India moves to make snakebites notifiable: A step towards saving thousands of lives every year

In a recent move, acting upon the recommendation of the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE), the Union health ministry urged states to make snakebites a notifiable disease. This would mean that it is legally mandated that the disease (snakebite) be notified to the government by both private and public hospitals. Earlier this year, the NAPSE was launched in India with the aim of halving snakebite deaths by 2030.

Snakebites are a major public health challenge in the country. Given that a large number of deaths are caused by snakebites every year, it has turned into a major public health hazard and the government is looking at ways to curb the deaths. The first step towards that is for the cases to be reported. Estimates suggest that about three to four million cases of snakebites are reported every year, and close to 60,000 persons die because of them annually.

Usually, infections that are likely to cause an outbreak, lead to deaths, and those that need to be investigated quickly to take appropriate public health measures, are declared as notifiable diseases. For instance, tuberculosis, HIV, cholera, malaria, dengue, and hepatitis among others, fall in the notifiable category.

Snakebites can result in severe medical emergencies such as paralysis, hemorrhage, and damage to different tissues. If not treated with anti-venom it can lead to the development of severe symptoms and even death. This is why it is crucial to make sure such cases are reported so as to ensure proper surveillance and determine the precise numbers of snakebite cases and deaths across India. Only then will the government be able to effectively manage, prevent, and control cases of snakebites, provide adequate anti-venom to various regions, and proper training can be imparted in areas where snakebites are frequent.

Besides, initiatives to spread awareness and advocate a change in social behaviour can be taken up in places where cases are reported because it has been found that snakebite victims either do not reach a healthcare centre in time or do not go there at all — and many reach out to faith-based healers instead.

In many cases, staff at healthcare centres are not adequately trained in treating snakebites. Tests for confirming snakebites are also not available. Another challenge is that the anti-venom which is made from the venom of different species of snakes, fails to work in certain regions of the country because of a diversity in snake species and also the effect of the venom from the same snake species may differ based on geography. Besides, anti-venom may also cause various reactions. Also, commercially available antivenom does not work against certain local snake species such as the green pit viper in the Northeast. As per the WHO, around 90 per cent of snakebites in India are caused by the 'big four' among the crawlers - common krait, Indian cobra, Russell's viper and saw scaled viper—and snakebite envenoming causes as many as 400,000 amputations and other permanent disabilities.

In a research paper published by researcher Bhagyalakshmi Satyanarayan in the Journal of Family Medicine and Primary Care, she writes about 427 snakebite cases that were admitted to the hospital during the study period of seven years. The victims were predominantly males. The majority of the bite cases encountered were from rural areas and were in the second quarter of the year. The site of the bite was largely on the lower limb and the upper limb had fewer bites. Most cases reported acute kidney injury, neutrophilic leucocytosis and deranged liver enzymes as a result of bad prognosis.

WHO added snakebite envenoming to its priority list of neglected tropical diseases (NTDs) in June 2017. Most snake bites happen in densely populated, low-altitude, agricultural areas in states including Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh, Telangana, Rajasthan, and Gujarat, according to NAPSE. India accounts for approximately half of the worldwide snakebite deaths. It is often a neglected public health problem, particularly in Jharkhand where medical facilities are limited.