Gutiérrez José María, Burnouf Thierry, Harrison Robert A, Calvete Juan J, Kuch Ulrich, Warrell David A, Williams David J
Instituto Clodomiro Picado, Universidad de Costa Rica, San José 11501, Costa Rica .
Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan, China .
Bull World Health Organ. 2014 Jul 1;92(7):526-32. doi: 10.2471/BLT.13.132431. Epub 2014 Mar 4.
Snakebite envenoming is a common but neglected public health problem, particularly in impoverished rural regions of sub-Saharan Africa, Asia and Latin America. The only validated treatment for this condition is passive immunotherapy with safe and effective animal-derived antivenoms. However, there is a long-lasting crisis in the availability of these life-saving medications, particularly in sub-Saharan Africa and parts of Asia. We herein advocate a multicomponent strategy to substantially improve the availability of safe and effective antivenoms at the global level. This strategy is based on: (i) preparing validated collections of representative venom pools from the most medically dangerous snakes in high-risk regions of the world; (ii) strengthening the capacity of national antivenom manufacturing and quality control laboratories and their regulatory authorities and establishing new facilities in developing countries through technology transfer, as an integral part of efforts to develop their biological products industry; (iii) getting established laboratories to generate antivenoms for various regions of the world; and (iv) getting governments and relevant organizations to give snakebite envenoming due recognition within national and international public health policy frameworks. These ways of making antivenom available should be complemented by actions to improve health information systems, the accessibility of antivenoms, the training of medical and nursing staff, and community-based education. Such a multicomponent strategy involving stakeholders on many levels could help consolidate sustainable improvements in antivenom availability worldwide.
蛇咬伤中毒是一个常见但被忽视的公共卫生问题，在撒哈拉以南非洲、亚洲和拉丁美洲的贫困农村地区尤为突出。针对这种情况，唯一经过验证的治疗方法是使用安全有效的动物源抗蛇毒血清进行被动免疫治疗。然而，这些救命药物的供应存在长期危机，特别是在撒哈拉以南非洲和亚洲部分地区。我们在此倡导一种多方面的策略，以大幅提高全球范围内安全有效抗蛇毒血清的可及性。该策略基于以下几点：（一）从世界高风险地区最具医学危险性的蛇类中制备经过验证的代表性毒液库；（二）加强国家抗蛇毒血清生产和质量控制实验室及其监管机构的能力，并通过技术转让在发展中国家建立新设施，作为其生物制品产业发展努力的一个组成部分；（三）让现有实验室为世界各地区生产抗蛇毒血清；（四）促使各国政府和相关组织在国家和国际公共卫生政策框架内给予蛇咬伤中毒应有的重视。这些使抗蛇毒血清可及的方式应辅之以改善卫生信息系统、提高抗蛇毒血清可及性、培训医护人员以及开展社区教育等行动。这样一个涉及多个层面利益相关者的多方面策略有助于巩固全球抗蛇毒血清可及性的可持续改善。
