Sunday, April 24, 2016

Myanmar - Increasing anti-venom production to prevent snakebite fatalities across Myanmar

Snake bites are well-known medical emergencies in many parts of the world, especially in rural areas.

The incidence of snake bite mortality is particularly high in South-East Asia, home to many different venomous snakes, and farmers, rural workers and children are often the most at risk. In 2009, snake bites were included in WHO’s list of neglected tropical diseases, recognising how snake bites represent a common occupational hazard and result in thousands of deaths and chronic physical handicap cases every year.

Much is now known about the species of venomous snakes responsible for these bites and the clinical effects of their venom in humans. In Myanmar, the most common venomous snakes are the Russell’s viper (Daboia siamensis) – responsible for almost 90% of bites in the country, the Monocellate cobra (Naja kaouthia) and the Banded krait (Bungarus fasciatus), which are widespread throughout the nation.

In 1999, the Ministry of Health initiated a programme for the management and prevention of snake bites, with technical support from WHO especially in terms of capacity building. Fellowships are provided to both staff members of the MoH and of the Myanmar Pharmaceutical Factory to conduct research in different institutions of the South East Asia region and receive training on the production of anti-snake venom and the clinical management of snake bites. In-country training is also provided to health personnel, especially in high risk townships where the occurrence of snake bites is most frequent.

The Anti Snake-Venom Production Centre of the Ministry of Industry in Yangon is one of the high-technology facilities that have benefitted from the collaboration with external partners, in particular Australian, Brazilian (Instituto Butanta, Sao Paulo, Brazil) and Thailand (Thai Red Cross) institutions” . The Production centre is responsible for the nationwide production of anti-venom, and is now able to cover for the country’s needs thanks to increased investments and the implementation of new technologies.

Thanks to improvements in all steps of the production process – from ensuring better health and survival rates of horses and sheep, from which the anti-venom anti-bodies are extracted, to using new purification methods to improve the quality of the product – the Production Centre has been able to increase production of specific anti-venom vials (anti-viper and anti-cobra the two most common forms of snake bites) from around 30,000 in 2007-08 to 80,000 vials in 2015-16”.

The production of anti-venom is essential to ensure that the consequences of snake-bites can be mitigated: around 8 vials are needed to treat a single bite, and there is a limited time span (only 3-4 hours after the bite) within which the anti-venom can be fully effective. The time limitations for treatment call for an increased dissemination of anti-venom across the country, in particular in Rural and Sub-rural health centres, where most cases are likely to be reported. In order to tackle the difficulties of storing the anti-venom vials and prolonging their shelf life, the Ministry of Industry and the MPF Anti Snake -Venom Production Centre has implemented a new technology for producing anti-venom, which will allow the lyophilisation of the product to ensure its durability and prolonging its effectiveness even in more difficult storage conditions.

WHO remains committed to supporting the Ministry of Health and the Ministry of Industry in improving the production and dissemination of anti-venom across the country, to ensure that this important public health threat for Myanmar can be effectively managed and controlled.

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