National Action Plan for Snakebite Envenoming

The National Action Plan for Snakebite Envenoming (NAPSE) is a strategic document based on One Health approach and will enable India to reach the Global target of reducing the deaths due to snakebite envenoming by half by 2030.

Snakebite envenoming

Snakebite envenoming is a potentially life-threatening disease following the bite of a venomous snake. Venomous snake bites can result in medical issues which can be deadly or lead to permanent impairment if timely and appropriate treatment is not given. Majority of snakebite envenomation deaths and catastrophic sequelae can be avoided with prompt availability to safe and effective antivenoms, timely transport and referral.

Snakebite envenoming Scenario

International scenario

As per World Health Organisation (WHO) data, global snake bite incidences stand at around 5.4 million with about 1.8 to 2.7 million accounting to snake envenoming annually resulting in approx. 8000-1.3 lakh deaths and triple the number of amputations and permanent disabilities. WHO listed snakebite envenoming as a priority neglected tropical disease in 2017 and advocates developing a global strategy to halve the number of snakebite-induced deaths and disabilities by 2030.

The highest burden of snake bite envenoming is seen in Asia, Africa and Latin America. Asia alone has around 20 lakh snakebite envenoming cases every year, while in Africa, snakebite cases requiring treatment are estimated to be around 44 to 58 lakhs annually. South Asia constitutes nearly 70% of global snakebite mortality, with India reporting 2-3 lakhs cases of snakebite annually with 1000-2500 deaths. Within the region, Bangladesh, India, Nepal, Pakistan, and Sri Lanka together constitute nearly 70% of global snakebite mortality.

National scenario

In India, approximately 50,000 fatalities result from an estimated 3 to 4 million snakebites each year, representing roughly half of all global snakebite-related deaths. Only a small proportion of snake bite victims across countries report to the clinics and hospitals and actual burden of snake bite is grossly underreported. As per the Central Bureau of Health Investigation (CBHI) reports (2016-2020), the average annual frequency of snakebite cases in India is around 3 lakhs and about 2000 deaths occur due to snakebite envenoming. 

In India, snakebite is a prominent problem in rural and peri-urban areas and the high burden states includes Bihar, Jharkhand, West Bengal, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh, Telangana, Rajasthan, and Gujarat.  It predominantly affects lower socioeconomic segments of the society and high-risk group/vulnerable population includes, agricultural workers, herders, fishermen, children aged 10-14 years and people living in poorly constructed houses etc.

Poisonous snakes and existing treatment scenario

India has more than 310 species of snakes, mostly non-Venomous. However, there are 66 species that are labelled as venomous or mildly venomous and majority of the snakebites result from four species, collectively named as “Big 4” species namely Russell’s Viper (Daboia russelii), Spectacled cobra (Naja naja), common krait (Bungarus caeruleus) and saw-scaled viper (Echis carinatus).

The clinical manifestation of the venomous snakebite includes paralysis, haemorrhage, tissue damage and irreversible kidney failures, pregnant women are
highly sensitive as haemorrhage due to venomous snakebite can cause miscarriage.

Administration of polyvalent anti-snake venom (ASV) containing antibodies against cobra, Russell’s viper, common krait and saw scaled viper is effective in 80% of the snakebite cases. However, lack of trained human resources and health facilities to treat snakebite patients remains a cause of concern. Also, the unavailability of data on incidence, morbidity, mortality, socio-economic burden, treatment patterns etc. are the major hindrances in planning for mitigation of snakebite in India.

Ministry of Health and Family Welfare, Government of India is implementing Snakebite Prevention and Control activities in all States/UTs through National Health Mission. Ministry of Health and Family welfare has also issued a National Snakebite Management Protocol in collaboration with WHO for use by medical officers for management of Snake bite cases in 2009 and updated in 2016. To ensure the availability of Anti Snake Venom (ASV), States and UTs have been directed to include Anti Snake Venom (ASV) in the list of essential drugs of the State, procurement of these drugs is supported under National Health Mission.

National Action Plan for Snakebite Envenoming (NAPSE) 

The National Action Plan for Snakebite Envenoming (NAPSE) was formulated during 2022.

It provides a broad framework for management, prevention and control of Snake bite envenoming in India. This NAPSE echoes the global voice of reducing the disability and deaths due to snakebite envenoming by half by 2030 and envisages all strategic components, roles and responsibilities of concerned stakeholders.

The NAPSE has identified key strategic actions to be undertaken for operationalization of human, wildlife and animal component.

• The strategic action for Human health component includes Ensuring Provision of Anti Snake Venom at all Health facilities, strengthening surveillance of Snake bite cases and deaths in Humans, strengthening of emergency care services at District Hospitals/ CHCs including services for Ambulance, Institutionalisation of Regional Venom Centre’s and Inter-sectoral coordination.
• The strategic action for wildlife health component includes Education awareness, Antivenom distribution, strengthening of the key stakeholders, Systematic research and monitoring and Snake venom collection and snake relocation.
• The strategic action for animal and agriculture component includes Prevention of snake bites in livestock, community engagement etc. 

The key interventions to reduce deaths due to snakebite include

• upskilling of medical officers for timely and standard treatment to ensure any victim of snakebite envenoming receives ASV in time and his/her progress is monitored with timely referral/dosage.
• mass awareness which holds key for prevention of snakebite especially in high risk areas. 

Source : National Action Plan for Snakebite Envenoming (NAPSE)