Menon Jaideep C, Nair Sabarish B, Sreekrishnan T P, Pillay Vijay V, Kanungo Srikanta, Pati Sanghamitra
Adult Cardiology & Public health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041, India.
Emergency Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041, India.
One Health Outlook. 2025 Mar 15;7(1):11. doi: 10.1186/s42522-024-00128-2.
Snakebite envenoming (SBE) was listed as a Neglected Tropical Disease (NTD), by the WHO in 2017. SBE kills more victims than all the other NTDs put together. SBE is a condition associated with poverty, inequity, inaccessibility and poor health systems. The major burden of SBE is borne by the countries of South-Asia, led by India, with an estimated 58,000 deaths annually. This as compared with the USA or Australia where deaths due to SBE is in a single digit, despite having equally venomous species. SBE is also a significant cause for loss of livestock in the Tropics. Research in the domain of snakebite has largely been limited to study of venoms and therapeutic aspects, and not as much on snake behaviour and habitats, and the environment. BODY: Snakebite is most often accidental, preventable and treatable. For mitigation of snakebite and the complications thereof, snakebite and SBE need be viewed from a one-health framework. The one-health approach to snakebite factors for the role of the environment, habitats, study of snakes, venom, factors and circumstances contributing to the accident. The current one-health framework proposed using the 'epidemiologic triad' model of agent-host-environment, allows for a better understanding and descriptione of the snake-human/livestock conflict. With snakes being the agent, humans/ livestock the host, and the ecosystem harbouring snakes the environment. This approach helps us to delineate the individual attributes influencing the snake-human conflict, and its outcomes. In the proposed one-health model we expand on the agent-host-environment (proximal factors), to an outer setting of more distal factors which too have an influence on snakebite and SBE. The outer setting includes the social determinants of health, eco climatic factors, socio-cultural factors, health systems, infrastructure and development all of which either directly or indirectly have a bearing on snakebite, and the outcomes resulting from the accident. (Fig. 1).
The one-health model built on the epidemiologic triad model helps encompass most of the factors that influence or lead to the snake-human/ livestock conflict. This model will facilitate preventative measures and help address the steps required to mitigate death and morbidity due to SBE.
2017年，蛇咬伤中毒被世界卫生组织列为被忽视的热带病（NTD）。蛇咬伤中毒导致的死亡人数比所有其他被忽视的热带病加起来还要多。蛇咬伤中毒是一种与贫困、不平等、医疗服务不可及以及卫生系统薄弱相关的疾病。蛇咬伤中毒的主要负担由南亚国家承担，其中印度最为严重，估计每年有58000人死亡。相比之下，美国和澳大利亚尽管也有同样有毒的蛇类，但蛇咬伤中毒导致的死亡人数为个位数。蛇咬伤中毒也是热带地区牲畜损失的一个重要原因。蛇咬伤领域的研究主要局限于毒液和治疗方面，而对蛇的行为、栖息地以及环境的研究较少。
蛇咬伤大多是意外发生的，是可以预防和治疗的。为了减轻蛇咬伤及其并发症，需要从“同一健康”框架的角度看待蛇咬伤和蛇咬伤中毒。“同一健康”方法考虑了环境、栖息地、蛇类研究、毒液、导致事故的因素和情况等在蛇咬伤中的作用。目前提出的“同一健康”框架使用了病原体 - 宿主 - 环境的“流行病学三角”模型，有助于更好地理解和描述蛇与人类/牲畜的冲突。其中蛇是病原体，人类/牲畜是宿主，容纳蛇的生态系统是环境。这种方法有助于我们勾勒出影响蛇与人类冲突及其结果的个体属性。在提出的“同一健康”模型中，我们将病原体 - 宿主 - 环境（近端因素）扩展到更外围的远端因素，这些因素也会对蛇咬伤和蛇咬伤中毒产生影响。外围因素包括健康的社会决定因素、生态气候因素、社会文化因素、卫生系统、基础设施和发展，所有这些因素都直接或间接地与蛇咬伤以及事故导致的后果相关。（图1）
基于流行病学三角模型构建的“同一健康”模型有助于涵盖影响或导致蛇与人类/牲畜冲突的大多数因素。该模型将促进预防措施，并有助于采取必要步骤减轻蛇咬伤中毒导致的死亡和发病情况。
