BBC: Why are so many people still dying from snake bites? (7) Snakebite envenoming in Honduras

26 January, 2019

Dear all,

We recently have published a Letter to the Editor in the journal Toxicon where we describe a multisectorial approach for addressing the problem of snakebite envenoming in Honduras, Central America.

Honduras, extension of 112,000 km2 and a population of 9.4 million inhabitants, harbors 19 described species of venomous snakes classified in the families Elapidae (coral snakes of the genus Micrurus and the sea snake Hydrophis platurus) and Viperidae (pit vipers of the genera Agkistrodon, Atropoides, Bothriechis, Bothrops, Cerrophidion, Crotalus and Porthidium). The MOH reported an estimated number of 650 snakebite cases per year, with an incidence of 7.6 cases per 100,000 inhabitants per year, with an unknown mortality rate. Data that are more recent report 750 cases per year (2017, 2018). Bothrops asper, locally known as barba amarilla, which inhabits the northern part of the country, produces the majority of cases, and the most severe ones. However, other species, such as the rattlesnake (cascabel) Crotalus simus, the jumping viper (timbo) Atropoides mexicanus and the hognose viper (tamagás negro) Porthidium ophryomegas also cause a number of accidents, although of a lower severity than those of B. asper.

The Letter is available at https://www.sciencedirect.com/science/article/pii/S0041010119300169?via%... , and briefly, we describe the following important activities that have taken place in Honduras in the last few years.

(1) Ministry of Health and Pan American Health Organization: Compulsory notification of snakebites was introduced in Honduras several years ago. More recently, upon the adoption of snakebite envenoming as a neglected tropical disease by the WHO, the Zoonosis and Neglected Infectious Diseases Surveillance Unit of the MOH incorporated this disease within its portfolio of programs and activities. The acquisition and distribution of antivenoms have been ongoing for several decades in this country. In addition, permanent education programs for health professionals in various regions of the country have been organized, in coordination with the representation of the Pan American Health Organization (PAHO) / World Health Organization (WHO) in Honduras, the National Autonomous University of Honduras (UNAH), and Instituto Clodomiro Picado (University of Costa Rica) (ICP). A seminar on the diagnosis and clinical management of snakebite envenoming was organized in August 2017 in Tegucigalpa in the framework of the XIII Congress of the Central American and Caribbean Association of Parasitology and Tropical Medicine (ACACPMT) (see http://www.bvs.hn/RMH/pdf/2017/html/Vol85-S2-2017.htm), with the participation of physicians who treat these envenomings from all over the country. The premiere in the Americas of the film Minutes to Die (http://minutestodie.com/) was also presented at this meeting. As a follow up, a series of seminars organized by the MOH, took place in September 2018 in the hospitals of three cities. These activities have prompted initiatives in regional hospitals to document clinical cases of envenoming. Moreover, the MOH and PAHO, with the support of UNAH and ICP, are preparing guidelines for the prevention, diagnosis and treatment of envenoming in Honduras. The political will of the MOH has become a driving force for the growing interest and attention to this health issue in the country.

(2) The National Autonomous University of Honduras (UNAH): The academic staff of the University Hospital and the Scientific Research Unit of the Faculty of Medical Sciences (Unidad de Investigación Científica, UIC) of UNAH have undertaken several initiatives on snakebites over the years, including the attention of patients referred to this hospital from various regions of the country, the development of theses by medical and nursing students on clinical aspects of snakebite envenoming, and the scientific dissemination of studies on the epidemiology and clinical features of snakebites (see for example http://www.bvs.hn/RFCM/pdf/2016/html/RFCMVol13-S1-2016.html). Moreover, several teleconferences for hospitals all over the country have been organized in coordination with ICP (see http://www.bvs.hn/Honduras/UICFCM/Afiche_Teleconferencias_JMGutierrez.pdf). The UIC was also involved in the presentation of the premiere of Minutes to Die, as part of the Congress on Research on Health Sciences held in 2017 (see http://www.bvs.hn/RFCM/pdf/2017/html/RFCMVVol14-S-2017.html). More recently, a key role is being played by Centro de Información Toxicológico (Center for Toxicological Information, CENTOX) of the School of Chemistry and Pharmacy of UNAH, which provides advice and information on toxicological issues, including prevention and management of snakebite envenoming. Additionally, researchers from the School of Microbiology of UNAH have become involved in the study of snake venoms from Honduras.

(3) The Honduras Medical College (Colegio Médico de Honduras): As a strong organization that embodies the physicians of the country, the Honduras Medical College organized, in collaboration with UIC UNAH, MOH and PAHO/WHO in September 2018, a permanent medical education activity on snakebite envenoming for physicians all over the country (see http://www.bvs.hn/RFCM/pdf/2018/html/RFCMVol15-S-2018.html). The activity was attended by 209 people, and an estimated 600 more professionals participated by teleconference in 21 facilities of the Medical College throughout the country. Staff of ICP, UNAH and the MOH presented the seminars. Similar activities are being planned for the near future, taking advantage of information and communication technologies.

(4) Ixchel. This is a Central American non-governmental organization (NGO) constituted by university students and other people interested in environmental and conservation issues. This NGO promotes several activities related with the study and conservation of biodiversity in this region, including snakes, and has initiated various research projects on snakes and their venoms, in close coordination with the Schools of Microbiology, Medicine, Chemistry and Pharmacy and CENTOX from UNAH. A workshop on herpetological and medical aspects of snakes is being organized at of the Animal Rescue Center el Ocotal (Sabana Grande, Francisco Morazán) in March 2019, with the participation of ICP and representatives of Ixchel and other organizations in Honduras.

Jackeline

The authors

Jackeline Alger1,2, Eduardo Enrique Boza-Oviedo3, Rosa Elena Mejía4, Fanny Navas5, Perla Simons-Morales2, Reina Teresa Velázquez6, José María Gutiérrez7

1Hospital Escuela Universitario, Tegucigalpa, Honduras

2Unidad de Investigación Científica, Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras (UNAH), Tegucigalpa, Honduras

3Proyecto Ixchel, Tegucigalpa, Honduras

4Organización Panamericana de la Salud / Organización Mundial de la Salud, Tegucigalpa, Honduras

5Secretaría de Asuntos Educativos y Culturales, Colegio Médico de Honduras, Tegucigalpa, Honduras

6Unidad de Vigilancia de Zoonosis y Enfermedades Infecciosas Desatendidas, Secretaría de Salud de Honduras, Tegucigalpa, Honduras

7Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, Costa Rica

HIFA profile: Jackeline Alger works in the Parasitology Service, Department of Clinical Laboratories, Hospital Escuela Universitario, and at the Faculty of Medical Sciences, Universidad Nacional Autonoma de Honduras, Tegucigalpa, Honduras. She is a Country Representative for HIFA and CHIFA and is the holder of HIFA Country Representative of the Year Award 2015. http://www.hifa.org/people/country-representatives/map

http://www.hifa.org/support/members/jackeline jackelinealger AT gmail.com