Outlining progress since the first International Snakebite Awareness Day and some key challenges for next year

Virus-like particles displaying conserved toxin epitopes stimulate polyspecific, murine antibody responses capable of snake venom recognition

Antivenom is currently the first-choice treatment for snakebite envenoming. However, only a low proportion of antivenom immunoglobulins are specific to venom toxins, resulting in poor dose efficacy and potency. We sought to investigate whether linear venom epitopes displayed on virus like particles can stimulate an antibody response capable of recognising venom toxins from diverse medically important species. Bioinformatically-designed epitopes, corresponding to predicted conserved regions of group I phospholipase A₂ and three finger toxins, were engineered for display on the surface of hepatitis B core antigen virus like particles and used to immunise female CD1 mice over a 14 weeks. Antibody responses to all venom epitope virus like particles were detectable by ELISA by the end of the immunisation period, although total antibody and epitope specific antibody titres were variable against the different epitope immunogens. Immunoblots using pooled sera demonstrated recognition of various venom components in a diverse panel of six elapid venoms, representing three continents and four genera. Insufficient antibody yields precluded a thorough assessment of the neutralising ability of the generated antibodies, however we were able to test polyclonal anti-PLA₂ IgG from three animals against the PLA₂ activity of Naja nigricollis venom, all of which showed no neutralising ability. This study demonstrates proof-of-principle that virus like particles engineered to display conserved toxin linear epitopes can elicit specific antibody responses in mice which are able to recognise a geographically broad range of elapid venoms.

The WHO strategy for prevention and control of snakebite envenoming: a sub-Saharan Africa plan

Snakebite is a critical public health issue in tropical countries, particularly in Africa, where 20% of snakebites globally occur. In 2017, the WHO added snakebite envenoming to the category A of neglected tropical diseases. In 2019, thanks to broad institutional and international NGO support, including strong mobilization of African experts and governments, WHO launched a strategy for prevention and control of snakebite envenoming with more ambitious goals. In sub-Saharan Africa, accessibility of antivenoms and symptomatic, adjuvant or replacement therapy is a priority. Several antivenoms are available but their evaluation has not been properly carried out and they remain expensive. To date, there are no manufacturers of antivenom in sub-Saharan Africa (except in South Africa), which requires their importation from other continents. The lack of experience in antivenom choice and its use by health authorities, health personnel and population largely explains the shortage in sub-Saharan Africa. The deficiency of epidemiological data does not allow the implementation of appropriate and efficient care. It is crucial to strengthen the health system which does not have the necessary means for emergency management in general and envenoming in particular. Providing peripheral health centers with antivenoms would decrease complications and deaths. The motivation of communities at risk, identified through the epidemiological data, would be to reduce the delay in consultation that is detrimental to the efficiency of treatment. Partnerships need to be coordinated to optimize resources from international institutions, particularly African ones, and share the burden of treatment costs among all stakeholders. We propose here a project of progressive implementation of antivenom manufacturing in sub-Saharan Africa. The various steps, from the supply of appropriate venoms to the production of purified specific antibodies and vial filling, would be financed by international, regional and local funding promoting technology transfer from current manufacturers compensated by interest on the sale of antivenoms.