let alone COVID vaccine (Author supplied).</span>
</figcaption>
</figure>
<p>They also <a href="https://doctorross.co.za/wp-content/uploads/2009/01/bush-sp-snakebite-suction-devices-suck-emerg-med-clin-n-am.pdf">cannot remove</a> enough venom to prevent serious systemic (widespread) effects of a snakebite. <a href="https://pubmed.ncbi.nlm.nih.gov/14747805/">One study</a> found the kit only removed 0.04% of the total load of venom, and ended up just removing body fluid.
Critically, they can destroy tissue around the site of the snakebite. </p>
<h2>We all play a part</h2>
<p>Information about devaccination continues to circulate on some platforms, such as BitChute and Telegram.</p>
<p>If you come across someone selling a wonder cure or drug online – whether that’s related to COVID or some other illness – here are <a href="https://theconversation.com/10-ways-to-spot-online-misinformation-132246">some tips for thinking</a> about what you see: </p>
<p><strong>1. Is it hard to believe?</strong> </p>
<p>When you see something posted that looks sensational, it is even more important to be sceptical. </p>
<p>In a popular TikTok video, an osteopathic physician, who <a href="https://www.mcgill.ca/oss/article/covid-19-pseudoscience/madej-madness">no longer practices</a>, suggests people “detox” by take a bath in baking soda, epsom salt and borax to get rid of “radiation, poisons and nanotechnologies”.</p>
<p>She says people need to detox because COVID vaccines have “RNA-Modifying Transhumanism-Nano-Technology”, and “the people pushing these injections want to change what it is to be human”. </p>
<p>She <a href="https://www.mcgill.ca/oss/article/covid-19-pseudoscience/madej-madness">also claims</a> to have identified a jellyfish-like tiny invertebrate called “Hydra Vulgaris” that can:</p>
<blockquote>
<p>multiply and form independent neural networks inside those who have received COVID-19 vaccines and could ultimately influence their thoughts and actions.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Jellyfish" src="https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/449386/original/file-20220302-13-1x1nah0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Now, we have to worry about jellyfish controlling our minds?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/jellyfish-439825462">Shutterstock</a></span>
</figcaption>
</figure>
<p>Even though sometimes we want to believe that someone has found the cure or answer to a question we are seeking, go with your gut reaction. If it sounds ridiculous, it probably is. If you are unsure whether the information is legitimate, talk to a family member, friend or your GP.</p>
<p><strong>2. Have you checked the facts?</strong></p>
<p>If a resource is provided in another language, how can you be sure what it says?</p>
<p>Using the cupping video as an example, Stephen Dickey, a professor of Slavic languages and literature at the University of Kansas, identified the dialogue in the video as Russian. But he <a href="https://checkyourfact.com/2021/09/29/fact-check-video-doctor-removing-covid-vaccine-cupping/">said</a> “there was no mention of the vaccine” and “there is no mention at all of exactly what is being extracted”.</p>
<p>When reviewing the resource, do you know who the author is and does that author specialise in the field the article is concerned with? Check LinkedIn or do a quick Google search to see if the author can speak about the subject with authority and accuracy. </p>
<p><strong>3. Is there a hidden agenda?</strong></p>
<p>Have you considered whether the person or organisation attempting to sell you a new drug or treatment has a hidden agenda? This can be increasing their reach on social media or making money. </p>
<p>For example, American “archbishop” <a href="https://www.theguardian.com/us-news/2021/aug/11/coronavirus-miracle-cure-bleach-covid-mark-grenon">Mark Grenon and his sons</a> are reported to have sold more than <a href="https://www.news.com.au/world/coronavirus/us-family-charged-for-selling-bleach-as-miracle-remedy-for-covid19-out-of-florida-church/news-story/557e1e318f202f647b9938ca423510d9">US$1 million</a> of their bleach-type “Miracle Mineral Solution”. They said it was <a href="https://www.justice.gov/usao-sdfl/pr/florida-family-indicted-selling-toxic-bleach-fake-miracle-cure-covid-19-and-other">a cure for</a> COVID, cancer, Alzheimer’s, diabetes, autism, malaria, hepatitis, Parkinson’s, herpes, HIV/AIDS and other serious medical conditions.</p>
<p><strong>4. What’s the source?</strong></p>
<p>When an article cites sources, it’s good to check them out. The post about the snakebite kit included references to three published papers. These were dated 1979-1992, decades before COVID.</p>
<p>It’s also important to look at the topic of the cited paper. In the case of the 1979 paper, this looked at measures for <a href="https://www.sciencedirect.com/science/article/pii/S0140673679905804">a particular type of snakebite</a>, which included examining the effects of applying firm crepe bandages on monkeys. There was no mention of the use of snake venom removal kits or COVID. </p>
<p>So, when you come across any videos or social media posts about fantastical new drugs or treatments that promise otherwise impossible cures or outcomes, it is important to <a href="https://utopia.ut.edu/FakeNews/factcheck">always think</a>:</p>
<blockquote>
<p>If what you’re reading seems too good to be true, or too weird, or too reactionary, it probably is.</p>
</blockquote><img src="https://counter.theconversation.com/content/177439/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Seale is an investigator on research studies funded by NHMRC and has previously received funding for investigator driven research from NSW Ministry of Health, as well as from Sanofi Pasteur and Seqirus. She is the Deputy Chair of the Collaboration on Social Science and Immunisation.</span></em></p><p class="fine-print"><em><span>Margie Danchin receives funding from the Commonwealth and State government, NHMRC, DFAT and WHO. She is chair, Collaboration on Social Science and Immunisation (COSSI). </span></em></p>If what you’re reading seems too good to be true, it probably is.Holly Seale, Associate professor, UNSW SydneyMargie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1440052020-08-06T13:36:17Z2020-08-06T13:36:17ZPasha 75: Facebook helped us to learn what snakes eat. Why this is important<figure><img src="https://images.theconversation.com/files/351260/original/file-20200805-18-mgbts.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Snake eating a frog</span> <span class="attribution"><span class="source">Theo Busschau</span></span></figcaption></figure><p>Snakes eat a great diversity of prey but the details of each species’ diet have long been a bit of a mystery. That’s because it’s difficult to observe their infrequent and unpredictable feeding behaviour. But it’s important to understand their diet because of its impact on ecological systems and its role in venom biochemistry. Snake bites account for many deaths on the African continent. Two researchers used a novel way to gather information about the reptiles’ diets and feeding behaviour.</p>
<p>In this episode of Pasha, Bryan Maritz, a senior lecturer in biodiversity and conservation biology at the University of the Western Cape, discusses how he and Robin Maritz, a research fellow in the same department, used a Facebook group to learn more about what snakes eat.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-we-tracked-the-eating-habits-of-snakes-in-africa-with-the-help-of-a-facebook-group-143569">How we tracked the eating habits of snakes in Africa with the help of a Facebook group</a>
</strong>
</em>
</p>
<hr>
<p><strong>Photo:</strong>
“Snake eating a frog” By Theo Busschau <a href="https://www.facebook.com/groups/PredationRecordsReptilesandFrogsSubSaharanAfrica">Facebook</a></p>
<p><strong>Music</strong>
“Happy African Village” by John Bartmann, found on <a href="http://freemusicarchive.org/music/John_Bartmann/Public_Domain_Soundtrack_Music_Album_One/happy-african-village">FreeMusicArchive.org</a> licensed under <a href="https://creativecommons.org/publicdomain/zero/1.0/">CC0 1</a>.</p>
<p>“Music Box & Sunshine” by Daniel Birch found on <a href="https://freemusicarchive.org/music/Daniel_Birch/Ambient_Vol3/Music_Box__Sunshine">Free Music Archive</a> licensed under <a href="http://creativecommons.org/licenses/by-nc/4.0/">Attribution-NonCommercial License.</a></p><img src="https://counter.theconversation.com/content/144005/count.gif" alt="The Conversation" width="1" height="1" />
Facebook groups exist to share information about most classes of animals and plants, and these communities have unprecedented observational power.Ozayr Patel, Digital EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1310162020-03-17T14:31:49Z2020-03-17T14:31:49ZFinally, snakebite is getting more attention as a tropical health issue<figure><img src="https://images.theconversation.com/files/320176/original/file-20200312-111237-1ny71kh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People most at risk from snakebite are often from the most impoverished populations.</span> <span class="attribution"><span class="source">Andre Coetzer/Shutterstock</span></span></figcaption></figure><p>Amid global health crises such as coronavirus, <a href="https://www.who.int/snakebites/disease/en/">snakebite envenoming</a> is easily overlooked. The disease caused by the toxins that come from a snakebite is not infectious and it can’t spread rapidly and without warning. Nevertheless, it’s found around the world, affects millions of people, and can be life-threatening. </p>
<p>According to the <a href="https://www.who.int/snakebites/disease/en/">World Health Organisation</a> (WHO), more than 5.4 million people are bitten by snakes each year, resulting in 2.7 million envenomings, 400,000 permanent disfigurements and 150,000 deaths. The region most severely affected is sub-Saharan Africa, with more than 20,000 deaths annually.</p>
<p>The WHO added snakebite envenoming to its list of <a href="https://www.who.int/neglected_diseases/diseases/en/">neglected tropical diseases</a> in 2009, but removed it in 2013 without any explanation. In 2017 the organisation reinstated snakebite – not because the threat itself had changed but because of campaigning by antivenom producers, researchers, and health-care providers.</p>
<p>Returning it to the list opened the way for the WHO to set four strategic goals to deal with with this issue. These are:</p>
<ol>
<li>empowering communities; </li>
<li>ensuring safe and effective treatments; </li>
<li>strengthening health systems; and,</li>
<li>increasing partnerships, coordination and resources.</li>
</ol>
<p>The goals support a target of halving the deaths and disability from snakebite by 2030.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/319842/original/file-20200311-116240-1jfc935.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/319842/original/file-20200311-116240-1jfc935.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=339&fit=crop&dpr=1 600w, https://images.theconversation.com/files/319842/original/file-20200311-116240-1jfc935.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=339&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/319842/original/file-20200311-116240-1jfc935.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=339&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/319842/original/file-20200311-116240-1jfc935.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=426&fit=crop&dpr=1 754w, https://images.theconversation.com/files/319842/original/file-20200311-116240-1jfc935.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=426&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/319842/original/file-20200311-116240-1jfc935.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=426&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Global annual deaths from snakebite compared to other Category A NTDs.</span>
<span class="attribution"><a class="source" href="https://theatlas.com/charts/By3KBFrUV)">https://theatlas.com/charts/By3KBFrUV</a></span>
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<h2>Empowering communities</h2>
<p>The first goal requires research to understand what influences the behaviour of people at risk and what would encourage people to seek treatment for snakebite?</p>
<p>In sub-Saharan Africa, disease caused by snakebite is often treated by traditional healers rather than medical doctors in hospitals. Some of the treatments don’t do harm but still delay the patient from getting to a hospital. But the traditional healers who administer these treatments are often highly revered and respected. So, any medical advice offered to communities must show cultural sensitivity and respect. </p>
<p>The WHO suggests using local champions to lead efforts to introduce “first aid” and help get patients medical help quickly and safely.</p>
<p>Making <a href="https://www.who.int/snakebites/antivenoms/en/">antivenoms</a> accessible and affordable is also key, since people need to pay for them out-of-pocket in most African countries. The current cost of antivenoms presents a huge issue even when they are available. This problem is amplified by the fact that the people <a href="https://www.who.int/snakebites/disease/en/">most at risk</a> from snakebite are also the most impoverished populations in sub-Saharan Africa. </p>
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Read more:
<a href="https://theconversation.com/snakebites-still-exact-a-high-toll-in-africa-a-shortage-of-antivenoms-is-to-blame-80982">Snakebites still exact a high toll in Africa. A shortage of antivenoms is to blame</a>
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<h2>Safe and effective treatment</h2>
<p>Most antivenoms consist of sheep or horse antibodies and they have been made in much the same way since they were invented 120 years ago. Consequently, the quality and safety of some antivenoms remain poor and production remains costly. </p>
<p>The WHO is pushing towards creating a stable and sustainable market for safe and effective antivenoms at reasonable cost. Producing treatments that meet internationally accepted standards will require cooperation between researchers, industry, and other institutions. </p>
<p>The plan to improve supply involves creating a revolving stockpile of effective antivenoms, so they can be distributed to the regions most in need. More specifically, the WHO aims to deliver at least 500,000 effective antivenom treatments to sub-Saharan Africa each year by 2024 and 3 million by 2030. </p>
<h2>Stronger systems</h2>
<p>The third goal is to improve aspects of health systems like pre-hospital care, transport, diagnosis, rehabilitation and recovery support. The benefits of doing this have already been seen in <a href="https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0006299">Myanmar</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748471/">Nepal</a>.</p>
<p>Finally, all the efforts towards these goals will require partnerships, coordination, and resources at a global scale. They will also make a difference to other diseases found in tropical areas. For example, promoting footwear to prevent snakebite will also help prevent <a href="https://www.who.int/news-room/fact-sheets/detail/soil-transmitted-helminth-infections">soil-associated diseases</a> such as <a href="https://www.cdc.gov/parasites/hookworm/index.html">hookworm</a> or <a href="https://www.who.int/lymphatic_filariasis/epidemiology/podoconiosis/en/">podoconiosis</a>. The use of bed nets to prevent nocturnal snakebites will also help prevent malaria. Better wound care will also benefit patients with <a href="https://www.who.int/features/factfiles/buruli-ulcer/en/">Buruli ulcer</a>.</p>
<p>The WHO will scale up its work on snakebite from 2021 to 2024, in 45 to 52 countries. The final rollout will be from 2025 to 2030 and many of the early measures will be tested in African countries.</p>
<p>Notably, such early efforts have already made an impact. Since snakebite envenoming was put on the WHO’s list of neglected tropical diseases again, media attention has improved and research funding has been mobilised. In fact, snakebite was on the World Health Assembly’s agenda for the first time in 2018.</p>
<p>Together, these developments suggest that the goal of reducing snakebite mortality and morbidity by 50% by 2030 might be achievable. At the very least there is hope for people in sub-Saharan Africa and elsewhere that they will get better support from the global health community. Snakebite will hopefully not remain neglected for long.</p><img src="https://counter.theconversation.com/content/131016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The World Health Organisation has a plan to halve deaths and disability from snakebitesAndreas Hougaard Laustsen, Associate Professor at the Department of Biotechnology and Biomedicine, Technical University of DenmarkLine Ledsgaard, PhD Candidate, Department of Biotechnology and Biomedicine, Technical University of DenmarkTimothy Patrick Jenkins, Post Doctoral Researcher, Technical University of DenmarkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1213862019-09-12T12:59:29Z2019-09-12T12:59:29ZWhy knowing what black mamba venom does to the human body is crucial<figure><img src="https://images.theconversation.com/files/286755/original/file-20190802-117861-h5lp88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black mamba venom can be lethal.</span> <span class="attribution"><span class="source">Photograph courtesy Thomas Birkenbach </span></span></figcaption></figure><p><a href="https://www.nationalgeographic.com/animals/reptiles/b/black-mamba/">Black mambas</a> are extremely dangerous reptiles – in fact, many consider the species to be one of the world’s deadliest snakes. They are found in southern and eastern Africa, and are shy, evasive creatures. They won’t seek out human interaction. But if cornered or confronted, they will strike. And their venom is lethal. </p>
<p>Black mambas (don’t let the name fool you – they’re very rarely black, and are more usually a dark brown – it is the inside of the mouth which is black) probably cause the largest number of <a href="https://www.africansnakebiteinstitute.com/snakebite/">snake-related deaths</a> in southern Africa. In a recent case, a South African judge <a href="https://www.timeslive.co.za/news/south-africa/2019-05-21-sa-judge-dies-from-black-mamba-bite-on-zambia-holiday/">died after being bitten by a black mamba</a> while he was travelling in Zambia. But the data for the whole continent is limited, so the precise number isn’t known. This is chiefly because most of these deaths occur in rural parts of Africa with limited health infrastructure and other resources. </p>
<p>Sub-optimal mortuary facilities, inadequate professional manpower, poorly developed protocols and the lack of an efficient and reliable toxicology service means many of these deaths in Africa’s more rural areas are not properly diagnosed. It is most likely that these snakebite victims get buried without a thorough forensic pathological autopsy.</p>
<p>The black mamba is born with two to three drops of venom per fang. It is a front-fanged snake, with fangs up to 6.5 mm in length, located at the front of the upper jaw. An adult of the species has between 12 and 20 drops per fang. It takes just <a href="http://www.krugerpark.co.za/krugerpark-times-17-facts-about-the-black-mamba.html">two drops of venom</a> to kill an adult human. This means that even young black mambas are extremely dangerous.</p>
<p>Not much is known about the pathology of trauma of black mamba bites – that is, what the black mamba’s toxin does, physically, inside a victim’s system. We do know that the venom is neurotoxic and cardiotoxic. That means that it has a direct effect on the nerves and the heart.</p>
<p>The more we know, the better. If we know precisely what the toxin does, hospitals and clinics might be better prepared to treat those who’ve been bitten. </p>
<h2>A recent case study</h2>
<p>Recently my colleagues and I <a href="https://europepmc.org/abstract/med/31318708">examined</a> the case of a young man who was bitten by a black mamba in South Africa. He arrived at the hospital 20 minutes after being bitten and had already suffered cardiac arrest with accompanying hypoxic brain injury.</p>
<p>This was my third encounter with the victim of a black mamba bite. My first fatal encounter, in 2000, involved a 12-year-old girl who was bitten on the thigh by a black mamba. The second involved a British tourist who was accidentally bitten at a snake park, and who also died.</p>
<p>In this latest case, the co-workers of the young man who died were certain that the snake was a black mamba. This gave us, as forensic pathologists, an excellent opportunity to thoroughly investigate this matter. Oftentimes, the history is scant, with victims unable to properly identify the snake which bit them.</p>
<p>The forensic examination consists of a thorough macroscopic post mortem examination, followed by histological (microscopic) examination and blood tests. </p>
<p>A black mamba’s venom is complex. It interferes with transmission across the motor end-plate, which is where the nerves and muscles connect, so it will result in paralysis. The venom is also cardiotoxic, which means it may have a direct effect on the heart. </p>
<h2>How to treat it</h2>
<p>So what should you do if you or someone around you is bitten by a black mamba? </p>
<p>The first priority is to transport the victim to an appropriate medical facility as soon as possible. First-aid should focus on maintaining vital functions, such as respiratory support. Keep the victim still and try limit any unnecessary movement. Remove constricting items (for example rings and clothing), especially those close to the bite site. </p>
<p>The first-aid treatment of black mamba bites includes lymphatic retardation with the pressure immobilisation technique – in other words try and wrap a tight crepe bandage or tourniquet close to the bite site. </p>
<p>Medical management comprises continuous monitoring, making sure the airways are open, treating symptoms and the immediate administration of antivenom. The antivenom is injected intravenously because absorption is poor via the muscles. It’s also important not to inject into or around the bite site. In rare instances the victim may be put on <a href="https://heart.bmj.com/content/105/18/1437">extracorporeal membrane oxygenation</a>, which is a way of providing prolonged cardiac and respiratory support to those whose heart and lungs are unable to provide oxygen to the body.</p>
<p>This combination of respiratory support and antivenom may save a person’s life. Over time, the antivenom will ease muscle paralysis and set the victim on the road to recovery.</p><img src="https://counter.theconversation.com/content/121386/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ryan Blumenthal does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Not much is known about the pathology of trauma of black mamba bites – that is, what the black mamba’s toxin does, physically, inside a victim’s system.Ryan Blumenthal, Senior Specialist, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/908732018-02-04T12:13:44Z2018-02-04T12:13:44ZBig strides are being made in the push for affordable, effective antivenoms<figure><img src="https://images.theconversation.com/files/204429/original/file-20180201-123846-1r5jek5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black mambas are extremely dangerous. </span> <span class="attribution"><span class="source">Shutterstock/NickEvansKZN</span></span></figcaption></figure><p>For city dwellers, especially those in the developed world, the idea of being bitten by a venomous snake seems outlandish. But it is a daily and very real risk for millions around the world – and that includes many people living in African countries.</p>
<p>Over one million snakebites occur annually in sub-Saharan Africa alone. These cause over 20 000 deaths and leave 60 000 people permanently <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Snakebite+envenoming+from+a+global+perspective%3A+Towardsan+integrated+approach">disabled or disfigured</a>. So approximately every hour in the region 115 people are bitten, seven suffer permanent damage, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Snakebite+envenoming+from+a+global+perspective%3A+Towardsan+integrated+approach">and three die</a>. </p>
<p>Snakebite can cause a variety of clinical symptoms. These include paralysis, necrosis and bleeding, among others. Snake venoms contain a myriad of highly diverse toxins that manifest in very different ways clinically. This means there’s no single “magic bullet” treatment. Even so, there’s no doubt that antivenoms are crucial in the fight against snakebites.</p>
<p>The World Health Organisation (WHO) is spearheading a global effort to get effective and affordable antivenoms to parts of the world that really need them. It is doing this in several ways, including thorough strict pre-testing for antivenoms whose manufacturers want to release them commercially.</p>
<p>Such coordinated international efforts may be key to improving the life expectancy and health of many snakebite victims.</p>
<h2>The impact of bad antivenoms</h2>
<p>The only specific treatment for snakebite envenoming (the injection of venom by a snake) is to intravenously administer antivenom to a victim. Antivenoms are made by immunising a larger animal, like a horse, with increasing doses of snake venom. This triggers a reaction in the animal’s immune system, increasing the production of specific antibodies against the venom toxins. The antibodies are then extracted from the horse’s plasma and formulated into the final antivenom product.</p>
<p>Because snake venom differs from snake to snake, even within the same species, the neutralising ability of an antivenom must be carefully assessed before a fresh batch can be released and used on patients.</p>
<p>Until recently there was no external process or committee established to assess antivenom manufacturers’ preclinical testing. This was because these processes required a major investment of time and money. The result has been that not all antivenom products have lived up to expectations while in some cases they haven’t met some regions’ actual therapeutic needs. In sub-Saharan Africa, for instance, <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Consequences+of+Neglect%3A+Analysis+of+the+Sub-Saharan+African+Snake+Antivenom+Market+and+the+Global+Context">low quality antivenoms</a> have been on sale. </p>
<p>This has been a major problem because certain antivenoms had little or no therapeutic value and can even cause harm, such as triggering allergic reactions and serum sickness. A case in point was the decision taken by Ghana’s health ministry to switch from using <a href="http://www.toxinfo.org/antivenoms/productinfo/FAV-AFRIQUE.html">Fav-Afrique</a> – one of sub-Saharan Africa’s most effective snakebite antivenoms – to the cheaper antivenom AsnaAntivenomC in 2004. This led to a significant increase in mortality <a href="https://www.ncbi.nlm.nih.gov/pubmed/18190937/">from 2% to 12%</a> because the new antivenom was inefficient. </p>
<p><a href="https://moh-it.pure.elsevier.com/en/publications/snake-bites-in-south-chad-comparison-between-three-different-poly">In Chad</a>, the use of inefficient antivenom drove the snakebite death rate up to 15%. </p>
<h2>Fixing the problem</h2>
<p>News that Fav-Afrique was set to expire in 2016 caused dismay among public health experts and advocates, and received a great deal of media coverage. The WHO decided to step in. </p>
<p>Recently, the WHO has implemented a risk-benefit <a href="http://www.who.int/medicines/news/antivenoms_spur_production/en/">assessment scheme</a> to evaluate the antivenoms for sub-Saharan Africa. This scheme involves the submission of a product dossier and antivenom samples to the WHO. Here an expert committee evaluates the information and the samples are independently blind tested. Thereafter, the WHO will carry out comprehensive site inspections of the manufacturer’s premises.</p>
<p>Following assessment, the WHO will then determine which antivenoms can be recommended to procurement agencies.</p>
<p>The WHO will also use the assessments to plan activities that may support improved manufacturing processes, regulatory agency capacities, and future assessment processes in other regions. Taken together, these activities may help guide organisations such as Doctors Without Borders and national health ministries make educated choices about which antivenom would be the most relevant, safest and most economical.</p>
<p>Although this new scheme is not a strict prequalification scheme, it offers hope to snakebite victims. In 2001, the WHO launched a prequalification scheme for AIDS medicines. This has been <a href="https://books.google.co.uk/books?id=yaYsDwAAQBAJ&pg=PA119&lpg=PA119&dq=prequalification+scheme+for+AIDS&source=bl&ots=3OvQHEU276&sig=sdC7RkzQcwIElcVb8rzLSDefDRA&hl=en&sa=X&ved=0ahUKEwi8ot_IgoLZAhUBbFAKHQ_pCqEQ6AEINTAC#v=onepage&q=prequalification%20scheme%20for%20AIDS&f=false">hugely successful</a> suggesting that the assessment scheme for antivenoms could make a real difference to millions of snakebite victims.</p>
<h2>A step further</h2>
<p>In 2017, the WHO took its attention to snakebite a step further: it re-added snakebite envenoming to its <a href="http://www.who.int/snakebites/resources/s40409-017-0127-6/en/">list</a> of neglected tropical diseases. It is expected that this will add impetus to antivenom development and boost the likelihood of investor funding for snakebite prevention and treatment access initiatives. </p>
<p>For example the Ministry of Health in Kenya is developing local guidelines on snakebite management and plans to engage local and international donor health agencies. </p>
<p>The WHO has recently established a working group on snakebite envenoming that aims to develop a strategy for prevention and <a href="http://www.who.int/snakebites/control/WHO_Working_Group_on_Snakebite_Envenoming/en/">treatment of snakebite</a>. Finally, snakebite is on the World Health Assembly’s agenda for the first time this year, receiving support from the <a href="http://www.kofiannanfoundation.org/blog/snakebite/">Kofi Annan Foundation</a>.</p>
<p>These are all developments worth celebrating. But it is important to continue pushing so that more can be achieved and snakebite deaths can, ultimately, become a thing of the past.</p><img src="https://counter.theconversation.com/content/90873/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andreas Hougaard Laustsen receives funding from the Novo Nordisk Foundation and is an advisor in the WHO Working Group on Snakebite Envenoming.</span></em></p><p class="fine-print"><em><span>Timothy Patrick Jenkins does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Coordinated international efforts may be key to improving the life expectancy and health of many snakebite victims.Andreas Hougaard Laustsen, Associate Professor at the Department of Biotechnology and Biomedicine, Technical University of DenmarkTimothy Patrick Jenkins, Doctoral student at the Department of Veterinary Medicine, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/778642017-09-18T01:49:50Z2017-09-18T01:49:50ZLike alchemists with killer precision, brown snakes make different venoms across their lifetime<p>It’s spring in Australia and that means reptiles are starting to move about again. Including snakes. </p>
<p>The venom of the eastern brown snake (<em>Pseudonaja textilis</em>) is, drop for drop, one of the most potent of any venoms tested on laboratory mice. </p>
<p>Venoms work by targeting the bitten animal with deadly chemicals. And our <a href="http://www.mdpi.com/2072-6651/8/11/309">recent research</a> shows toxins in the venom of eastern brown snakes change as the snakes grow from juveniles to adults. It’s the first example of a significant age-related change in venom from an Australian snake. </p>
<p>It’s a beautiful example of evolutionary adaption, in which the chemistry of the snake’s venom appears to change in parallel with its diet. </p>
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<a href="https://theconversation.com/why-i-love-surrounding-myself-with-venomous-critters-42996">Why I Love: surrounding myself with venomous critters</a>
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<h2>What is snake venom?</h2>
<p>Venoms are typically a mixture of different toxins, each of which attacks the system of a potential prey animal or predator <a href="https://theconversation.com/why-i-love-surrounding-myself-with-venomous-critters-42996">in a different way</a>. </p>
<p>Sometimes toxins work together, each making the other more powerful, and sometimes they work completely independently, engaging in chemical warfare on multiple fronts.</p>
<p>Brown snake venom contains many toxins, but there is one toxin above all others that is responsible for the life-threatening effects of bites to humans. This toxin is a “haemotoxin”, which means it attacks the blood. </p>
<p>The haemotoxin starts clotting the blood at an extremely elevated rate, using up all of the <a href="https://theconversation.com/what-can-go-wrong-in-the-blood-a-brief-overview-of-bleeding-clotting-and-cancer-76400">coagulation factors</a>, which clot the blood under normal circumstances. When all these are used up, the victim is at risk of bleeding to death. </p>
<p>In the worst case scenario this toxin, perhaps working with others, gives the system such a shock that people collapse within a short period of time following the bite. In this situation, <a href="https://theconversation.com/snakebites-are-rarer-than-you-think-but-if-you-collapse-cpr-can-save-your-life-81614">immediate CPR</a> can be the difference between life and death. </p>
<h2>Why venom evolved</h2>
<p>Venom is a tool that has evolved in snakes to help them secure a meal: it gives them a chance of overpowering animals that would otherwise be very difficult for them to subdue. Venom and its toxins are therefore “designed” (by evolution) to mess up the normal operations of a prey animal’s body. </p>
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Read more:
<a href="https://theconversation.com/curious-kids-how-do-snakes-make-an-sssssss-sound-with-their-tongue-poking-out-81086">Curious Kids: How do snakes make an 'sssssss' sound with their tongue poking out?</a>
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<p>The best toxins for this purpose may differ according to the specific type of prey animal (e.g. mammal or reptile), or the condition of that prey animal (e.g. whether it is active or inactive) when the snake finds it. As a result, we often find snakes that feed upon different types of animals have different toxins in their venoms. </p>
<p>This starts to get really interesting when you consider brown snakes, because adult brown snakes seem to have quite different diets from baby brown snakes. </p>
<h2>Testing a venom hypothesis</h2>
<p>Age-related shifts in venom chemistry have already been demonstrated for the venoms of a few species of <a href="http://pubs.acs.org/doi/abs/10.1021/pr901027r">pit vipers</a> from <a href="http://www.bioone.org/doi/abs/10.1643/HA03-037.1">the Americas</a>, but not for anything even remotely related to Australian brown snakes. </p>
<p>This wasn’t because people hadn’t looked – several species of Australian snake <a href="https://www.ncbi.nlm.nih.gov/pubmed/20937295">had been investigated</a>, but no evidence of a significant age-related change in venom had been found for any of them. This made sense to me, because none of those snakes dramatically change their diets throughout their lives. </p>
<p>Brown snakes are special – as far as we know the juveniles eat lizards almost exclusively, whereas the adults are generalists that eat a lot of mammals. </p>
<h2>Baby snake venom is different</h2>
<p>When we compared venom in <a href="http://www.mdpi.com/2072-6651/8/11/309">adult and baby brown snakes</a>, we did indeed find them to be different. Baby brown snake venom seems to entirely lack haemotoxins: instead, it’s almost exclusively composed of neurotoxins – toxins that attack nerve junctions. </p>
<p>What this suggests is that the haemotoxins that are so dangerous to humans (and lab mice) aren’t very effective against the lizards that baby brown snakes eat. We can make this dietary link with a degree of confidence because many other Australian snakes that feed exclusively on lizards have similar venom – no haemotoxins, only neurotoxins.</p>
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Read more:
<a href="https://theconversation.com/snakebites-are-rarer-than-you-think-but-if-you-collapse-cpr-can-save-your-life-81614">Snakebites are rarer than you think, but if you collapse, CPR can save your life</a>
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<p>We don’t yet know what this means from a clinical perspective. It may be that baby brown snake venom is less dangerous to humans than adult brown snake venom, but the opposite might also be true – brown snake antivenom might be less effective against the venom of the babies. </p>
<p>There has been at least one fatal bite from a very small brown snake in Australia, so they must be treated with respect at any age. </p>
<p>As always, the best policy for snakes is to leave them alone and let them go about their business, and to teach children to do the same – snakes want no more to do with us than we want with them.</p><img src="https://counter.theconversation.com/content/77864/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The Australian Venom Research Unit receives funding from the NHMRC. </span></em></p>There has been at least one fatal bite from a very small brown snake in Australia. But now we know that venom is different in adult and baby brown snakes.Timothy N. W. Jackson, Postdoctoral Research Fellow, Australian Venom Research Unit, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/815642017-09-17T19:39:07Z2017-09-17T19:39:07ZCurious Kids: What happens if a venomous snake bites another snake of the same species?<figure><img src="https://images.theconversation.com/files/180138/original/file-20170728-23784-v68xsb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scientists usually use the word "venomous" rather than "poisonous" when they're talking about snakes.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/sirenzlorraine/5464847013/in/photostream/">Flickr/Sirenz Lorraine</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky!</em> </p>
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<blockquote>
<p><strong>If a lethally poisonous snake bites another lethally poisonous snake of the same species does the bitten snake suffer healthwise or die? – Ella, age 10, Wagga Wagga.</strong> </p>
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<p>Hi Ella,</p>
<p>That’s a great question. </p>
<p>If a venomous snake is bitten by another venomous snake of the same species, (for example during a fight or mating), then it will not be affected. </p>
<p>However, if a snake is bitten by a venomous snake of another species, it probably <em>will</em> be affected. </p>
<p>This is probably because snakes have evolved to be immune to venom from their own species, because bites from mates or rivals of the same species probably happen fairly often. </p>
<p>But a snake being regularly bitten by another snake from a different species? It’s unlikely that would happen very often, so snakes haven’t really had a chance to develop immunity to venom from other species. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/guams-forests-are-being-slowly-killed-off-by-a-snake-83224">Guam’s forests are being slowly killed off – by a snake</a>
</strong>
</em>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180153/original/file-20170728-23739-12fiqcf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scientists often collect venom from snakes to create anti-venoms.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Venom_extraction.jpg">Kalyan Varma/Wikimedia</a></span>
</figcaption>
</figure>
<h2>Snakes can break down venom in the stomach</h2>
<p>Many people believe that snakes are immune to their own venom so that they don’t get harmed when eating an animal it has just injected full of venom.</p>
<p>But in fact, they don’t need to be immune. Scientists have found that special digestive chemicals in the stomachs of most vertebrates (animals with backbones) break down snake venom very quickly. So the snake’s stomach can quickly deal with the venom in the animal it just ate before it has a chance to harm the snake.</p>
<p>People that have snakes as pets often see this. If one venomous snake bites a mouse and injects venom into it, for example, you can then feed that same dead mouse to another snake. The second snake won’t die.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-do-snakes-make-an-sssssss-sound-with-their-tongue-poking-out-81086">Curious Kids: How do snakes make an 'sssssss' sound with their tongue poking out?</a>
</strong>
</em>
</p>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182914/original/file-20170822-3713-1q8l9y9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A snake’s stomach can quickly deal with the venom in the animal it just ate.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/8604504@N03/5663950262/in/photolist-9Cve5S-aVheS-aVh72-nB5LLB-8aQ28P-eTfyRM-TCZHUW-4ZahmK-jEURr2-jEVvs5-73z3EF-nHD4gg-cFs6g7-9d4mja-gDCLnD-osf6kg-3AqhUr-4xemko-Cm3kEZ-6kRuSd-64TFp3-ojvX2b-z96rq-2JQD6a-6Lnr9y-87sXPi-7RzxQp-dnDrwN-5dh2TJ-5WCLjL-87sXXx-87dtnp-f3Ruq-7R8ZoY-nXAFMX-4zyAQT-65XvYJ-afpvy4-4ZGZzd-6XgReK-65TeuX-yeT753-6stmxU-8EsQS8-4WdnwD-deECtF-3aTKPM-6nVQuz-7R5HTk-4Ck8ZB">Flickr/Justin Otto</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>The difference between venom and poison</h2>
<p>By the way, scientists usually use the word “venomous” rather than “poisonous” when they’re talking about snakes. Many people often mix those words up. Poisons need to be ingested or swallowed to be dangerous, while venoms need to be injected via a bite or a sting. </p>
<p>Some snakes can inject their toxins into their prey, which makes them venomous. However, there seem to be a couple of snake species that eat frogs and can store the toxins from the frogs in their body. This makes them poisonous if the snake’s body is eaten. Over time, many other animals will have learned that it is not safe to eat those snakes, so this trick helps keep them safe.</p>
<hr>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. You can:</em></p>
<p><em>* Email your question to curiouskids@theconversation.edu.au
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* Tell us on <a href="https://twitter.com/ConversationEDU">Twitter</a> by tagging <a href="https://twitter.com/ConversationEDU">@ConversationEDU</a> with the hashtag #curiouskids, or
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<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/165749/original/image-20170419-32713-1kyojyz.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/81564/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Seymour does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If one venomous snake bites a mouse and injects venom into it, you can then feed that same dead mouse to another snake. The second snake won’t die.Jamie Seymour, Associate Professor, James Cook UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816142017-07-30T20:10:53Z2017-07-30T20:10:53ZSnakebites are rarer than you think, but if you collapse, CPR can save your life<figure><img src="https://images.theconversation.com/files/180118/original/file-20170727-28974-7lutuk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bites from brown snakes like this one were the most common, followed by
tiger snakes, then red-bellied black snakes.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Eastern_Brown_Snake_(Pseudonaja_textilis)_(8582601994).jpg">Matt Clancy/SunOfErat/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Despite the common belief that Australia has some of the most venomous snakes in the world, our <a href="http://www.mja.com.au">new research shows</a> being bitten by a snake is uncommon in Australia and dying from a snakebite is very rare. </p>
<p>And of the few unlucky people to collapse after venom enters their bloodstream, a bystander performing cardiopulmonary resuscitation (CPR) is the most likely thing to save them.</p>
<p>These are just some of the findings from 10 years of data from the Australian Snakebite Project published <a href="http://www.mja.com.au">today</a> in the Medical Journal of Australia.</p>
<p>Although many people go to hospital with a suspected snakebite, many do not turn out to have envenomation (when venom enters the bloodstream) after all.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/12675626">In more than 90% of cases</a> people are bitten by a non-venomous snake, venom is not injected when the snake bites (known as a “dry bite”) or are not even bitten by a snake (known as a “stick” bite).</p>
<p>Our analysis of about 1,548 cases of suspected snakebites from all around Australia, showed there were on average just under 100 snake envenomations a year, and about two deaths a year. </p>
<p>The most common snakebites were from brown snakes, then tiger snakes and red-bellied black snakes. Brown snakes were responsible for 40% of envenomations. Collapsing, then having a heart attack out of hospital was the most common cause of death (ten out of 23), and most deaths were from brown snakes.</p>
<h2>What happens after a snakebite and how can CPR help?</h2>
<p>Venom from a snakebite travels via the <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lymphatic-system">lymphatic system</a> to the bloodstream. There, it circulates to nerves and muscles where it can cause paralysis and muscle damage. In the blood itself, the venom destroys clotting factors, which makes the blood unable to clot, increasing the risk of bleeding. </p>
<p>In the most severe cases, most commonly in brown snake bites, someone can collapse because they have low blood pressure (we don’t know for certain what causes the low blood pressure). In this situation, insufficient blood is pumped around the body for the brain and other vital organs. </p>
<p>Clearly the accurate diagnosis of snake envenomation and the timely administration of antivenom are essential to treating snakebites in hospital.</p>
<p>But when people collapse, CPR will keep the blood circulating to the vital organs – and is life-saving – however inexpertly a bystander performs it.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180113/original/file-20170727-9209-wva510.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If a snakebite victim collapses, CPR is vital to keep the blood circulating to the vital organs.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/657810997?src=gSIYdvpfkdaGnxGsgex89A-1-50&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
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<p>In other words, we found basic first aid <em>before</em> people reached hospital, of which bystander CPR is one, may be more important than any changes in how people are treated <em>in</em> hospital to improve people’s chance of survival. People who survived after collapsing received CPR on average within one minute of being bitten compared with 15 minutes for those who died.</p>
<p>Our study also showed that in most cases, people used <a href="https://theconversation.com/explainer-what-should-you-do-if-youre-bitten-by-a-snake-34238">other first-aid measures</a> (pressure bandages and immobilising both the limb and the patient). These aim to prevent the venom travelling from the bite site, via the lymphatic system, to the bloodstream.</p>
<h2>Antivenom saves lives for those who need it</h2>
<p>Our study confirmed the role of antivenom in treating snakebites and the need for it to be administered before irreversible damage is done to the nervous system and paralysis occurs. </p>
<p>However, we found one in four patients given antivenom had an allergic reaction to it and about one in 20 have severe anaphylaxis requiring urgent treatment. </p>
<p>So it is essential only patients with snake envenomation, and not just a suspected snakebite, are treated with antivenom. We found 49 patients (around 6%) were given antivenom unnecessarily, out of the total 755 patients who received it.</p>
<h2>What needs to change?</h2>
<p>We know <a href="https://www.ncbi.nlm.nih.gov/pubmed/27903075">the earlier</a> someone receives antivenom <a href="https://www.ncbi.nlm.nih.gov/pubmed/21143062">the better</a>. Yet our study found that the time from being bitten until receiving antivenom had not improved over the study period.</p>
<p>So we need to find ways to make sure patients get antivenom as early as possible. This requires laboratory tests that can identify patients with snake envenomation in the first couple of hours after the bite. </p>
<p>It is also essential anyone bitten by a snake or suspected to be bitten by a snake seeks immediate medical attention and goes to hospital by ambulance.</p>
<p>But the best thing is to avoid being bitten in the first place:</p>
<ul>
<li><strong>avoid snakes</strong>, difficult if you’re a snake handler (up to 11% of cases in our study), and take care if trying to catch or kill a snake (which led to a bite in 14% of cases)</li>
<li><strong>wear long pants and sturdy shoes</strong> when walking in the bush or rural areas (47% of snakebites were when people didn’t know one was nearby) or when gardening (8% of cases)</li>
<li><strong>be alert inside too</strong>, with 31% of snakebites near houses and 14% in buildings.</li>
</ul>
<p>Our study confirms Australian snakes <a href="https://theconversation.com/a-venomous-paradox-how-deadly-are-australias-snakes-79433">don’t really deserve</a> their deadly reputation, <a href="https://theconversation.com/yes-australian-snakes-will-definitely-kill-you-if-youre-a-mouse-51809">unless you’re a mouse</a>. But if you are bitten, or think you have been, hospital is still the best place for you.</p><img src="https://counter.theconversation.com/content/81614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geoff Isbister receives funding from the National Health and Medical Research Council. </span></em></p>Don’t hold back. Performing CPR on a snakebite victim who has collapsed can save their life, however imperfect your technique.Geoff Isbister, Director, Clinical Toxicology Research Group, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/809822017-07-20T17:58:12Z2017-07-20T17:58:12ZSnakebites still exact a high toll in Africa. A shortage of antivenoms is to blame<figure><img src="https://images.theconversation.com/files/178650/original/file-20170718-10334-1b8s0tu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A snakebite is one of the most excruciating experiences a person can go through. Depending on how venomous the snake is, it can cause morbidity, pain, and death. Snakebite envenoming can lead to paralysis of the nerves and muscles, local tissue damage and the death of cells in an organ, haemorrhaging, and it may interfere with the blood’s ability to coagulate.</p>
<p>Snakebites are a major public health issue in most tropical parts of the world, where <a href="http://www.who.int/mediacentre/factsheets/fs337/en/">more than 5 million bites occur each year</a>. This leads to more than 150,000 deaths and about three times as many amputations. Poor people living in snake infested areas are the worst affected. But in sub-Saharan Africa, victims not only suffer from the snakebite, but also from a lack of effective treatment options. Only <a href="http://www.sciencedirect.com/science/article/pii/S1874391911002181?via%3Dihub">about 2% of victims receive antivenom</a>.</p>
<p>Antivenoms that are made from serum from large mammals, immunised with snake venom are the mainstay of treating snakebites. But they are in short supply in sub-Saharan Africa, as they are costly to manufacture, and limited financial incentive holds the development of new antivenoms.</p>
<p>In an effort to overcome the shortage of antivenoms, the global snakebite community has declared <a href="http://www.nature.com/news/africa-braced-for-snakebite-crisis-1.18357">an antivenom crisis</a>. These efforts have brought international attention from both private foundations, researchers, and the World Health Organisation to this neglected tropical disease.</p>
<h2>Africa’s venomous snakes</h2>
<p>Two main snake families that cause the most dangerous snakebites in sub-Saharan Africa are – <a href="https://www.livescience.com/54023-vipers.html">vipers</a> and <a href="https://www.britannica.com/animal/elapid">elapids</a>. The viper family has a number of species, like the gaboon viper (<em>Bitis gabonica</em>), which holds the world record for the largest fangs. The carpet viper (<em>Echis ocellatus</em>) has the highest death toll of any snake. The elapid snake family includes neurotoxic cobras, spitting cobras, and mambas. It also holds the most notorious snake of them all, <a href="http://www.nationalgeographic.com/animals/reptiles/b/black-mamba/">the black mamba (<em>Dendroaspis polylepis</em>)</a>. </p>
<p>The venoms of these two snake families are fundamentally different. The venom of elapid snakes cause toxicity to the entire body. The primary clinical symptoms include paralysis caused by neurotoxins that stops muscles receiving signals from the nerves.</p>
<p>In contrast, viper venoms hold a large arsenal of toxins that destroy tissue and interfere with the bloods ability to clot.</p>
<p>For their part, spitting cobra venoms produce both effects. This includes paralysis as well as cell destruction (or cytotoxicity), which can lead to significant tissue damage in eyes or bitten limbs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/178651/original/file-20170718-10341-1o8n8eh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The black mamba is part of the elapid snake family.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Antivenom – the only effective therapy</h2>
<p>The severe effects of bites by both vipers and elapids need to be treated with antivenom. But a scarcity of antivenoms in Africa has had a devastating impact on thousands of victims. Factors leading to this shortage include low profitability for manufacturers (due to high cost of production and low purchasing power of most victims and health care systems affected by snakebite), lack of advocacy, and simply that many researchers and politicians are not aware that snakebites are a pressing issue.</p>
<p>Unfortunately, this isn’t likely to change immediately. </p>
<p>One silver lining is that the World Health Organisation has recently reintroduced snakebite on the <a href="http://www.who.int/neglected_diseases/diseases/en/">list of neglected tropical diseases.</a> This may help create awareness as well as incentives to get <a href="https://theconversation.com/how-biotechnology-could-offer-hope-for-snakebite-victims-68244">antivenoms to the clinic</a>.</p>
<p>There are two types of antivenoms available. </p>
<ol>
<li><p>Those that can neutralise the venom of a single snake species and sometimes closely related ones too. These are known as monovalent antivenoms.</p></li>
<li><p>Antivenoms that neutralise a wider range of snake venoms, these are known as polyvalent antivenoms. </p></li>
</ol>
<p>The benefit of using monovalent antivenoms is that they may have a higher efficacy against bites from the specific species they are raised against. For their part, polyvalent antivenoms are useful because they can be used against a range of different bites. This is particularly helpful when the perpetrating snake hasn’t been identified. </p>
<p>In Africa, only polyvalent antivenoms are on the market due to the existence of many different snake species, difficulties in distinguishing them from each other, and since administration of an incorrect antivenom in a given case is avoided by having only one alternative (for the given geographical region) to choose from. Typically these antivenoms are manufactured to be effective against the venom from several vipers, selected cobras, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27339430">one to three mamba species.</a>.</p>
<h2>What to do, and not to do</h2>
<p>Symptoms and clinical presentation in patients bitten by a snake can be affected by a number of factors. These include: the snake species, the precondition of the patient, the dose of venom injected, and the availability of treatment options. Symptoms can develop quicker in children. </p>
<p>What’s important is that people, in the first instance, try to identify the snake. Proper identification – like a photo – is highly valuable.</p>
<p>Efforts should be made to ensure that the bitten section is immobilised or kept below the heart to reduce the spread of the venom. The patient should be kept still until help arrives or until safe transport is arranged to a health care facility. Patients bitten by a venomous viper or elapid species should be admitted for at least 12 hours. </p>
<p>If someone’s eyes are exposed to venom they should be washed thoroughly. But no other specific home treatment should be initiated. It’s a really bad idea to cut, suck or wash the bite site. </p>
<p>The numbers of deaths from snakebites won’t be reduced unless more, and preferably less expensive, antivenom is made available. This will require a joint effort between researchers, policymakers, and funding bodies.</p>
<p>Snakebites still claim the lives of many causing much morbidity to humans each year, but recent <a href="http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005361">technological developments</a>, <a href="http://www.mdpi.com/2072-6651/8/12/351">rising awareness</a>, and <a href="https://www.statnews.com/2017/06/12/snakebite-who-priority/">increasing political focus</a> may hold the promise for a brighter future for snakebite victims.</p><img src="https://counter.theconversation.com/content/80982/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andreas Hougaard Laustsen receives funding from the Novo Nordisk Foundation and the Hørslev Foundation. </span></em></p><p class="fine-print"><em><span>Lotte Høgberg does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The best cure against a snakebite is to avoid being bitten at all. Here is what you need to know about snakebites, antivenom, and what you need to do if bitten.Andreas Hougaard Laustsen, Associate Professor at the Department of Biotechnology and Biomedicine, Technical University of DenmarkLotte Høgberg, Pharmacist, PhD, at the Danish Poisons Information Center (GIFTLINJEN), Department of Anaesthesiology, Copenhagen University HospitalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/682442016-11-13T07:00:33Z2016-11-13T07:00:33ZHow biotechnology could offer hope for snakebite victims<figure><img src="https://images.theconversation.com/files/144546/original/image-20161104-25329-m9kg8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The black mamba is one of the most notorious venomous snakes in the world.</span> <span class="attribution"><a class="source" href="https://c2.staticflickr.com/6/5556/14707823092_fc246dc441_b.jpg">Flickr</a></span></figcaption></figure><p>Snakebite is a major public health burden for low-income countries in tropical parts of the world. There are around <a href="http://www.snakebiteinitiative.org/?page_id=577">5 million bites and 150,000 deaths</a> every year. And about <a href="https://www.msf.org.za/about-us/publications/briefing-documents/snakebite-how-public-health-emergency-slithered-under-radar">400,000 victims become permanently disabled</a> annually.</p>
<p>In Africa, the most notorious of snake species is the black mamba (<em>Dendroaspis polylepis</em>). It is feared for its <a href="http://www.sciencedirect.com/science/article/pii/S1874391915000561">potent rapid-acting venom</a> and its characteristic feature of typically striking more than once. The problem is that it always injects venom in its bite. So a bite from this species has an almost 100% fatality rate if left untreated. Other venomous African snake species that pose a danger to humans include other mambas, cobras, puff adders, boomslangs, and a range of vipers.</p>
<p>Treatment against snakebite venom is currently limited to antiserum derived from animals. There have been incremental innovations in the manufacture of antivenoms. But most are still produced using <a href="http://www.who.int/bloodproducts/snake_antivenoms/snakeantivenomguideline.pdf">methods developed 120 years ago</a>. Current antivenom production involves immunising animals, like horses or sheep, with venom milked from snakes and then isolating antibodies from the serum. The process is expensive and labour intensive.</p>
<p>A combination of these factors and a difficult market environment has some led commercial producers <a href="http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0001670">to withdraw</a>. As a result, current stocks of functional antivenom will <a href="http://www.nature.com/news/vipers-mambas-and-taipans-the-escalating-health-crisis-over-snakebites-1.20495">soon expire</a>. The situation is so bad that experts and NGOs active in the field refer to the lack of antivenom – particularly in sub-Saharan Africa – as <a href="http://www.nature.com/news/africa-braced-for-snakebite-crisis-1.18357">a neglected health crisis</a>.</p>
<p>But there is hope on the horizon. Innovations in biotechnology being used to produce pharmaceuticals for other treatments could also be applied to producing antivenoms. These would be made in laboratory conditions rather than extracted from animals.</p>
<p>We have been exploring various avenues to produce antivenoms based on mixtures of antibodies, rather than having them derive from animals. This is a scientifically and commercially sound opportunity that promises to bring the shortage of snakebite antivenoms in sub-Saharan Africa to an end, not immediately but certainly in the medium to longer term.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/144548/original/image-20161104-25322-wxr379.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/144548/original/image-20161104-25322-wxr379.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=613&fit=crop&dpr=1 600w, https://images.theconversation.com/files/144548/original/image-20161104-25322-wxr379.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=613&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/144548/original/image-20161104-25322-wxr379.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=613&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/144548/original/image-20161104-25322-wxr379.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=771&fit=crop&dpr=1 754w, https://images.theconversation.com/files/144548/original/image-20161104-25322-wxr379.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=771&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/144548/original/image-20161104-25322-wxr379.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=771&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Schematic representation of serum-based antivenom production.</span>
<span class="attribution"><span class="source">Andreas Hougaard Laustsen</span></span>
</figcaption>
</figure>
<h2>What biotechnology can deliver</h2>
<p>Innovations in biotechnology can make antivenoms more cost-effective and easier to produce. They can also be made more effective against snakebites. Alternative avenues, already established within biotechnology, could be pursued to create novel ones. These have the potential to improve treatment against snakebite and lower cost of production. Lower manufacturing costs would make it profitable for pharmaceutical companies to bring low cost antivenoms to the market. It could even provide a financial incentive for antivenom manufacturers to distribute antivenoms to rural parts of the tropics.</p>
<p>One established method that could be adapted is the use of DNA immunisation techniques. This would do away with laborious venom extractions. This technique would involve immunising horses <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030184">with toxin-encoding DNA</a>, inducing immunisation (similar to the effect that venom itself provides). This technique has been investigated in various animal models and may enable venom-independent antivenom manufacture <a href="https://www.researchgate.net/publication/268810231_Developing_Snake_Antivenom_Sera_by_Genetic_Immunization_A_Review">in the future</a>. </p>
<p>But we are following a different avenue. We are pursuing the replacement of the active components (antibodies) in the animal-derived antivenom with <a href="https://www.researchgate.net/publication/308249085_Recombinant_Antivenoms">recombinant human versions</a> – antivenoms produced by cell cultivation in biotechnological production systems. This method, producing pharmaceutical products through cell cultivation <a href="http://www.diabetesforecast.org/2013/jul/making-insulin.html">in fermentation tanks</a>, has been developed and perfected over the last 30 years. It’s been used to produce a range of pharmaceutical products like blood factors and human hormones such as insulin. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/144549/original/image-20161104-25362-kwu41t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/144549/original/image-20161104-25362-kwu41t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=502&fit=crop&dpr=1 600w, https://images.theconversation.com/files/144549/original/image-20161104-25362-kwu41t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=502&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/144549/original/image-20161104-25362-kwu41t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=502&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/144549/original/image-20161104-25362-kwu41t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=631&fit=crop&dpr=1 754w, https://images.theconversation.com/files/144549/original/image-20161104-25362-kwu41t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=631&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/144549/original/image-20161104-25362-kwu41t.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=631&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Schematic representation of two strategies for the manufacture of oligoclonal antibody mixtures by cell cultivation.</span>
<span class="attribution"><span class="source">Andreas Hougaard Laustsen</span></span>
</figcaption>
</figure>
<p>Future recombinant antivenoms could be based on mixtures of human antibodies. These antivenoms would be more compatible with the human immune system, limiting the incidence of adverse reactions. The concept has seen success in <a href="http://www.nature.com/nature/journal/vnfv/ncurrent/full/nature13777.html?utm_content=bufferb2c23&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer#affil-auth">ZMapp, a medication used to fight Ebola</a> and therapies involving oncology based <a href="http://www.symphogen.com/pipeline">antibody mixtures</a>.</p>
<h2>Costing</h2>
<p>A recombinant antivenom would also be more effective. This is because current antivenoms contain a large fraction of therapeutically irrelevant antibodies. These are generated by animals’ immune systems to fight a range of bacteria and viruses. A recombinant antivenom, based on a mixture of human antibodies, would be designed in a way that the antibodies would be specifically selected to target the most relevant toxins in snake venom. Therapeutically irrelevant antibodies not targeting snake toxins would be absent. </p>
<p>But, wouldn’t this be exorbitantly <a href="http://www.nature.com/news/vipers-mambas-and-taipans-the-escalating-health-crisis-over-snakebites-1.20495">expensive?</a> Not at all. Our estimates show that recombinant antivenoms would be a <a href="http://www.nature.com/nature/journal/v538/n7623/full/538041e.html">cost-effective solution</a> to the snakebite crisis. They could be used to treat an average snakebite case in Africa for $30-$150 per treatment compared with the current cost of well <a href="http://www.reuters.com/article/us-uk-snake-venom-idUSKBN0MT2F320150402">over $500</a>. </p>
<p>Recombinant antivenoms are still under development. They are unlikely to be on the market for about a decade. More focus and resources are needed to accelerate the discovery and testing of toxin-targeting antibodies of human origin. We hope our efforts will help catalyse this process and shorten the time in which more effective – and less expensive – antivenoms reach clinics.</p><img src="https://counter.theconversation.com/content/68244/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andreas Hougaard Laustsen receives funding from the Novo Nordisk Foundation (NNF16OC0019248).</span></em></p><p class="fine-print"><em><span>Mikael Engmark receives funding from The Novo Nordisk Foundation (NNF13OC0005613)</span></em></p>One way to tackle the snakebite antivenom crisis may be through biotechnological innovation to make antivenoms more cost-effective, easier to produce, and more efficacious against snakebites.Andreas Hougaard Laustsen, Postdoctoral Fellow at the Department of Biotechnology and Biomedicine, Technical University of DenmarkMikael Engmark, PhD Student Department of Bio and Health Informatics, Technical University of DenmarkLicensed as Creative Commons – attribution, no derivatives.