Snakebite envenoming is a significant public health problem, particularly in rural areas of Africa, Asia and Latin America, where access to healthcare may be limited.
The severity of envenoming depends on factors such as the snake species, the amount of venom, the bite location, the victim’s age and health, and the speed of receiving treatment. Antivenom medication is highly effective and should be given quickly – however, there is a shortage of treatment as many countries are not able to manufacture antivenoms for their particular snake species.
There are three types of snake in the UK, with the adder being the only venomous one, although bites are rare. The rise in the number of snakes kept as exotic pets has led to a rise in snakebites – a paper in the journal Clinical Toxicology reported 321 cases from 68 different species between 2009 and 2020. Of these 15 were serious with one death and one patient having their finger amputated.
Symptoms of snakebite envenoming can appear within minutes to hours and vary depending on the type of venom. Some bites may result in minimal effects, while others can rapidly become life-threatening.
Common symptoms include:
Neurotoxic venom (from snakes from the elapid family such as cobras and mambas) can cause:
Haemotoxic venom (from snakes including copperheads and rattlesnakes) can cause:
Snakebite envenoming can lead to severe complications if untreated. Neurotoxic venoms may cause respiratory failure, which can be fatal without ventilatory support. Haemotoxic venoms can result in extensive bleeding and organ damage.
Other complications include infections, necrosis of affected limbs, kidney failure, and long-term disabilities such as limb amputation or chronic pain.
Snakebite envenoming occurs through direct contact with venomous snakes, typically during accidental encounters outdoors – children and anyone working outdoors are most at risk. Snake venom is produced in glands behind the snake’s eyes and is pumped down a duct to the fangs when it bites down on something or someone. Snakes with fangs at the front of their mouths are most dangerous – such as the cobra, puff adder, viper, rattlesnake and mamba, for example.
Immediate medical attention is crucial. First aid includes keeping the patient calm and immobilising the bitten limb. Traditional remedies such as cutting the wound or applying a tourniquet are harmful and should be avoided.
Antivenom should be administered quickly and matched to the type of snake. Supportive care may include:
Wound care and monitoring for secondary infections are also important. Amputation is sometimes required in severe cases.
Preventing snakebite envenoming focuses on avoiding snakes and public education. Measures include:
Snakebite envenoming has been around as long as people and snakes have co-existed, although it is a generally under-researched condition. Up until the 17th century one treatment involved sucking venom out of the wound. The first antivenom was developed in the 1890s by a French immunologist, Albert Calmette, who witnessed a large number of cobra bites in Vietnam during the rainy season. This was then developed into commercial antivenoms.
In 2019, the UK Wellcome Trust launched an initiative to modernise antivenom research and production and the World Health Organization announced a plan to halve death and disability from snakebite by 2030.
wellcome.org/infectious-disease/snakebite
who.int/fact-sheets/snakebite-envenoming
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