Vipers, mambas and taipans: the escalating health crisis over snakebites | Hacker News Reader

Vipers, mambas and taipans: the escalating health crisis over snakebites

nature.com

It should surprise no one that in much of Africa there are economic and sociopolitical challenges involved in supplying antivenin. It's an economic challenge even in first world countries, and antivenin is expensive as a result.

There's no mention of what the snakes are doing in the first place when humans run across them and get bitten, or how much good those snakes are doing by saving people in those countries from a host of rodent-transmitted diseases.

The article seems to focus on two things:

1. Focus less on advanced gene-splicing antivenin R&D, and more on traditional antivenin production, because Africa has unmet demand. This is merely a coy way of saying [more] developed countries should supply and subsidize antivenin for less developed countries that can't pay.

Rather than blame developed countries for focusing on R&D that doesn't solve Africa's immediate problem, some understanding would be in order. Genetic engineering approaches, once R&D is done, probably scale better than the traditional way of producing antivenin. Furthermore, anaphylaxis is a common problem with many kinds of antivenin and other vaccines. Genetic engineering approaches, which don't rely on purification of antibodies from animal blood, lead to fewer, and perhaps not any, extraneous proteins in the antivenin. That means less risk of an allergic reaction.

I don't know if that's the entire reason, but pharma companies don't intentionally throw away money on R&D. If they're funding something, there's a good reason.

2. Improve the economics, politics, and scientific awareness of developing regions of Africa (that is to say, most of it). I'm sure nobody has thought of that before.

"Africa has an antivenin supply problem, and all we have to do to fix it is modernize, educate, and politically stabilize those countries." Oh, that's all? Why didn't someone say something before? Such an easy and obvious solution to all those untreated snakebites.

> It's an economic challenge even in first world countries, and antivenin is expensive as a result.

Here in Australia, the funnelweb spider (around Sydney) is our only particularly lethal arachnid. Recently they've been struggling to find enough spiders to milk for the antivenom, and so have started to ask the general public to lend a hand in catching the damn things.

http://www.smh.com.au/environment/nsw-reminded-to-help-catch...

Interestingly, the 'spider safety kit' in that article is "a glass jar and a plastic ruler" :)

Asking the public to catch venomous spiders so they can produce anti-venom seems potentially counter productive.

Maybe not. Clearly the vast majority of spider bites are accidental, the recipient being unaware. When you're actually looking for the critters you're on your toes so to speak. Now if they said 'Reward! $10,000 for every xyz spider captured, then you'll have a lot of dumb people doing a lot of foolish things.

The problem, as I experienced with two black widow bites a few weeks ago is I did not realize I had been bitten until the symptoms were in full effect. By the time I realized it was not a flu virus it was already too late. I didn't even realize they were spider bite until the weeping craters appeared at the presumed mosquito bite site.

Are you sure? Alleged spider bites without a captured spider (or by comparison to previously observed bites... with captured spider in those cases) are often misdiagnosed. With recluse/widow/hobo spider bites, play devil's advocate. Could it have been some other bite, an infection, allergic reaction, or maybe even food poisoning? Could it have been a chigger bite, perhaps? Some kind of hymenoptera? Break down local and systemic symptoms, carefully and critically.

The classic widow bite symptom is pain. That's not easy to confuse with the flu or with a mosquito bite. Other symptoms like fever, nausea, and vomiting might be caused by a spider bite... but they might not be, particularly when the wound site is either infected or showing an allergic reaction (which can lead to a constellation of other symptoms that confuses the diagnosis), and particularly when there's no accompanying pain.

Even the classic flesh-destruction of brown recluse bites is not always caused by brown recluses. Plenty of "brown recluse" bites are really flesh eating bacteria infections following some other kind of bite, sting, or other small injury.

Funnel-web bites are a different thing entirely. One component of their venom specifically targets primates.

Verbose account posted above, I appear to have double-posted... am blaming the android browser, again.

I work in utility closets, in the rafters, under desks and in my free-time leaning up against trailers. Phoenix is experiencing a relatively cool, wet August and I have knocked down over a dozen webs in the last month: inside my house & outside on my chair, grill, trailer and floating in air as I walk from house to truck.

Edit: On the Wednesday I was bit, I spent the morning working on top of large part racks amidst water, air, oil & conduit lines in a heavy equipment repair shop and that afternoon I was rummaging under desks replacing old modem/router wall-warts with new equipment for a client's ISP swap. Although, my property is still the most probable candidate with it being low in a wash on the fringe of the metro area. Have had a scorpion in the tub & another in my rash guard already this summer.

The problem, as I experienced with two black widow bites a few weeks ago is I did not realize I had been bitten until the symptoms were in full effect. By the time I realized it was not a flu virus it was already too late. I didn't even realize it was a spider bite until the weeping crater appeared at the presumed mosquito bite sites.

> already too late

Ignorance here; too late for what? Treatment? Meaning the wound was already bad enough that you just had to let it heal on its own?

Just curious about what that meant.

Black Widows are primarily neurotoxic. They don't cause a lot of hemolytic tissue damage at first and so the bite itself might not be noticable and the bite wound might just look like mosquito bites. And the onset of the venom takes hours. So you might not know you've been bitten until hours later when you go from flulike symptoms to freaking full on insane pain all over. And then all of your organs fail. So a major complication of venomous bites is that your window to get to a medical facility can be notably decreased.

I'd be interested to hear more about your bite experience. Did you eventually make it to a hospital? Did you take the anti-venin? What did the symptoms feel like?

Edit: Inadvertently cut 1st three sentences(frikkin Android browser) and neglected to post my citation at the end.

On a normal Wednesday afternoon I noted two egg-yolk sized lumps on my calves that itched like mosquito bites, yet were squishier but I didn't put much thought into that facet initially. With all the wet weather here in Phoenix the last few weeks the skeeters are back with a vengeance, I figured it/they hit pay-dirt while I was sleeping. That night I woke up repeatedly with extreme chills and cold sweats, but did not make any connection to the lumps. Went to work the next day extremely exhausted.

We got the job done, ran a 2nd call and I went home and passed out around 4pm. At 9pm I started awake w/ massive headache, extreme nausea & all my joints/spine were pins & needles of pain. I 'emergency walked'[0] to the toilet for extreme anterior & posterior purges and passed out after the spasms desisted.

Called in sick the next day(Friday) & dozed on couch through unceasing headache, GI purges and joint pains... intense pain, but still flu-like symptoms 40 hours later. Sometime after dark that night I woke up to all my muscles in my body experiencing the intense pain of the worst muscle cramps I could previously imagine, yet without the contracting of muscle tissues. The only exception was my calves & feet, they may have been numb but I only know with certainty I did not hurt below the knees. Cannot say how many hours this went on before I lost consciousness but it felt like an eternity. I do not believe I was paralyzed while awake, but I was hyper-focused on mellowing my thoughts/heartrate, and most importantly not amplifying the agony by moving anything. I honestly never even thought to call for assistance, I still didn't know what was happening, only that it was already in play and while my chest felt like I was having an infarction, so did every other part of my body... except below the knees.

Next morning my muscles felt like I ran several marathons(except my legs, lol), the nausea was replaced with what felt like knives passing through my intestines and my diaphragm and peritoneum felt like they were going to tear apart(didn't purge that for several days, my GI tract shut down & I could only hold down liquids). Joints and old injury sites continued to ache throughout Sunday, but the spinal burn, needling pains & headache had subsided in time for my 16 hour, uninterrupted sleep Saturday night.

Sunday was spent feeling completely shattered and aching but without acute pain at long last. Layed on couch all day.

Went to work Monday and all the pain my calves did not experience finally arrived. Ankles swelled and bolts of pain shot through both calves with each step(much more so in the right leg) until 3pm when I told the boss I couldn't go on. If you've ever walked long distance on concrete with bad shoes, that's the stabbing pain my calves were experiencing.

That day, Monday, I noticed my right calf lump had a small, open sore and was oozing. The left calf lump was smaller, had a red spot that never completely opened up, didn't ooze as much and not until nearly a week later...presumably the 2nd bite with no/less venom delivered.

Took rest of week off as my ankles & scrotum swelled/retained fluid whenever I wasn't laying down. Three weeks later & I am 99%, I do still experience a couple genuine, but mild, muscle cramps a day. Never went to doctor, but did speak to several friends/family who are in medical on Tuesday and determined if it were a desert recluse I would have already been in the ICU or dead...I kept up the Zika-Swine-Avian-Ebola flu story to that point as I was still unsure what happened and wanted to spare family & friends undue stress.

[0] Emergency-walk http://www.urbandictionary.com/define.php?term=Emergency%20w...

[1]21 days later: right-leg bite site http://imgur.com/2JjBCIm

Wow. Thanks much for posting that. I'm fascinated by venoms effects. Sounds like a nightmare but not many people can say they've had that experience. I think you're kind of badass for just powering through like that.

It sounds exactly like another experience I read from a doctor who purposefully allowed himself to get bitten by a black widow to see what it was like. He said it was the worst pain he had ever experienced and would never do it again.

Because of the chills and abdominal issues it sounds like a black widow and not a brown recluse.

I'm really glad you're feeling better. I hope the recovery is going well. Did you ever have any luck finding the spider?

I have been back to the two work sites I worked at the day the lumps appeared. Dusty & cobwebs, but did not see any spiders. Dismantled mattresses & box springs to find only dust bunnies. Couch cushions' sole inhabitants were coins & food crumbs. I had been spending inordinate hours diagnosing a "gremlin" in my jet ski over the previous 8 weeks; it is sitting on a trailer I often lean my shins against the frame just above the affected sites. I have knocked many webs off it over the last rainy weeks in Phoenix. That is all I know so far, and admittedly, it could still not even be BW bites. Other than that, my stamina is back, minor crmps are gone and I trimmed off 10lbs(4.5kg) of excess weight, which is nice.

Coincidentally, I had a blood infection 17 years ago to the day recent symptoms started, Aug 11, 1999. It was misdiagnosed(sans blood tests) as mono-nucleosis and I suffered similar intensity of pain and kidney/liver damage for weeks before identifying the genuine problem. I was young & most lingering issues have abated but system is still compromised and a hit by a strong enough hemotoxin(recluse or a rattle snake) will likely be permanently debilitating, if not terminal. So, no, not courageous, just at peace w/ mortality & very grateful for every new day.

Edit: A correction to original post, as well, the site on my left leg did also open up, didn't see it under all the leg hair[0].

http://i.imgur.com/l0KZWhT.jpg

Edit 2: original right leg pic moved, link broken. new url:

http://i.imgur.com/dX6N39V.jpg

> If they're funding something, there's a good reason.

Capitalism is amoral. There is only necessarily a reason. I would say it must be a financial reason, but it's actually not necessarily even a rational reason.

I know it's not always popular around here, but sometimes when ethics and morals conflict with money and power, the problem needs to be solved by regulation. This is hard.

According to Nassim Taleb, when all the lions were killed in the Middle East, the goats multiplied, and they apparently love tree roots, which led to the Middle East turning into desert (not sure if it's true, but he says it is and I'm inclined to believe it).

Does anyone know what could be some unintended negative consequences of exterminating all snakes?

It always amazes me that in North America, they exterminated Wolves from most of place, and so were able to create a safe working environment for farming. Although the deer population is a little out of control, it's not a as bad as goats turning the land into desert.

Snakes kill rodents that transmit various diseases (mentioned in the article)

Could domestic animals (e.g. cats & dogs) keep the rodent populations in check? Would they get out of hand?

Perhaps if it was managed properly, ie: spay/neuter before release & replenish the 'supply', as needed. For example, without natural predators the Hawaiian islands are now swarming with feral cats, albeit theirs started as a human problem(abandonment):

https://encrypted.google.com/search?q=hawaii+cat+problem&gbv...

To a large extent, humans took the place of wolves (and other predators) in North America.

Exactly, we are the apex predator, even if deer are the most deadly animal in the US (from car crashes). I can't quickly find any details on the total annual harvest, but it looks like there are about 10 million of us hunting deer every year. And in general we control the populations of various animals in all sorts of ways (sometimes unfortunate ones, e.g. changes in farming practices have virtually eliminated quail hunting in my part of SW Missouri).

So why is no African government / company stepping in to produce antivenoms, if the technology is supposed to be 80 years old and rather basic?

Well, this is going to be an unpopular opinion I'm sure, but a lot of Sub-Saharan African countries seem to be shuffling Health and Human Services off to Western countries to handle, while they use economic aid for more "corrupt" purposes.

On the one hand it is always good to help people in need (especially children), but on the other hand, since it is just "given help" and not infrastructure development -- it tends to just kick the can down the road a little further.

Worse, sometimes aid even helps to stimulate corruption and economic imbalance that keeps many of those countries trapped in a borderline desperate cycle.

Here is an older, but still relevant, Wall Street Journal article that discusses the predicament from an economic standpoint[1].

[1] http://www.wsj.com/articles/SB123758895999200083

Development aid also undermines democracy in developing countries because the elites focus on pleasing foreign donor organisations, rather than being accountable to their own population.

There is also a tendency of aid to destroy local economic structure, as the local producers can often not compete on price with free aid.

If you look at countries that managed to develop (e.g. South Korea or China in recent years), then they all did it without substantial involvement of foreign aid.

It is interesting to reflect on why development aid is so popular in the developed countries despite its obvious failures. Here are some reasons.

- Development organisations serve as levers of soft power. (If you give us XYZ, we'll fund your railway/sewage treatment plant/school).

- On-the-ground workers of development organisations are convenient sources of information and can often be used to supply false IDs for spies, military operatives and the like.

- Multi-national companies regularly support development aid, because it's good and cheap PR.

- Aid organisations are lucrative sources of income for their senior staff in the developed world, and they well-oiled PR machines to keep the funds flowing, and mute criticisms.

> Development aid also undermines democracy in developing countries because the elites focus on pleasing foreign donor organisations, rather than being accountable to their own population.

Of course, it can be good to undermine democracy, when the majority of the population support e.g. female genital mutilation or burning witches.

I'm wondering that myself. If we can't find a reliable place within the continent of Africa to produce this anti-venom then something is seriously wrong.

Something doesn't seem right with the statistics used here. 5 million bites sounds very high. The likely difference is the disclaimer from the article "these numbers reflect estimated, rather than reported, cases". My guess is that non-reporting is very prevalent, but it's disproportionately likely for non-serious bites. Deaths and very serious bites probably do get reported much more frequently.

As a counterpoint, take this article investigating South Africa's KZN province [1]. This province has most of SA's most venomous snakes, and also some of the highest incidences of snake bites in SA. The article estimates this at 24 to 34 bites per 100,000 people per year. The mortality rate is between 1 to 2% of these reported cases, bringing the total to 49 to 69 people per year, in a province of just over 10 million. It's easy to see why snake bites are not a particular focus; there are 9 different species venomous snakes in a geographically large province. Contrasted with HIV / AIDS which kills many tens of thousands a year in the same province, the difference is stark.

I'm honestly not sure why there's such a difference between the numbers in these articles, but it's day and night.

[1] http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S...

Why are you focusing only on SA? SA is not representative of Africa as a whole, much less Asia.

https://en.wikipedia.org/wiki/Epidemiology_of_snakebites paragraphs 2 and 3.

https://en.wikipedia.org/wiki/Epidemiology_of_snakebites#/me...

SA is simply where I live / have some heresay experience with. While snake bites are not unheard of, they are not exactly common either, so I'm skeptical on the topic.

Nevertheless, I still think the poster on the original article is misleading. It headlines with "~5 million snake bites", while your citation puts it at anything between 1.2 to 5.4. Actual envenomings are between 420K to 1.8 million. That's a huge variance in itself, and the uncertainty is not reflected in the article much.

My point is also that if they're inflating the estimated deaths by as much as the reported bites to estimated bites, it's likely incredibly incorrect. Deaths generally get investigated and reported, while lesser bites would not necessarily.

I can't avoid to think that, at least in the case they use to illustrate the problem at the start of the article, the problem would be solved with boots, not with expensive antivenin.

That's partly economic: to be effective, you'd need to provide all of the at-risk population with boots, whilst with antivenin, the cost is treatment for those affected.

It wouldn't surprise me if the cost of prevention was higher than the cost of treatment.

Secondly, there's also a cultural/environmental question: if the population generally wear sandals or go barefoot, could they be easily persuaded to don protective boots - especially if their feet are then continually hot and wet? A Discomfort aside, could the boots increase the risk of other issues, such as trenchfoot?

These are a lot of agricultural workers. I'm sure they get alot of hand and arm bites as well bending over doing labor outside.

I don't believe the header so i don't believe the article. The header claim, tens of thousands, "tens of thousands" - 20,000 to 99,999 kills a year. I call bs.

Yeah Science: http://journals.plos.org/plosntds/article?id=10.1371/journal...

It was linked from the footnotes. Your uninformed beliefs or opinions are irrelevant and your "bs" bravado is juvenile.

Reply on news.ycombinator.com