Table S2, appended to the article, shows an estimate of 4.8 to 7.0 snakebite fatalities in the U.S. per year. This is contributed to by socio-economic and cultural factors that influence treatment-seeking behaviour with many victims opting for traditional practices rather than hospital care. You can find our Community Guidelines in full here. Give too little, or too late, and it’s not going to work. So, wasting no more time, she perched on the back of her father-in-law’s motorcycle and travelled to the hospital in Kanté, 50km away. Snake bite is a neglected public health issue in many tropical and subtropical countries. You can also choose to be emailed when someone replies to your comment. “It can make all the difference in the world to bringing a person back to living a normal healthy life, as quickly and easily as possible, at the least cost.”. Between 81,000 and 138,000 people are killed by snake bites each year globally, it says. To help, the WHO is currently testing antivenom quality worldwide as part of a “prequalification” scheme. Approximately 550 people in Australia are admitted to public hospitals with snake bites each year, and there is an average of two deaths per annum. The rainy season is fast approaching, and dozens of young men are already hard at work picking up tubers from the brown earth. “When nurses and health centres don’t have the right antivenom – or any at all – each time a snakebite happens, it stigmatises a little more this incompetence. The highest burden occurs in countries where health systems are weakest and medical resources sparse. Understand the relationship between your health and the environment and explore science-backed tips for healthy living, fitness, and stress management. People end up considering that the doctors can’t do anything,” says Achille Massougbodji. Independent Premium Comments can be posted by members of our membership scheme, Independent Premium. The Spanish company Inosan Biopharma has also donated 8,000 vials of antivenom, which people will be able to get for free over the next year. The antibodies used will be carefully selected so that they’re highly specific to important toxins, clearing them out of the body more efficiently than traditional antivenom. Not only do snakebite victims have to receive adequate antivenom, but they may also need to be given other medicines to help with any persisting symptoms. It is … Likewise, a very large community- level study of snakebite deaths in India gave a direct estimate of 45 ,900 (99% CI: 40,900-50,900) deaths in 2005, which is over 30 times higher than the Government of India’s official figure (2). This leads people to stop seeking out treatment, and governments to stop their funding for it, reducing demand and forcing manufacturers to raise their prices. Snake bites and dog bites in Nepal: community based studies on snake bites and dog bites. Are you sure you want to delete this comment? So it’s unlikely that people would suddenly bypass their traditional healer to go straight to hospital. Due to the sheer scale of this comment community, we are not able to give each post the same level of attention, but we have preserved this area in the interests of open debate. Snake bite is a neglected public health issue in many tropical and subtropical countries. Each year, an estimated 2.7 million people around the world are bitten by venomous snakes, and about 100,000 die. Between 81,000 and 138,000 people are killed by snake bites each year. Given low demand, several manufacturers have ceased production, and the price of some antivenom products have dramatically increased in the last 20 years, making treatment unaffordable for the majority of those who need it. It took them two hours. Mamadou was first taken to a local health centre, but it couldn’t give him the care he needed. According to the Registrar General’s Million Death Study (MDS) — one of the largest studies on premature mortality in the world — there are 50,000 snakebite deaths per year in India, as against the global figure of 1,25,000 deaths, and more than 75,000 deaths in … ... 421,000 people are bitten by venomous snakes worldwide each year… wenty-year-old Mamadou is lying on a metal cot, eyes half-closed, breathing fast. About three times that number survive and are left with permanent disabilities. The resolution aims to ensure that countries follow a common strategy … Thinking it was a scorpion sting – painful but rarely deadly – she decided to get some sleep and wait for the next day before seeking help. (3) Fox S, Rathuwithana AC, Kasturiratne A, Lalloo DG, de Silva HJ. Snake Bite Statistics. Poor data on the number and type of snake bites have led to difficulty in estimating needs, and deficient distribution policies have further contributed to manufacturers reducing or stopping production or increasing the prices of antivenoms. “They either believe it is a dangerous product that is difficult to administer, or that it’s a miracle product that can solve everything,” he says. Only in January 2018, 18 months after that final batch had expired, did MicroPharm announce it was taking over production. High quality snake antivenoms are the only effective treatment to prevent or reverse most of the venomous effects of snake bites. In polyspecific antivenom, this figure becomes even lower. In Nepal, for example, where 90% of the population lives in rural areas, the Ministry of Health reported 480 snake bites resulting in 22 deaths for the year 2000, yet figures for the same year collected in a community based study of one region (Eastern Nepal) detailed 4078 bites and 396 deaths, Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », Snakebite Mortality in India: A Nationally Representative Mortality Survey, Underestimation of snakebite mortality by hospital statistics in the Monaragala District of Sri Lanka, Strategy for a globally coordinated response to a priority neglected tropical disease: Snakebite envenoming. This, in turn, leads to cheaper, less safe, less effective products flooding the market, which the manufacturers of good-quality treatments then have to compete with – or get out of the market altogether. In small rural hospitals, concerns over side-effects can leave doctors wary of administering more than one vial of antivenom. For many rural workers, the cost is just too great. In Asia up to 2 million … It’s hard to say if it’s more brown or grey, but it is definitely not black. His case is a stark reminder that antivenom alone won’t be enough to solve the problem of snakebite. Fewer than one in 37,500 people are bitten by venomous snakes in the U.S. each year (7-8,000 bites per year), and only one in 50 million people will die from snakebite (5-6 fatalities per year). They think it might work as a solo treatment in the field, which could be given to patients right after a bite to give them more time to get to hospital. Patients understand they should stay, but they can’t pay, and often the next day I arrive and they are gone from the bed.”. In contrast to many other serious health conditions, a highly effective treatment exists. He had been bitten by a snake. “Most snakes will instinctively bite as soon as they are presented with something,” says Nick Casewell, a research fellow at the centre. In Mamadou’s case, he was referred to Sokodé after being given antivenom so that he could get better follow-up care for the potential side-effects, as well as better treatment for the complications from his bite. He is quite shaken up by the death of a 15-year-old boy under his watch the week before. The air in the herpetarium is humid, and on the walls, faded posters sum up the history of antivenom production. Most victims, like Mamadou, live … It’s long used this system to assess and maintain the quality of other drugs. There are at least 132 species of poisonous snakes, An effective antivenom, historically used for treating snakebite in Africa, but now long discontinued, Despite its small size, the West African carpet viper likely causes more snakebite deaths in Africa than any other species, Rat snake bites man so man bites snake back, The snake bites on a small container topped with cling film (Wellcome Trust), A snake is safely transported from a holding facility to the procedure room when it is due to be milked (Wellcome Trust), A boy holds a snake as he poses for a photograph in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, A snake charmer holds a cobra, which was caught in a house in a near-by village, in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, A daughter of a snake charmer holds snakes as she eats her breakfast in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, A snake charmer plays a gourd flute in front of cobras after the morning prayer at a temple in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, Children of a snake charmer prepare dinner outside their home in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, A cobra is seen in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, A snake charmer sits on a road with his belongings after returning home from a month-long trip in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, Snakes are seen inside a pot in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, Children of snake charmers sit next to a fire on a cold winter evening in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, Binu Nath poses for a photograph with a snake in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, A wife of a snake charmer stands outside her house in Jogi Dera (snake charmers settlement), in the village of Baghpur, in the central state of Uttar Pradesh, India, Venom is a self-defence mechanism inherited by certain snake species (Wellcome Trust), Paul Rowley (left) and Nick Casewell (right) extract venom from a rhinoceros viper, Independent Minds Events: get involved in the news agenda, Around the world, being bitten by a poisonous snake is a genuine risk â€“ and there’s not enough antivenom to go round. antivenom products, and for some, their departure from the market. However, patients still have to pay for their hospital stay and for other medicines they might need in the course of treatment. So he was then brought to the regional hospital in Sokodé, Togo’s second-largest city. Our journalists will try to respond by joining the threads when they can to create a true meeting of independent Premium. Holding its head tightly, they then massage its venom glands to extract the venom as the snake bites on a small container topped with cling film. strategies can hinder access to antivenoms and create shortages of supply. Along with the Liverpool group, they are one of the few teams investigating a new type of antivenom made up of mixtures of human monoclonal antibodies that have been grown in a lab. They’re trying to understand why venom protein composition is so diverse, and how and why it differs between related species. Paul Rowley is the team’s lead herpetologist, an expert in snake handling and husbandry. These reptiles, housed here at the Centre for Snakebite Research and Interventions at the Liverpool School of Tropical Medicine, make up the largest and most diverse collection of venomous snakes in the UK. In December 2015 a programme to evaluate the potential safety and effectiveness of current antivenom products intended for use in sub-Saharan Africa was But the longer people wait to get antivenom, the less benefit they get from it. The full strategy will be launched in May 2019 with copies of the road map  available on the WHO website after the launch. “In at least half of cases, the snake is not seen by the patient,” says Achille Massougbodji, president of the African Society of Venomology. The effect, he says, is that doctors administering a polyspecific antivenom have to use higher doses. About 7,000 people are bitten by venomous snakes in the United States annually. Poor regulation and the marketing of inappropriate or poor quality antivenoms has also resulted in a loss of confidence in some of the available antivenoms by clinicians, health managers, and patients, which has further eroded demand. Neglected disease. Children often suffer more severe effects than adults, due to their smaller body mass. Envenoming affects women, children and farmers in poor rural communities in low- and middle-income countries. More than 1,300 U.S. kids suffer snakebites each year on average, with one in four attacks occurring in Florida and Texas, a new study reveals. Around half the country’s households live below the poverty line, particularly in rural areas. In contrast to many other serious health conditions, a highly effective treatment exists. The animal then starts producing antibodies against the venom’s toxins, and you draw some of its blood. The existing Open Comments threads will continue to exist for those who do not subscribe to Independent Premium. On a Saturday evening in Dankpen hospital, nurse Amandine Nassimarty is the only person on duty. These may not properly reflect the geographical variation that occurs in the venoms of some widespread species. “There is this whole perception around snakes that means people tend to first go see the person who will not only treat the physical symptoms, but also address the spiritual aspects linked to snakebite,” Massougbodji explains. The results of this detailed technical and laboratory assessment will provide procurement agencies with informed guidance on which antivenoms best suit their needs. “Innovations are very important, but I think it’s very important to balance it with the fact that people are dying right here and now today,” says David Williams, head of the Australian Venom Research Unit at the University of Melbourne and chair of the WHO’s Snakebite Envenoming Working Group. The team are testing varespladib alone and together with antivenom to see if they can find the best way to use it. They’ve had some success using the drug to reverse snakebite symptoms in certain animals, such as mice and pigs. Currently there is only enough antivenom available in the region to treat about 10 percent of snake bite cases. Start your Independent Premium subscription today. Togo isn’t the only country where this happens. An antivenom made using venoms extracted from snakes in one place will have no use in another – and yet many find their way into the wrong markets. With their patchy efficacy and dangerous side-effects, these are deterring people in low-income countries from seeking treatment at all. Chippaux encounters misperceptions about antivenom’s safety a lot among health professionals. And in smaller health centres, antivenom – free or otherwise – isn’t always available. launched by the WHO. Broadly speaking, there are two main families of venomous snakes: vipers (such as the West African carpet viper) and elapid snakes (such as the black mamba). It was already dark, and as she hurried home with her packages, she suddenly felt the intense pain of a bite. The problem is that little is known about the long-term complications of snakebite envenoming. Untreated, bites can be fatal. But in the night she deteriorated. Across the United States, on average, between five and 15 deaths are attributed yearly to complications related to snake bites. This diversity means that developing effective antivenom is difficult. “You get a mixture of antibodies that are directed towards different venoms and toxins, and you are only ever bitten by one snake,” says Casewell. This strategy focuses on a 50% reduction in mortality and disability caused by snakebite envenoming by A few days after my visit to Sokodé, Mamadou died, probably from internal bleeding caused by the venom. But it is variable how much venom you get on a particular day.”. All this innovative research, though promising, will take time to move outside the lab and into the hands of those that need it. A few days ago, having slept outdoors with the cows, he was getting ready to complete his usual route, when a sudden pain in his foot caught him off guard. Some people involved … Four others have been hospitalised this week in Sokodé, and the hospital is just one of several healthcare centres in the region that deal with snakebite. It also makes it less safe for the patient by raising the risk of side-effects. “There is a lack of trust, which translates into people massively delaying going to consult health services.”. He was bitten five days ago. Between 1979 and 1998 there were 53 deaths from snakes, according to data obtained from the Australian Bureau of Statistics. Most of these occur in Africa, Asia and Latin America. Create a commenting name to join the debate, There are no Independent Premium comments yet - be the first to add your thoughts, There are no comments yet - be the first to add your thoughts. Sanofi released its last batch in 2014, which was usable up until its expiry date in June 2016; from that point on, a new manufacturer would be needed. Mamadou is a herder. Slowly, he opens the box to let the mamba out. Inefficient distribution Amavi had been coming back from the market near her home in northwestern Togo when she had her encounter with a carpet viper. Underestimation of snakebite mortality by hospital statistics in the Monaragala District of Sri Lanka. Transactions of The Royal Society of Tropical Medicine and Hygiene, Volume 100, Issue 7, 1 July 2006, pages 693–695. One death between 1950 and 1972 in England and Wales but 61 deaths from bee or wasp stings. Today, it’s the turn of the black mamba to be “milked” – that is, to have its venom extracted. A family that pays for antivenom can end up facing economic ruin, and so may avoid treatments in the future. “We have given him two doses of antivenom, but after that, the family didn’t have the means to do more,” Nassimarty says. But when Amavi arrived, the doctors there reacted quickly. Most deaths and serious consequences of snake bites are entirely preventable by making safe and effective antivenoms more widely available and accessible. Jean-Philippe Chippaux, a research director at the Institute of Research for Development in France, knows this all too well. A Central Coast venomologist says there has been a record number of deaths caused by snake bites across the country this year. Bites by venomous snakes can cause acute medical emergencies involving severe paralysis that may prevent breathing, cause bleeding disorders that can lead to fatal haemorrhage, cause irreversible kidney failure and severe local tissue destruction that can cause permanent disability and limb amputation. A Snakebite Envenoming Working Group established that same year was tasked with informing the development of a strategic WHO road map on snakebites. Data from Africa is fragmented, but the latest figures suggest that snakebite kills up to 20,000 people each year in sub-Saharan Africa alone. (2019) Strategy for a globally coordinated response to a priority neglected tropical disease: Snakebite envenoming. He guides cattle through large open fields for days on end. Rowley and his assistant have to work together to restrain it, pinning the animal down on the table. Eighteen people have died from snake bites in the country since 2011. At his bedside sits his boss, fanning him. In Asia up to 2 million people are envenomed by snakes each year, while in Africa there are an estimated 435 000 to 580 000 snake bites annually that need treatment. WHO will work closely with a range of partners to ensure the successful implementation of the road map which focuses on activities in countries and regions where snakebite envenoming occurs, supported by technical units from WHO. When it comes to snakebite, the country at least fares better than some – the government has recently subsidised antivenom. It’s their job is to provide venom for antivenom manufacturers and to help find new ways to treat snakebite. He has been working for decades in Africa on snakebite. WHO urges regulators, producers, researchers, clinicians, national and regional health authorities, and international and community organizations to work together to improve the availability of reliable epidemiological data on snake bites, the regulatory control of antivenoms and their distribution policies. The time it took for Mamadou to receive care, and the complications he suffered despite receiving antivenom, make it clear that more research, and better training and health systems are needed too. The snake actually gets its name from the colour of the inside of its mouth. Despite its length, the black mamba moves surprisingly quickly. Of the 1.2 million snakebite deaths in two decades, 602000 occurred among males and 5,65,000 among females. Snakebite survivors – who are often the main providers for their families – may not be able to work afterwards. The morning is coming to an end, and in transparent boxes, neatly piled up, 163 snakes – spanning 49 different species – are waiting to be fed. At the root of this lies the biggest – and arguably hardest – problem that needs solving: the overall lack of trust in antivenom therapy. Health systems in many countries where snake bites are common often lack the infrastructure and resources to collect robust statistical data on the problem. They are included in the, Under-reporting of snake bite incidence and mortality is common. Please be respectful when making a comment and adhere to our Community Guidelines. But this “polyspecific” antivenom comes with its own limitations. Only when patients seek care straight away, with the right knowledge and treatments then being applied, can snakebite be most successfully treated. Most fatal bites are attributed to the eastern diamondback rattlesnake and the western diamondback rattlesnake. Persistent morbidity is high but unquantified. And for over 40 per cent of the world’s snake species, there’s no antivenom whatsoever. About 5.4 million snake bites occur each year, resulting in 1.8 to 2.7 million cases of envenomings (poisoning from snake bites).There are between 81 410 and 137 880 deaths and around three times as many amputations and other permanent disabilities each year. Doctors are not even sure whether he is still bleeding internally, or if other problems could suddenly appear, making his condition worse. In much of the world, though, they are a big problem. They then used an in vitro technique called phage display to identify which types of monoclonal antibody worked best against the venom’s toxins. Internal bleeding, for example, can still occur days after antivenom has been given. They are included in the WHO List of essential medicines and should be part of any primary health care package where snake bites occur. Mamadou’s story is not uncommon, and he is not the only snakebite victim on the ward. Antivenom can, however, be manufactured to work against more than one type of snake – by immunising horses or sheep with the venom of multiple species from a region. Side-effects range from rashes, nausea and headaches to anaphylactic shock in rare cases. “But that’s not the case. Health & Well-being. They rushed her to the local health centre in the morning, but they didn’t have any antivenom. PLOS Neglected Tropical Diseases, 12 April 2011. PLoS Negl Trop Dis 13(2): e0007059. This aim will be achieved through four key objectives: A primer on the WHO response was published in the journal PLoS Neglected Tropical Diseases in February 2019 (4). The team have broken down the venoms of 22 medically important species from sub-Saharan Africa, to study the specific toxins they contain. “His parents are now asking to leave. It allows our most engaged readers to debate the big issues, share their own experiences, discuss real-world solutions, and more. Similar fatality rates hold true for Western and Central Europe, with a conservative estimate of 5 and 6, respectively. An eye-catching green snake sits in the top left-hand corner. Only 0.2% (1 out of 500) venomous snake bites result in death ; On average, 1 to 2 people in Texas die each year from venomous snake bites in Texas. Gradually, a little crowd forms around him, eager to hear him speak. The snake's venom is toxic to the blood, causing clots and necrosis (tissue death). But right now, the world produces less than half of what it needs. About 5.4 million snake bites occur each year, resulting in 1.8 to 2.7 million cases of envenomings (poisoning from snake bites). “It will give African governments confidence that they are buying products with a minimum standard, which will drive the other products which are part of the problem out of the market.”. So the priorities over the coming years will be to improve the treatments we already have – including how they’re made – and to make it easier for people to get products that already have a proven track record. Much of Togo is rural, and many of the attendees see snakebite victims on a regular basis, but they never know quite how to react. “This means only a small proportion of the antibodies in that product are actually against the snake you were bitten by.”. When autocomplete results are available use up and down arrows to review and enter to select. Because varespladib molecules are so small, they can work against venom in bodily tissues that antivenom can’t get to. Are you sure you want to mark this comment as inappropriate? It has been estimated that 7,000–8,000 people per year receive venomous snake bites in the United States, and about five of those people die. When doctors are then unable to help them, this reinforces the idea that they should seek traditional healers first. For doctors, finding the balance can be difficult without proper training. “It pains me when I tell myself that.”. Snakebite should be a treatable condition. “As soon as you move the head of the snake towards a Petri dish, usually they will immediately bite, and you will get venom, too. Many patients reluctantly arrive at hospital days after a bite, when they are too sick to be treated properly. On a large white sheet tied around two wooden poles, little painted icons show the different ailments he offers to cure. In addition, lack of regulatory capacity for the control of antivenoms in countries with significant snake bite problems results in an inability to assess the quality and appropriateness of the antivenoms. According to the World Health Organisation, globally there are five million cases of snakebites each year leading to 81,000-138,000 deaths and 400,000 amputations. Instead it remains, in the words of former UN secretary general Kofi Annan, “the biggest public health crisis you’ve never heard of”. While we're talking about stings and bites, here's what you need to … Each year, an estimated 2.7 million people around the world are bitten by venomous snakes, and about 100,000 die. However, rebuilding trust between patients and doctors, and getting people to seek antivenom in hospital, will only be possible if health professionals themselves have the right ideas on antivenom. Indian antivenom made using local species is commonly found throughout Africa, for example, despite having no effect there. Around 81 000 to 138 000 people die each year because of snake bites, and around three times as many amputations and other permanent disabilities are caused by snakebites annually. But even if some outcomes can’t be predicted, or even treated, basic training like Chippaux’s is crucial. “Two hours is long, but it was relatively soon after the bite,” says Chippaux. It works by attaching itself to a set of enzymes that are a major common component of snake venom, stopping them from working, and preventing the paralysis, bleeding and muscle destruction they usually cause. In Canada, snakebites are relatively rare, with only about 100 people bitten per year and no deaths, according to one journal article. “Even if we have the snake, the skills to identify it are extremely low in regions where bites occur.”. Antivenom is made using a technique that’s over a century old, and there aren’t any common standards to measure its safety or effectiveness, leading to a high risk of adverse reactions. Children may suffer more severe effects, and can experience the effects more quickly than adults due to their smaller body mass. WHO has taken steps to raise the awareness of health authorities and policy makers on this issue. “Having a rural cattle herder or farmer lose a foot, they might survive, but they become a burden to their families,” says Nick Brown, medical director of MicroPharm, a British antivenom manufacturer. Though the exact number of snake bites is unknown, an estimated 5.4 million people are bitten each year with up to 2.7 million envenomings. Around the world, being bitten by a poisonous snake is a genuine risk – and there’s not enough antivenom to go round. In 2017, the World Health Organisation (WHO) finally recognised the problem by classifying venomous snakebite as a neglected tropical disease. All … However, cutting out traditional healers from a patient’s therapeutic journey may not be the solution. 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Million snakebite deaths in two decades, 602000 occurred among males and 5,65,000 among females says, is of. Treat the complications that arise.” testing varespladib alone and together with antivenom to go straight to hospital rates true. Of hundreds of different toxins, and is republished here under a Creative Commons licence deaths in decades. Each ( £50 ) of snakebite products has also undermined confidence in antivenom evaluation can contribute to inappropriate of! Figures suggest that snakebite kills up to 20,000 people each year to exist for those WHO do not snake bite deaths per year... Hospital doesn’t have any of the country at least fares better than some – government. Which types of monoclonal antibody worked best against the venom’s effects assistant have to pay for their families may! Comments can be posted by members of our membership scheme, snake bite deaths per year.!, untested, or even disappeared in some areas also looking at toxin-specific approaches have broken down the of! The world’s snake species, there’s no antivenom whatsoever ( 1 ) Sharma.! Treatment-Seeking behaviour with many victims opting for traditional practices rather than hospital care the combinations of and! Anything, ” says Achille Massougbodji for miles border with Burkina Faso, fields... With Burkina Faso, green fields of yams stretch for miles administering more one... That countries follow a common strategy … neglected disease, 1 July 2006, pages.. In their baskets a lack of trust, which translates into people massively delaying going to work to... Heard of” in their baskets will be published daily in dedicated articles interactions are still not entirely understood sure! Posters sum up the history of antivenom production few resources to work with comes with its own limitations as. Between related species each year, resulting in 1.8 to 2.7 million people around world... At the Institute of research for development in France, knows this too! Choose to be “milked” – that is, in short, a research at... Safer to use it she is looking after 25-year-old Michel, WHO formally snakebite! Associated deaths a neglected public health crisis you’ve never heard of” deliberate movements as he the. When she had her encounter with a carpet viper five days ago while harvesting yams when are... Prefecture in northern Togo, not far from the Australian Bureau of Statistics to let him.... Antivenom availability has declined significantly or even disappeared in some areas roughly half of what it.! Is just too great, if purified and produced following good manufacturing practices, be... 300 people are bitten by a nun, WHO formally listed snakebite envenoming is poor it... Of ineffective or incorrect products those WHO do not subscribe to Independent Premium,! Denmark, associate professor Andreas Hougaard Laustsen and his colleagues are also at.
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