Treatment outcomes among snakebite patients in north-west Ethiopia-A retrospective analysis.

Autor: Steegemans I; Médecins Sans Frontières, Amsterdam, The Netherlands.; VU University, Amsterdam, The Netherlands., Sisay K; Médecins Sans Frontières, Abdurafi, Ethiopia., Nshimiyimana E; Médecins Sans Frontières, Abdurafi, Ethiopia., Gebrewold G; Ethiopia Public Health Institute, Addis Ababa, Ethiopia., Piening T; Médecins Sans Frontières, Addis Ababa, Ethiopia., Menberu Tessema E; Médecins Sans Frontières, Addis Ababa, Ethiopia., Sahelie B; Médecins Sans Frontières, Addis Ababa, Ethiopia., Alcoba G; Médecins Sans Frontières, Geneva, Switzerland., Gebretsadik FS; Federal Ministry of Health, Addis Ababa, Ethiopia., Essink D; VU University, Amsterdam, The Netherlands., Collin S; Federal University of Espírito Santo, Vitória, Brazil., Lucero E; Médecins Sans Frontières, Amsterdam, The Netherlands., Ritmeijer K; Médecins Sans Frontières, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2022 Feb 09; Vol. 16 (2), pp. e0010148. Date of Electronic Publication: 2022 Feb 09 (Print Publication: 2022).
DOI: 10.1371/journal.pntd.0010148
Abstrakt: Background: Millions of people are bitten by venomous snakes annually, causing high mortality and disability, but the true burden of this neglected health issue remains unknown. Since 2015, Médecins Sans Frontières has been treating snakebite patients in a field hospital in north-west Ethiopia. Due to the poor market situation for effective and safe antivenoms for Sub-Saharan Africa, preferred antivenom was not always available, forcing changes in choice of antivenom used. This study describes treatment outcomes and the effectiveness and safety of different antivenoms used.
Methodology / Principal Findings: This retrospective observational study included 781 snakebite patients presenting at the field hospital between 2015 and 2019. Adjusted odds ratios, 95%-CI and p-values were used to compare the treatment outcome of patients treated with Fav-Afrique (n = 149), VacSera (n = 164), and EchiTAb-PLUS-ICP (n = 156) antivenom, and to identify the risk of adverse reactions for each antivenom. Whereas only incidental snakebite cases presented before 2015, after treatment was made available, cases rapidly increased to 1,431 in 2019. Envenomation was mainly attributed to North East African saw-scaled viper (Echis pyramidum) and puff adder (Bitis arietans). Patients treated with VacSera antivenom showed lower chance of uncomplicated treatment outcome (74.4%) compared to Fav-Afrique (93.2%) and EchiTAb-PLUS-ICP (90.4%). VacSera and EchiTAb-PLUS-ICP were associated with 16- and 6-fold adjusted odds of treatment reaction compared to Fav-Afrique, respectively, and VacSera was weakly associated with higher odds of death.
Conclusions / Significance: Snakebite frequency is grossly underreported unless treatment options are available. Although EchiTAb-PLUS-ICP showed favorable outcomes in this retrospective analysis, prospective randomized trials are needed to evaluate the effectiveness and safety of the most promising antivenoms for Sub-Saharan Africa. Structural investment in sustained production and supply of antivenom is urgently needed.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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