File picture: Pexels, David Selbert
WHILE South Africa has its fair share of shortages, there is a shortage that is little spoken of but which is absolutely crucial. There is a shortage of snake antivenom in the country.
This is according to the African Snakebite Institute.
According to the World Health Organization, the shortage is felt not only in South Africa but the rest of the world too.
“Snake antivenom immunoglobulins (antivenins) are the only therapeutic products for the treatment of snake-bite envenoming. The lack of availability of effective snake antivenom immunoglobulins to treat envenoming by medically important venomous snakes encountered in various regions of the world has become a critical health issue at global level. The crisis has reached its greatest intensity in sub-Saharan Africa, but other regions, such as South and South-East Asia, are also suffering from a lack of effective and affordable products,” said the WHO.
In South Africa, antivenom is produced by the South African Vaccine Producers (SAVP) in Sandringham, Johannesburg.
SAVP produces two antivenom for snakebite – a monovalent antivenin for the venom of the Boomslang, and a polyvalent antivenin.
The polyvalent antivenom is made from venom from 10 snake species: the puff adder, Gaboon adder, rinkhals, green mamba, Jameson’s mamba, black mamba, Cape cobra, forest cobra, souted cobra and Mozambique spitting cobra.
From information on the websites of the African Snakebite Institute, the SAVP and the World Health Organization, we reveal everything we know about the antivenom and the shortage.
What type of snake bites to look out for
It’s worth noting that bites from snakes such as the common night adder, Berg adder, Bibron’s stiletto snake and the vine snake are not covered by an antivenom, and doctors treat such bites symptomatically.
This may be problematic – a bite from a Bibron’s stiletto snake can cause severe tissue damage. It may even result in the amputation of a digit or two as many victims are bitten on a finger or thumb when handling one of these snakes.
Berg adder bites often present as a cytotoxic bite in the early stages, so you can expect pain and swelling. The venom affects taste, smell and vision and after a few hours breathing may be compromised.
The common night adder is often considered to be mildly venomous, but you should still proceed with caution near them.
A bite on a small child could result in severe pain and swelling and may require hospitalisation.
Vine snakes rarely bite and spend most of their lives camouflaged. However, if provoked, this snake will inflate the neck region and lunge out with repeated strikes.
What happens when someone is bitten by a snake?
All snakebite victims are hospitalised and are observed for weakness, painful progressive swelling or, if bitten by a boomslang or vine snake, bleeding.
If the symptoms are severe and justify the administration of antivenom, then and only then will the doctor administer this intravenously via a drip.
A bite from a potentially lethal snake will not automatically result in the administration of antivenom. Most patients have mild symptoms that do not warrant the administration of antivenom and they can be easily treated with pain relief and fluids to flush the kidneys.
In most cases, blood is drawn and sent to a laboratory for analysis.
How many vials of antivenom does a patient need?
The number of vials a patient receives depends on the snakebite.
In boomslang bites, most patients receive two vials of monovalent boomslang antivenom. In some cases a third vial may be necessary.
In cytotoxic bites, such as a bite from a puff adder, doctors will usually start with 5 or 6 vials of polyvalent antivenom.
In serious neurotoxic bites, such as a bite from a black mamba or Cape cobra, the patient will start with 10 – 12 vials of polyvalent antivenom.
Patients are monitored and may require more antivenom later.
How much does antivenom cost?
Monovalent boomslang antivenom costs R6,800 per vial while polyvalent antivenom costs R2,130 per vial.
About 10% of snakebite victims that are hospitalised require and are treated with antivenom.
Treatment for snakebites is expensive – it can cost more than R100,000.
Why is there a shortage of antivenom?
The South African Vaccine Producers have had production problems over the years and experienced significant production problems early in 2022. It cited power outages and supply problems as the main contributing factors.
Doctors, hospitals and veterinarians have felt the brunt of the shortage with veterinarians particularly hard hit by the crisis as they often treat pets for serious snakebites.
The SAVP antivenom is popular throughout Africa and several African countries rely on antivenom purchased from the South African Vaccine Producers.
Steps have been taken to get production back to normal. However, there is still a massive backlog and many hospitals and veterinary clinics will not be able to obtain sufficient antivenom for months.
According to the SAVP, doctors will treat the following symptoms:
– Painful progressive swelling syndrome
– Progressive weakness syndrome
– Mixed painful progressive swelling and progressive weakness syndrome
– Bleeding syndrome
The antivenoms available are: Black mamba, green mamba, Jameson's mamba, Cape cobra, snouted cobra, (Egyptian cobra), forest cobra, Gaboon adder, Mozambique spitting cobra, puff adder, rinkhals.
How can you help?
In a bid for members of the public to help snakebite victims, the African Snakebite Institute has created the African Snakebite Institute Foundation, a registered non-profit organisation (NPO no 231-106).
The ASI Foundation's plan is to establish more than 20 antivenom banks across the country, with both monovalent and polyvalent antivenins available 24 hours a day.
The project will cost about R1 million and will rely on donations from corporates and the public.
Every cent donated will go towards purchasing antivenom. To donate to this cause, you can find details on the website, or make payments directly using the following banking details:
African Snakebite Institute Foundation NPO
First National Bank
Account Number: 62858750055
Branch Code: 250655