Snake Envenomation in Bangladesh

Abstract

Snakebite is an important cause of morbidity and mortality in Bangladesh. Recent countrywide epidemiological survey estimated an annual incidence of 623/100,000 and 6,041 deaths annually. The prevalent groups of venomous snakes are cobras, kraits, and vipers. Bites are common during the monsoon and are mostly related to occupational activities. The identification of two previously unrecorded species (Bungarus walli, B. niger) among specimens brought to hospitals by victims has pointed out the deficiency of geo-epidemiological data and strongly argues for further research.

Most of the bites produce no features of envenoming. Among the venomous bites, main clinical features include neurotoxicity with local tissue necrosis in cobra bites, neurotoxicity in most krait (Bungarus sp.) bites, and neurotoxicity and myonecrosis in B. niger and local swelling with or without coagulopathy in green pit viper bites. In addition to the burden of acute morbidity and mortality, the injuries inflicted by the envenoming bites of snakes in Bangladesh frequently result in permanent disability and its associated long-term socioeconomic consequences.

In spite of recent scientific progress in management of the snakebite victim, treatment of this eminently treatable condition is complicated by social, cultural, geographical, economical, and ecological issues. The price of antivenom (AV) is still beyond reach of many people. Government supply is limited. The private sector has little interest in producing this only marginally profitable product because of limited demand. Polyvalent AV produced in India is being used in Bangladesh, exposing the victim to an unnecessarily wide spectrum of antibodies and to potentially fatal anaphylactic AV reactions. Yet the outcome is satisfactory enough to encourage its continuing use.