Monday, 11 March 2013

National Survey of Snake bites in India - Protocol Development Workshop

By Sowmyadeep Bhaumik. 
Bhaumik is a medical doctor, an independent researcher and free-lance writer from Kolkatta, West Bengal.

March 11 - 12, 2013.  

National survey of Snake bites in India (venomous and non-venomous): syndrome-snake species correlations, outcomes and ASV dose requirements for the Indian Sub-continent

Day 1
April of last year saw a two-day workshop titled "Formulating a research agenda for treatment: A workshop on pesticide and plant poisonings and snake envenomations" being organised at the South Asian Cochrane Network & Centre (SASIANCC) in Vellore , The workshop then brought together scientists , activists , clinicians. health advocates, industry as well as various other stakeholders from across South Asia and they had identified potential research gaps in the snakebite research arena as well as identified it as a major public health issue in the Indian sub-continent affecting thousands. It has also been found out then that there is an immense need about the syndrome-species correlation to be done. The need to conduct a anti-snake venom dose finding study was also considered.

From there the SASIANCC has taken a remarkable leap in the way of holding the protocol development workshop for a national survey which I would like to call SSSSSSNAKES-India - Survey of Snake Species, Syndromes, Snake-bite outcomes, and anti-Snake venom requirements in Indian Sub-Continent.
The study is expected to be done simultaneously in more than 15 centres across the nation and is being jointly organised by the Toxicology Special Interest group and the South Asian Cochrane Network & Centre. This multi-centric study, aims to evaluate the profile of snakebites in centers located across the country that deal with snake envenomation and to assess whether the clinical syndromes correlate with the identified snake species. This study also aims to demonstrate the outcomes including morbidity and mortality due to snake envenomation in the different centres and the anti-snake venom dose.

Day 1 of the workshop saw the presentation regarding the study protocol-by the Christian Medical College Toxicology Group which were then deliberated upon in some details followed by presentations about the snakebite treatment data and information about the protocols being used by all the individual hospitals which are supposed to be centres for this study. What was evident from these presentations is that the there is an entire gamut signs of symptoms of snakebite being available across the nation and also about varying dosage patterns of anti-snake venoms being used in India (from 2 vials to 20 vials and rare 50 vials too). The rate of bites as well as envenomations was also surprisingly very varied and so also was the adverse effect profile (from 2% to 80%).Even prophylactic medications for this purpose is also quite varied with some areas having reported even no use of them and achieving no anaphylaxis whereas some centres reported higher anaphylaxis rates and yet having used no prophylactic medicines. 
Prof. Oommen, Chairman, State Biodiversity Board, Kerala
The day also saw a presentation by Professor Oommen , Chairman of the Kerala Biodiversity Board where he talked about his new inventions which biosensors and mobile applications in identifying the snake in a very accurate fashion. 

Rom Whitaker, internationally acclaimed herpetologist 
Post –lunch, a session on the training in snake storage ,specimen collection and species identification was held by Mr Gerry Martin and Mr Romulus Whitaker who extensively identified gaps in the knowledge about ecology of snakes as well as the problems which the study group might face in collection and transportation of snake victims on account of them being protected by various wildlife laws . 
The practical problems of identifying snakes by photographs was also discussed and so also the idea of identification vide DNA analysis was discussed upon.

The day ended with the a presentation by Dr Khadilkar, Technical Director from Premium Pharmaceuticals who talked about the various problems in the anti-venom manufacturing business which affect the cost and quality of ASV. 

Dr. Khadilkar of Premium Pharmaceuticals

With almost all problems that might be faced in the national survey being discussed the day winded up with dinner at Hillside Resort, Bagayam where the enthusiasm among participants  was palpable where people were more interested about discussing on the study than actually concentrating on the very delicious meal. The issue of variability in clinical response from various manufactures and even batch-to batch variations were discussed. 

(Read my feature titled 'Snakebite: a forgotten problem' at the British Medical Journal
Blog @