IRIN (UN Office for the Coordination of Humanitarian Affairs) 17 November 10 Why snakebites matterBangkok: Despite an age-old widespread fear and distrust of snakes, their bites have only recently been added to the World Health Organization’s (WHO) list of “neglected tropical diseases”.

Snakes bite an estimated five million people each year worldwide, seriously injuring or disabling up to three million and killing an estimated 125,000, according to WHO and the Australian Venom Research Unit (AVRU).

Snake bites cause more death and disability than some far more notorious tropical diseases, including dengue fever, cholera, Japanese encephalitis, Chagas disease and leishmaniasis, according to WHO.

“In some provinces of Papua New Guinea, the rate of death due to snake bite is two times higher than malaria,” said David Williams, coordinator of the Global Snakebite Initiative, a Melbourne-based global research project.

Roughly half the world’s snakebites occur in Asia, mostly in India, which has the largest snake bite problem in the world, with up to 50,000 people bitten every year.

“Snake bites are a widespread problem in this region particularly for the poorer populations,” Williams said.

Accurate figures for Asia are difficult to ascertain, since many bites are never reported. “The people who are most affected by snake bites are poor rural farmers. They often can’t afford or don’t have access to national healthcare facilities so turn to informal local healers instead,” said Williams.

Sombat Kaewsaeng, a 45-year-old gardener, was cutting the grass in central Bangkok where he lives and works when he suddenly felt a sharp pain on the top of his right foot.

“I thought it might be a bug or something, but then I saw something slithering away in the grass and looked down and saw two fang markings half a centimetre deep in the top of my foot,” he said.

Sombat, who only works in flip-flops, used a rope to tourniquet his knee and went immediately to the hospital.

“I saw on TV that this was what to do when you get bit,” he said. “As soon as I got to the hospital [30 minutes later] they immediately identified that it was non-venomous, much to my relief.”

Gardeners, agriculture workers and snake handlers - those most likely to invade the habitat of snakes - are the most likely people to be bitten. So much so that WHO considers snake bites an “occupational hazard”.

“Snakes only bite when they are afraid,” said Montri Chiobamroonkiat, head of the Bangkok-based “Snake Farm”, a WHO Collaborating Centre for Venomous Snake Toxicology and Research located in the Queen Saovabha Memorial Institute (QSMI).

QSMI, the primary snake toxicology research unit in Thailand, holds annual conferences with healthcare workers across the country and produces some 100,000 anti-venom treatment vials annually.

Deaths by snake bites sharply increase during and following monsoon seasons - periods of peak agricultural activity.

Sharp rises in the number of snake bite victims have been reported from India, Bangladesh and Myanmar, typically after heavy flooding as large work forces re-built roads or dug irrigation.

Aid agencies reported dramatic increases in snake-bite victims in the year following Cyclone Nargis in Myanmar.

In order to reduce the number of people killed or disabled by snake bites each year, experts say countries need to educate health service employees about how to treat snake-bites, as well as produce anti-venoms.

“The biggest challenge in the past was getting the right diagnosis [venomous or not] but now the region needs to make available anti-venoms,” said Suchai Suteparuk, associate director of the QSMI’s Snake Farm.

Williams pointed out regional disparities in managing snake bites.

Snakes kill less than 10 people every year in Thailand, out of the some 10,000 people bitten, while 500-1,000 people die annually from snake bites in neighbouring Myanmar, though about the same number are bitten.

The situation has worsened to the point the Myanmar Ministry of Health in 2010 set a five-year plan with annual targets for the reduction of snake bites.

Meanwhile, even a Bangkok snake research institute cannot protect gardeners like Sombat from risk. “I will be more careful now when working. I’m much more afraid lately when I’m working in the garden,” he said.
Why snakebites matter

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