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6 April 2023
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Urgent intervention called for to alleviate crisis in management and care of snakebite victims
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In a bid to save life and limb, medical and trauma practitioners in the public and private sectors have called for the intervention of The Minister of Health, Dr Joe Phaahla to alleviate the critical shortage of antivenom in South Africa and on the African continent. An open letter has been signed by 27 experts in the field of snakebite treatment including highly experienced medical and trauma practitioners as well as anti-venom and snake handling experts. The letter calls for the prevention of a situation where life-saving care can no longer be provided to patients in need of healthcare assistance for snakebites.
“Antivenom is a critical life-saving treatment in patients bitten by venomous snakes and has excellent outcomes when used timeously and correctly,” says trauma surgeon Professor Timothy Hardcastle, who is a member of The National Snakebite Advisory Group (NSAG) and the Trauma Society of South Africa.
NSAG offers a free national advisory support service to medical personnel, clinicians and centres in both the public and private sectors who may need to treat snakebite victims. Since 2017 the Group and its affiliated members have actively educated the public and healthcare professionals to facilitate the appropriate management of snakebites in southern Africa.
Commenting on the current situation, Professor Hardcastle said that the main source of reliable cost-effective antivenom against the common major venomous snakes in South Africa and other parts of the continent is the SAVP group of products, namely the 10-snake polyvalent, the Echis monovalent and the Boomslang monovalent antivenoms.
“Unfortunately, there is no suitable alternative product approved for use in South Africa, even under Section 21. At present our greatest concern and challenge is the unreliable production of the South African Vaccine Producers’ products due to management, staffing constraints, animal welfare, unreliable generator capacity, machine breakdowns and refrigeration issues.”
“There has been a promise of product since December 2022, however, more than four months have passed and at present extremely limited numbers of polyvalent vials are left in the South African Vaccine Producers stores, while a large backlog of orders have yet to be filled. Certain public and private hospitals – many of which are situated in high snakebite areas – have already run out of stock while others have preciously little antivenom on hand. There is also a shortage of antivenom among veterinarians who are currently unable to acquire any antivenom. There is no sign that these will be replenished anytime soon.”
“There is a serious risk of death from Black and Green Mamba, Cape Cobra and limb loss from other venomous snakes. While Boomslang bites are less common they require a specific antivenom. In particular, children are at high risk of poor outcomes. Patient medical management, hospital length of stay, morbidity and mortality are all adversely affected without early and appropriate administration of antivenom, an essential component in the clinical management of snakebites over the last few decades. The inability and lack of expected delivery of antivenom therefore pose a major health risk, despite it being a listed drug on the Essential Drug List,” adds Professor Hardcastle.
The appeal from the NSAG to The Minister of Health is to intervene by funding and approving emergency upgrades to allow improved functionality at the Johannesburg based South African Vaccine Producers (SAVP) production plant. The group of signatories have also implored Minister Phaahla to ensure that the procurement processes are effectively and compliantly performed so that appropriate equipment, backup generators, reagents and other essential production items can be procured to significantly improve production that will ensure a sufficient volume of antivenom to restock the country.
An investigation of the outsourcing of production to recently built drug production operations established in other parts of the country, as a longer-term solution, was also mooted. In addition, the potential identification of alternative products covering South African snakes could be tested to provide another option until the current antivenom shortage is resolved.
“It is furthermore imperative that an information campaign be launched to warn the public to be careful when in the natural environment and to take the necessary precautionary measures. We as the National Snakebite Advisory group and the leaders of Emergency Medicine, Trauma Surgery and Critical care across South Africa implore The Minister to act before lives and limbs are lost,” cautions Professor Hardcastle.
Dr Hardcastle concluded by saying that while the NSAG service is only directly available to healthcare practitioners and facilities, there are several resources available to the public. These include the Poison Information Centre and the African Snakebite Institute, which offers a special free information app from their website: https://www.africansnakebiteinstitute.com/app/.
Source: National Snakebite Advisory Group (NSAG)
“Antivenom is a critical life-saving treatment in patients bitten by venomous snakes and has excellent outcomes when used timeously and correctly,” says trauma surgeon Professor Timothy Hardcastle, who is a member of The National Snakebite Advisory Group (NSAG) and the Trauma Society of South Africa.
NSAG offers a free national advisory support service to medical personnel, clinicians and centres in both the public and private sectors who may need to treat snakebite victims. Since 2017 the Group and its affiliated members have actively educated the public and healthcare professionals to facilitate the appropriate management of snakebites in southern Africa.
Commenting on the current situation, Professor Hardcastle said that the main source of reliable cost-effective antivenom against the common major venomous snakes in South Africa and other parts of the continent is the SAVP group of products, namely the 10-snake polyvalent, the Echis monovalent and the Boomslang monovalent antivenoms.
“Unfortunately, there is no suitable alternative product approved for use in South Africa, even under Section 21. At present our greatest concern and challenge is the unreliable production of the South African Vaccine Producers’ products due to management, staffing constraints, animal welfare, unreliable generator capacity, machine breakdowns and refrigeration issues.”
“There has been a promise of product since December 2022, however, more than four months have passed and at present extremely limited numbers of polyvalent vials are left in the South African Vaccine Producers stores, while a large backlog of orders have yet to be filled. Certain public and private hospitals – many of which are situated in high snakebite areas – have already run out of stock while others have preciously little antivenom on hand. There is also a shortage of antivenom among veterinarians who are currently unable to acquire any antivenom. There is no sign that these will be replenished anytime soon.”
“There is a serious risk of death from Black and Green Mamba, Cape Cobra and limb loss from other venomous snakes. While Boomslang bites are less common they require a specific antivenom. In particular, children are at high risk of poor outcomes. Patient medical management, hospital length of stay, morbidity and mortality are all adversely affected without early and appropriate administration of antivenom, an essential component in the clinical management of snakebites over the last few decades. The inability and lack of expected delivery of antivenom therefore pose a major health risk, despite it being a listed drug on the Essential Drug List,” adds Professor Hardcastle.
The appeal from the NSAG to The Minister of Health is to intervene by funding and approving emergency upgrades to allow improved functionality at the Johannesburg based South African Vaccine Producers (SAVP) production plant. The group of signatories have also implored Minister Phaahla to ensure that the procurement processes are effectively and compliantly performed so that appropriate equipment, backup generators, reagents and other essential production items can be procured to significantly improve production that will ensure a sufficient volume of antivenom to restock the country.
An investigation of the outsourcing of production to recently built drug production operations established in other parts of the country, as a longer-term solution, was also mooted. In addition, the potential identification of alternative products covering South African snakes could be tested to provide another option until the current antivenom shortage is resolved.
“It is furthermore imperative that an information campaign be launched to warn the public to be careful when in the natural environment and to take the necessary precautionary measures. We as the National Snakebite Advisory group and the leaders of Emergency Medicine, Trauma Surgery and Critical care across South Africa implore The Minister to act before lives and limbs are lost,” cautions Professor Hardcastle.
Dr Hardcastle concluded by saying that while the NSAG service is only directly available to healthcare practitioners and facilities, there are several resources available to the public. These include the Poison Information Centre and the African Snakebite Institute, which offers a special free information app from their website: https://www.africansnakebiteinstitute.com/app/.
Source: National Snakebite Advisory Group (NSAG)