Editorial: Wake up to the snakebite season

The reason why health scares break out in Kerala first is that the state's administration is responsive to that sort of thing. The early alerts on the Nipah and COVID-19 outbreaks came first from Kerala. It's no surprise then that Kerala has reacted fast to the sudden uptick in snakebite cases this summer. With incidents being reported from multiple locations like Idukki, Kannur, Thrissur, Alappuzha, and Thiruvananthapuram (six on April 17 alone), the Kerala Health department has launched a special action plan to tackle the problem from multiple angles, including mapping of vulnerable areas, revision of response and treatment protocols, and live monitoring of antivenin inventories in local healthcare centres. Since snakebites, like malaria and other tropical diseases, are an endemic public health hazard in rural India, other states would do well to act with similar alacrity.

Kerala typically sees 4,000-5,000 snakebites yearly, a large share of them being envenomation cases (snakebites with injection of venom). Deaths are disproportionately few, 18 last year, which again attests to an alert healthcare system. This year there has been a spurt in cases due to the unusually hot pre-monsoon months, which is the hatching season for reptiles. The heat is driving juveniles towards cooler shelter, including homes, leading to accidental encounters. Well over 1,500 cases have been reported in the March-April period in Kerala, while there have been sporadic incidents along the Western Ghats in neighbouring states.

Despite their scale and ubiquity, snakebites are a neglected public health problem in India. A signature study of snakebite mortality in India, published in e-Life in 2020, found that the country had a shocking total of 1.2 million snakebite deaths, half the global count, between 2000 and 2019, at an average of 58,000 per year. The World Health Organisation classifies snakebite envenoming as a neglected tropical disease, in some years exceeding deaths from malaria. Yet, while malaria rightly commands policy attention, surveillance and funding, snakebites as a public health issue get only sporadic attention at the policy level. Response tends to be incident-related and largely left to village panchayats and primary health centres.

The morbidity profile of snakebites demands a better response. According to the e-Life study, nearly half of the 58,000 snakebite deaths annually were of individuals in 30-69 age bracket and over a quarter of them were children. Most of the fatalities occurred at home, in rural areas. About 70% of the deaths occurred in eight high-burden states Bihar, Jharkhand, Madhya Pradesh, Odisha, Uttar Pradesh, Andhra Pradesh, Telangana, Rajasthan, and Gujarat - all states whose public health agendas are due for a revision.

For these states, Kerala's latest action plan on snakebites is a good example to follow. It's a good reminder that the wealth of new technology available - app-based information dissemination systems, integrated health management software, 24/7 inventory monitoring down to PHCs and CHCs can be used to tackle an old and forgotten problem. The plan red flags vulnerable areas, maps local species distribution and makes nuanced tweaks to ensure that treatment facilities match local needs, such as special antivenin for vipers, which do not respond to the generic anti-snake venom.

Snakebites do not get the policy attention they deserve because they don't come with the urgency of outbreaks or have urban relevance like air pollution. But given their national spread and scale, there's no good reason to treat it as a problem for panchayats and faith healers to deal with.