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Maduwage K, Kodagoda Gamage S, Gutiérrez JM. First aid and pre-hospital practices in snakebite victims: The persistent use of harmful interventions. Toxicon 2024; 238:107582. [PMID: 38128838 DOI: 10.1016/j.toxicon.2023.107582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
First aid intervention and pre-hospital (FAPH) practices are common in patients suffering from snakebite envenomation (SBE). In this study, we have reviewed the literature concerning the use of these practices in various regions of the world in the period 1947-2023 based on published prospective studies. A total of 71 publications fulfilled the inclusion criteria. In terms of the total number of patients in all studies that used each FAPH intervention, the most common practice was the application of tourniquets (45.8%). Other FAPH practices described include cuts/incisions (6.7%), the application of a variety of natural or synthetic substances at the bite site (5.6%), and ingestion of natural, usually herbal, remedies (2.9%). Washing the site of the bite was described in 9.1% of patients. There were other less frequent FAPH practices, including suction, splinting-immobilization, pressure-bandage, ice packs, application of a snake/black stone, and administration of alcoholic beverages. There were differences in the extent of application of FAPH interventions in different continents. Tourniquets were highest (55.7%) in Asia. Topical application of various products was common in South America, while pressure-bandage was only reported in Australia. We did not find any statistically significant variations in the frequency of the most frequent FAPH interventions at three-time intervals (before 2006, between 2006 and 2015, and after 2015). Our findings highlight the use of FAPH interventions in patients suffering SBE, some of which are known to be harmful. It is necessary to study these practices to a higher level of geographic granularity, using community-based surveys. Programs tailored to local contexts should be promoted, aimed at avoiding the use of harmful FAPH practices. It is also necessary to assess the efficacy and safety of some interventions through robust preclinical and clinical studies.
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Affiliation(s)
- Kalana Maduwage
- Discipline of Biomedical Sciences, University of New England, NSW, 2350, Australia.
| | | | - José María Gutiérrez
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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Araújo SCM, Câmara JT, Guedes TB. Snakebites in Northeastern Brazil: accessing clinical-epidemiological profile as a strategy to deal with Neglected Tropical Diseases. Rev Soc Bras Med Trop 2023; 56:e02242023. [PMID: 37820102 PMCID: PMC10561396 DOI: 10.1590/0037-8682-0224-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Brazil ranks first in the number of snakebites in South America. A detailed analysis of these cases is required to improve the public health planning. In this study, we retrospectively examined the clinical and epidemiological profiles of snakebites in Maranhão between January 2009 and December 2019. METHODS Data were obtained from the compulsory notification forms provided by the Health Department of Maranhão. RESULTS A total of 17,658 cases were recorded during the study period. Most of the bites were from snakes belonging to the genus Bothrops. Medical care was mostly within three hours after the bite. Most cases were classified as mild and most victims recovered; however, 139 deaths were recorded. Most bites occurred among people aged 20-39 years, mainly among rural workers. The most frequent local clinical manifestations were pain, edema, and ecchymosis. The most common systemic clinical manifestations include neuroparalysis, vagal syndrome, and myolysis. Most snakebites occurred between January and March. The municipalities with the highest number of notifications were Buriticupu (936 cases), Arame (705 cases), and Grajaú (627 cases). CONCLUSIONS The clinical profile of snakebites in Maranhão is similar to that observed in other states of Northeast Brazil. However, we found that some systemic manifestations are not compatible with the etiology of snakebites, which leads us to believe that the problem could be the lack of knowledge of the health professionals at the site of envenomation, who may not be ready for attendance, and an important lack of health centers with snake antivenom to treat snakebites.
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Affiliation(s)
- Sâmia Caroline Melo Araújo
- Universidade Estadual do Maranhão, Programa de Pós-Graduação em Biodiversidade, Ambiente e Saúde, Caxias, MA, Brasil
| | - Joseneide Teixeira Câmara
- Universidade Estadual do Maranhão, Programa de Pós-Graduação em Biodiversidade, Ambiente e Saúde, Caxias, MA, Brasil
| | - Thaís B. Guedes
- Universidade Estadual de Campinas, Instituto de Biologia, Departamento de Biologia Animal, Campinas, SP, Brasil
- Gothenburg Global Biodiversity Center, University of Gothenburg, Department of Biological and Environmental Sciences, Göteborg, Sweden
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Bravo-Vega C, Renjifo-Ibañez C, Santos-Vega M, León Nuñez LJ, Angarita-Sierra T, Cordovez JM. A generalized framework for estimating snakebite underreporting using statistical models: A study in Colombia. PLoS Negl Trop Dis 2023; 17:e0011117. [PMID: 36745647 PMCID: PMC9934346 DOI: 10.1371/journal.pntd.0011117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 02/16/2023] [Accepted: 01/20/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Snakebite envenoming is a neglected tropical disease affecting deprived populations, and its burden is underestimated in some regions where patients prefer using traditional medicine, case reporting systems are deficient, or health systems are inaccessible to at-risk populations. Thus, the development of strategies to optimize disease management is a major challenge. We propose a framework that can be used to estimate total snakebite incidence at a fine political scale. METHODOLOGY/PRINCIPAL FINDINGS First, we generated fine-scale snakebite risk maps based on the distribution of venomous snakes in Colombia. We then used a generalized mixed-effect model that estimates total snakebite incidence based on risk maps, poverty, and travel time to the nearest medical center. Finally, we calibrated our model with snakebite data in Colombia from 2010 to 2019 using the Markov-chain-Monte-Carlo algorithm. Our results suggest that 10.19% of total snakebite cases (532.26 yearly envenomings) are not reported and these snakebite victims do not seek medical attention, and that populations in the Orinoco and Amazonian regions are the most at-risk and show the highest percentage of underreporting. We also found that variables such as precipitation of the driest month and mean temperature of the warmest quarter influences the suitability of environments for venomous snakes rather than absolute temperature or rainfall. CONCLUSIONS/SIGNIFICANCE Our framework permits snakebite underreporting to be estimated using data on snakebite incidence and surveillance, presence locations for the most medically significant venomous snake species, and openly available information on population size, poverty, climate, land cover, roads, and the locations of medical centers. Thus, our algorithm could be used in other countries to estimate total snakebite incidence and improve disease management strategies; however, this framework does not serve as a replacement for a surveillance system, which should be made a priority in countries facing similar public health challenges.
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Affiliation(s)
- Carlos Bravo-Vega
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
| | | | - Mauricio Santos-Vega
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Leonardo Jose León Nuñez
- Observatorio de Salud Pública y epidemiología "José Felix Patiño", Universidad de los Andes, Bogotá, Colombia
| | - Teddy Angarita-Sierra
- Grupo de investigación Biodiversidad para la sociedad, Universidad Nacional de Colombia sede de La Paz, Cesar, Colombia
| | - Juan Manuel Cordovez
- Grupo de investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
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Valladales-Restrepo LF, Rojas-Ramirez AS, Santander-Pai MJ, Lozada-Castaño V, Bedoya-Duque LV, Sabogal-Sanchez DY, Gómez-Gómez NS, Machado-Alba JE. Clinical characteristics and use of antibiotics in a group of patients with snake bites in Colombia. Ther Adv Infect Dis 2023; 10:20499361231210400. [PMID: 37954406 PMCID: PMC10637142 DOI: 10.1177/20499361231210400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Millions of snake bites occur worldwide each year. Clinical practice guidelines generally do not recommend the use of prophylactic antibiotics. Objective To determine the sociodemographic, clinical, and pharmacological variables and the use of antibiotics in a group of patients with snake bites in Colombia. Methods A retrospective cross-sectional study was carried out. Patients affiliated with a Colombian health insurer who presented with snake bites between 2015 and 2022 were included. The cases were identified from the National Public Health Surveillance System. Sociodemographic, clinical and pharmacological variables were identified. Descriptive and bivariate analyses were performed. Results A total of 643 patients were analyzed, with a median age of 30.8 years, and 74.7% were men. The most frequently identified genus of snake was Bothrops (88.8%), and most incidents were classified as mild ophidian accidents (61.6%). A total of 59.7% of patients received snake antivenom. A total of 13.8% and 2.2% of the patients had cellulitis or abscesses, respectively. A total of 63.5% received antibiotics (50.6% for prophylaxis and 12.9% for treatment), especially cephalexin (25.9%), and most of the antibiotic management was considered inappropriate (91.7%). Conclusion Most patients with snake bites received antibiotics, especially for prophylactic purposes, a clinical behavior that goes against current evidence. The use of antibiotics with an unsuitable spectrum for the microorganisms that are usually found in the wounds of these patients is frequent. The development of local clinical practice guidelines is required to help reduce the overprescription of antibiotics, as the excessive use of antimicrobials is the main determinant of antimicrobial resistance.
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Affiliation(s)
- Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Risaralda, Colombia
- Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Ana Sofia Rojas-Ramirez
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Melba Jasbleidy Santander-Pai
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Valeria Lozada-Castaño
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Laura Valentina Bedoya-Duque
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Dayana Yuliet Sabogal-Sanchez
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Nicolas Stiven Gómez-Gómez
- Semillero de Investigación en Farmacología Geriátrica, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Risaralda, Colombia
| | - Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 # 14-140, Pereira, Risaralda 660003, Colombia
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Quiroz S, Henao Castañeda IC, Granados J, Patiño AC, Preciado LM, Pereañez JA. Inhibitory Effects of Varespladib, CP471474, and Their Potential Synergistic Activity on Bothrops asper and Crotalus durissus cumanensis Venoms. Molecules 2022; 27:8588. [PMID: 36500682 PMCID: PMC9737558 DOI: 10.3390/molecules27238588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
Snakebite is a neglected tropical disease that causes extensive mortality and morbidity in rural communities. Antivenim sera are the currently approved therapy for snake bites; however, they have some therapeutic limitations that have been extensively documented. Recently, small molecule toxin inhibitors have received significant attention as potential alternatives or co-adjuvant to immunoglobulin-based snakebite therapies. Thus, in this study, we evaluated the inhibitory effects of the phospholipase A2 inhibitor varespladib and the metalloproteinase inhibitor CP471474 and their synergistic effects on the lethal, edema-forming, hemorrhagic, and myotoxic activities of Bothrops asper and Crotalus durissus cumanensis venoms from Colombia. Except for the preincubation assay of the lethal activity with B. asper venom, the mixture showed the best inhibitory activity. Nevertheless, the mix did not display statistically significant differences to varespladib and CP471474 used separately in all assays. In preincubation assays, varespladib showed the best inhibitory activity against the lethal effect induced by B. asper venom. However, in independent injection assays, the mix of the compounds partially inhibited the lethal activity of both venoms (50%). In addition, in the assays to test the inhibition of edema-forming activity, the mixture exhibited the best inhibitory activity, followed by Varespladib, but without statistically significant differences (p > 0.05). The combination also decreased the myotoxic activity of evaluated venoms. In these assays, the mix showed statistical differences regarding CP471474 (p < 0.05). The mixture also abolished the hemorrhagic activity of B. asper venom in preincubation assays, with no statistical differences to CP471474. Finally, the mixture showed inhibition in studies with independent administration in a time-dependent manner. To propose a mode of action of varespladib and CP471474, molecular docking was performed. PLA2s and SVMPs from tested venoms were used as targets. In all cases, our molecular modeling results suggested that inhibitors may occupy the substrate-binding cleft of the enzymes, which was supported by specific interaction with amino acids from the active site, such as His48 for PLA2s and Glu143 for the metalloproteinase. In addition, varespladib and CP471474 also showed interaction with residues from the hydrophobic channel in PLA2s and substrate binding subsites in the SVMP. Our results suggest a synergistic action of the mixed inhibitors and show the potential of varespladib, CP471474, and their mixture to generate new treatments for snakebite envenoming with application in the field or as antivenom co-adjuvants.
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Affiliation(s)
- Sara Quiroz
- Research Group in Toxinology, Pharmaceutical, and Food Alternatives, Pharmaceutical and Food Sciences Faculty, University of Antioquia, Medellín 50010, Colombia
| | - Isabel C. Henao Castañeda
- Research Group in Marine Natural Products, Pharmaceutical and Food Sciences Faculty, University of Antioquia, Medellín 050010, Colombia
| | - Johan Granados
- Research Group in Pharmaceutical Promotion and Prevention, Universidad de Antioquia, Medellín 050010, Colombia
| | - Arley Camilo Patiño
- Research Group in Toxinology, Pharmaceutical, and Food Alternatives, Pharmaceutical and Food Sciences Faculty, University of Antioquia, Medellín 50010, Colombia
| | - Lina María Preciado
- Research Group in Toxinology, Pharmaceutical, and Food Alternatives, Pharmaceutical and Food Sciences Faculty, University of Antioquia, Medellín 50010, Colombia
| | - Jaime Andrés Pereañez
- Research Group in Toxinology, Pharmaceutical, and Food Alternatives, Pharmaceutical and Food Sciences Faculty, University of Antioquia, Medellín 50010, Colombia
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Estrada-Gómez S, Vargas-Muñoz LJ, Higuita-Gutiérrez LF. Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008-2020: Produced Vials Do Not Meet the Needs. Drug Healthc Patient Saf 2022; 14:171-184. [PMID: 36199542 PMCID: PMC9528913 DOI: 10.2147/dhps.s367757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Snakebite envenomation is a public health event of mandatory reporting in Colombia. It is considered a medical emergency in which the government must guarantee antivenom availability. We describe snakebite epidemiological figures in Colombia between 2008 and 2020 and correlate them with antivenom manufacturing figures to determine rate coverage and the need for antivenom. Methods We performed an ecological study based on secondary official figures from the National Health Institute, the National Institute for Surveillance of Medicines and Foods, the National Administrative Department of Statistics and the Ministry of Health and Social Protection. Absolute and relative frequencies were calculated with 95% confidence intervals, position measurements, dispersion and central tendency. Results Through our research, we revealed that in the last 13 years (2008-2020), there were an average of 4467 annual snakebite envenomation cases affecting all the departments in Colombia. Antioquia reported the highest number of snakebites with 647 (95% CI 588-706) cases per year. The population incidence per 100,000 inhabitants was 9.5; the highest rates were found in Vaupés at 116.1 and Guaviare at 79.24. During the last seven years (2014-2020) Colombia produced an average of 21,104 antivenom vials per year, while the annual demand for antivenom is estimated at 54,440 units needed to guarantee access. Discussion Colombia does not produce sufficient vials to cover their needs, and this is why only 74.4% of accidents (out of the 92% not classified as dry bites) were treated, and even 9.7% of the severe accidents did not receive the specific treatment (8% of the victims were classified as dry bites). Figures support the regular antivenom shortages declared by the Ministry of Health and Social Protection in the last 13 years (11 health emergency declarations). New efforts are needed to: 1) boost the production of GMP-based high-quality antivenom, that covers the national needs and is made availability, 2) a better estimation method to calculate the need for antivenom in Colombia, and 3) implementation of production-distribution chains guaranteeing access in remote communities.
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Affiliation(s)
- Sebastián Estrada-Gómez
- Grupo de Toxinologia y Alternativas Terapeuticas Alimentarias, Universidad de Antioquia UdeA, Medellin, Antioquia, Colombia
- Tech Life Saving (TLS), Medellin, Antioquia, Colombia
- Centro de Investigación en Recursos Naturales y Sustentabilidad, Universidad Bernardo O’Higgins, Santiago de Chile, Chile
| | - Leidy Johana Vargas-Muñoz
- Tech Life Saving (TLS), Medellin, Antioquia, Colombia
- Facultad de Medicina, Universidad Cooperativa de Colombia, Medellin, Antioquia, Colombia
| | - Luis Felipe Higuita-Gutiérrez
- Facultad de Medicina, Universidad Cooperativa de Colombia, Medellin, Antioquia, Colombia
- Escuela de Microbiología, Universidad de Antioquia UdeA, Medellin, Antioquia, Colombia
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Bravo-Vega C, Santos-Vega M, Cordovez JM. Disentangling snakebite dynamics in Colombia: How does rainfall and temperature drive snakebite temporal patterns? PLoS Negl Trop Dis 2022; 16:e0010270. [PMID: 35358190 PMCID: PMC8970366 DOI: 10.1371/journal.pntd.0010270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/21/2022] [Indexed: 11/21/2022] Open
Abstract
The role of climate driving zoonotic diseases' population dynamics has typically been addressed via retrospective analyses of national aggregated incidence records. A central question in epidemiology has been whether seasonal and interannual cycles are driven by climate variation or generated by socioeconomic factors. Here, we use compartmental models to quantify the role of rainfall and temperature in the dynamics of snakebite, which is one of the primary neglected tropical diseases. We took advantage of space-time datasets of snakebite incidence, rainfall, and temperature for Colombia and combined it with stochastic compartmental models and iterated filtering methods to show the role of rainfall-driven seasonality modulating the encounter frequency with venomous snakes. Then we identified six zones with different rainfall patterns to demonstrate that the relationship between rainfall and snakebite incidence was heterogeneous in space. We show that rainfall only drives snakebite incidence in regions with marked dry seasons, where rainfall becomes the limiting resource, while temperature does not modulate snakebite incidence. In addition, the encounter frequency differs between regions, and it is higher in regions where Bothrops atrox can be found. Our results show how the heterogeneous spatial distribution of snakebite risk seasonality in the country may be related to important traits of venomous snakes' natural history.
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Affiliation(s)
- Carlos Bravo-Vega
- Grupo de Investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
| | - Mauricio Santos-Vega
- Grupo de Investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
| | - Juan Manuel Cordovez
- Grupo de Investigación en Biología Matemática y Computacional (BIOMAC), Departamento de Ingeniería Biomédica, Universidad de los Andes, Bogotá, Colombia
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ANGARITA-SIERRA TEDDY, MONTAÑO-LONDOÑO LUISAFERNANDA, BRAVO-VEGA CARLOSANDRÉS. ID please: Evaluating the utility of Facebook as a source of data for snake research and conservation. AN ACAD BRAS CIENC 2022; 94:e20211043. [DOI: 10.1590/0001-3765202220211043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/25/2022] [Indexed: 11/30/2022] Open
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Pintor AF, Ray N, Longbottom J, Bravo-Vega CA, Yousefi M, Murray KA, Ediriweera DS, Diggle PJ. Addressing the global snakebite crisis with geo-spatial analyses - Recent advances and future direction. Toxicon X 2021; 11:100076. [PMID: 34401744 PMCID: PMC8350508 DOI: 10.1016/j.toxcx.2021.100076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/08/2023] Open
Abstract
Venomous snakebite is a neglected tropical disease that annually leads to hundreds of thousands of deaths or long-term physical and mental ailments across the developing world. Insufficient data on spatial variation in snakebite risk, incidence, human vulnerability, and accessibility of medical treatment contribute substantially to ineffective on-ground management. There is an urgent need to collect data, fill knowledge gaps and address on-ground management problems. The use of novel, and transdisciplinary approaches that take advantage of recent advances in spatio-temporal models, 'big data', high performance computing, and fine-scale spatial information can add value to snakebite management by strategically improving our understanding and mitigation capacity of snakebite. We review the background and recent advances on the topic of snakebite related geospatial analyses and suggest avenues for priority research that will have practical on-ground applications for snakebite management and mitigation. These include streamlined, targeted data collection on snake distributions, snakebites, envenomings, venom composition, health infrastructure, and antivenom accessibility along with fine-scale models of spatio-temporal variation in snakebite risk and incidence, intraspecific venom variation, and environmental change modifying human exposure. These measures could improve and 'future-proof' antivenom production methods, antivenom distribution and stockpiling systems, and human-wildlife conflict management practices, while simultaneously feeding into research on venom evolution, snake taxonomy, ecology, biogeography, and conservation.
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Affiliation(s)
- Anna F.V. Pintor
- Division of Data, Analytics and Delivery for Impact (DDI), World Health Organization, Geneva, Switzerland
- Australian Institute of Tropical Health and Medicine, Division of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - Nicolas Ray
- GeoHealth Group, Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Joshua Longbottom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre for Health Informatics, Computing and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Carlos A. Bravo-Vega
- Research Group in Mathematical and Computational Biology (BIOMAC), Department of Biomedical Engineering, University of Los Andes, Bogotá, Colombia
| | - Masoud Yousefi
- School of Biology, College of Science, University of Tehran, Iran
| | - Kris A. Murray
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, UK
- MRC Unit the Gambia at London School of Hygiene and Tropical Medicine, Atlantic Blvd, Fajara, Gambia
| | - Dileepa S. Ediriweera
- Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Peter J. Diggle
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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