The following is written with the hope that somebody who reads this has enough ‘everything’ to make life saving decisions.
DARK FAIRY TALE VERSION #1
Once upon a time, not so long ago, lived a beautiful princess. Her evil stepmother made her go into the forest to collect firewood – hoping that leopards would eat her. They didn’t. One day she stepped on a venomous serpent, which bit her. Fortunately some woodcutters were passing by and carried her to the nearest primary health center. A charming young doctor-prince, who was doing his rural internship, was certain he could save the princess’ life. He administered anti-snake venom serum – the liquid type. Despite this, she died. Unfortunately, somewhere along the chain from manufacture to treatment, the electricity had gone off. Due to global warming the temperature was much higher than 10 degrees C and the ASVS ‘died’ much before the poor princess. Our fairy tale ends unhappily ever after. It needn’t have.
LIQUID ANTI-SNAKE VENOM SERUM (ASVS) SHOULD NOT BE MADE
Liquid ASVS requires refrigeration, usually below 10 degrees C, to remain viable. Electricity in India is at best unreliable – especially in rural areas – where most cases of snakebite occur. Deaths due to snakebite compounded by electricity failing – thus causing ASVS to lose its efficacy, are avoidable if lyophilized ASVS is used.
If the stuff doesn’t work – it’s a waste of snake venom … and human life.
A government directive enforcing the manufacture of only lyophilized ASV might help . . . if such a ruling were ever passed. It probably won’t be, so when one has a choice, I suggest using lyophilized ASVS (see box). If people don’t buy it, commercial pressure may persuade manufacturers to make lyophilized ASVS only.
DARK FAIRY TALE VERSION #2
Once upon a time, not so long ago, lived another beautiful princess, this time in Rajasthan. Her evil stepmother made the young maiden sleep on the floor. One night the princess got up to drink water and stepped on a venomous serpent. It bit her. Unsure of the beneficiaries of the princess’ will, the stepmother sent her to the nearest primary health center. The same charming young doctor-prince (still doing his rural internship) was dead sure that this time around he’d save the princess’ life. He administered anti-snake venom serum – the lyophilized type. Despite this, she died. Unfortunately, the snake that bit her was Bungarus sindanus. Anti-venom made in India is effective against Bungarus caeruleus (and three other species). The tale ends unhappily ever after. And it needn’t have.
THERE ARE MORE THAN 4 SPECIES OF SNAKES IN INDIA WHOSE VENOM IS CAPABLE OF CAUSING DEATH IN HUMANS
The catchy term ‘Big Four’ is probably one reason for the common misconception that there are only four species of venomous snakes in India. Absolutely untrue! Snakebite deaths caused by any snake are attributed to either – Naja naja – the Common Indian Cobra or Spectacled Cobra; Echis carinatus – the Saw-scaled Viper; Daboia russelii – Russell’s Viper and Bungarus caeruleus – the Common Indian Krait. The truth is that there are several species whose venom is capable of causing human death. Most (not all) of these are rarely encountered and recorded deaths are few. Due to the ‘only four venomous snakes in India’ misconception and the ‘Big Four’ moniker, anti-venoms have not been made for several of the venomous snakes of medical significance. Translation – has enough ‘juice’ to kill humans.
A few examples:
Maharashtra (also parts of the Gangetic plain, parts of U.P., Bihar and Bengal)
has two species of similar looking kraits – Bungarus caeruleus – the Common Indian Krait, and Bungarus cf sindanus walli or Bungarus cf walli. The Common Indian Krait has 15 midbody dorsal scale rows and the ‘other’ krait has 17. Two additional scale rows may seem like no big deal, but their venoms are different. No ASVS is made for Bungarus cf walli. Despite no known tests having been carried out on the efficacy of polyvalent ASVS against venom of this ‘second krait’, it is routinely administered for all cases of snakebite. If death occurs, it is usually attributed to Bungarus caeruleus.
Bungarus sindanus – the Sind Krait and Echis sochurecki – Sochureck’s Saw-scale Viper occur in Rajasthan (and probably adjacent Gujarat). Deaths resulting from a krait, are most often attributed to Bungarus caeruleus and ‘Saw-scaled vipers’ bites are still attributed to Echis carinatus. No specific ASVS is made for either species.
Parts of Haryana, most of the Gangetic plain, West Bengal up to Arunachal Pradesh
There are (at least) two species of cobra: Naja naja – the Common Indian Cobra/ Spectacled Cobra and Naja kaouthia – Monocellate Cobra/ Monocled Cobra. Though it is easy to recognize typical forms of both species, there is still no ASVS made specifically for Naja kaouthia in India.
An endemic cobra Naja sagittifera – the Andaman Cobra is found on some of the Andaman Islands. No ASVS is made for this species.
Though bites are extremely rare, no ASVS is made in India for Ophiophagus hannah – the King Cobra. It is uncertain whether the anti-venom made in Thailand is effective against the venom of king cobras found in India.
It is up to herpetologists (me included), animal rights groups (instead of shutting down ASVS manufacturing facilities, they could regulate them), pharmaceutical companies (nix the liquid ASVS folks. You might need it yourselves one day) and politicians (dead people can’t vote) – to work together to ensure that dark fairy tales like those above never happen. The beautiful princess might easily be related to you.
Written by Ashok Captain