Jordan Ellis
Antivenom is a critical treatment for venomous snake bites, which can cause pain, bleeding, swelling, and tissue damage. While the World Health Organization includes antivenom on its List of Essential Medicines, hospitals face challenges in keeping it on hand due to its high cost, the risk of it expiring, and the rarity of snake bites. As a result, some hospitals, particularly those in rural areas, may not stock antivenom, instead transferring patients to larger facilities that have it available. However, the sooner a patient receives the first dose of antivenom, the better their outcomes, so it is important for families to know which hospitals carry it and be prepared in case of a snake bite emergency.
| Characteristics | Values |
|---|---|
| Cost of anti-venom | Expensive, nearly $30,000 for an initial course of treatment |
| Availability in hospitals | Not all hospitals stock anti-venom due to cost and rarity of snake bites |
| Effectiveness | Very effective in minimizing pain, bleeding complications, swelling and tissue damage |
| Treatment | Patients often need multiple rounds of anti-venom and close monitoring |
| Shortage | There is a global shortage of anti-venom |
| Allergic reactions | Patients can suffer serious allergic reactions to anti-venom |
| First-aid kit | The American Medical Association predicted in 1927 that anti-venom should be included in every first-aid kit |
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What You'll Learn
Cost of anti-venom
Antivenom is an essential medicine, according to the World Health Organization, but it is also expensive and inaccessible to many. The cost of antivenom treatment varies depending on location and the hospital or clinic in question. In the United States, a single vial of antivenom can cost upwards of $14,000, whereas in Mexico, the same medicine from the same manufacturer can be purchased for $100 to $200.
In North Carolina, antivenom treatment can cost around $5,400, while in Arizona, it can be as low as $347, even with the same insurance provider. The cost of antivenom treatment at UNC Health in North Carolina can range from $76,000 to $115,000 for an initial dose of four to six vials. At Duke Health, 12 vials of antivenom cost $200,000 in 2020, but the introduction of a second treatment option has since reduced the price.
The high cost of antivenom is due to various factors beyond the production cost, which only accounts for a small fraction of the total price. Hospital markups, for instance, make up about 70% of the cost and are used as negotiating tools with insurance providers, who usually discount these markups. Licensing fees, legal costs, and other miscellaneous expenses make up about 28% of the cost, while clinical trials account for a mere 2%.
The relatively small market for antivenom due to the rarity of snakebites compared to other illnesses also contributes to the high prices. Pharmaceutical companies tend to deprioritize antivenom production due to low profitability, leading to potential shortages of this critical treatment.
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Shortages of anti-venom
Although the World Health Organization includes snakebite antivenom on its List of Essential Medicines, the world is currently facing a serious shortage of antivenom. The populations hardest hit by the shortages tend to be those living and working in rural areas where highly venomous snakes are common, especially in less-developed nations with housing that allows for easier access by venomous snakes.
The high cost of antivenom is a significant factor contributing to the shortage. Antivenom can be very expensive, and this problem is exacerbated when the product goes unused before its expiration date. For example, in Australia, polyvalent antivenom costs about $2000 per dose. The high cost of antivenom has led many pharmaceutical companies to stop producing it, as it is not profitable, particularly in parts of the world that are not high-income. As a result, finding someone who wants to produce antivenom is challenging. In addition, even when antivenom is available, it may not be accessible to those who need it due to the high cost of treatment.
Other factors contributing to the antivenom shortage include a lack of sufficient training among medical professionals in selecting the correct antivenom and administering the treatment, as well as the risk of serious allergic reactions to antivenom, which requires careful medical supervision during treatment.
To address the shortage, cross-border collaborations and innovative biologics are being developed. For example, the University of Arizona received a $1.6 million FDA grant to work with a Mexico-based drug manufacturer to research new coral snake antivenom. These efforts aim to improve access to effective treatments and break the cycle of the anti-venom shortage.
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Effectiveness of anti-venom
Antivenom is a specific treatment for envenomation, composed of antibodies used to treat venomous bites and stings. Antivenom is recommended only if there is significant toxicity or a high risk of toxicity. The specific type of antivenom needed depends on the venomous species involved. For instance, in the US, approved antivenom for pit viper snakebites is based on a purified product made from sheep, called CroFab. Antivenom is traditionally made by collecting venom from the relevant animal and injecting small amounts into a domestic animal. The antibodies that form are then collected from the domestic animal's blood and purified.
Antivenom can be life-saving, but its effectiveness is limited by several factors. Firstly, there are issues with the quality and efficacy of some antivenoms. For example, studies have raised concerns about the effectiveness of brown snake antivenom in neutralising venom-induced clotting in human envenoming cases. Secondly, antivenom failure can occur due to factors such as the irreversibility of venom-mediated effects, the rapidity of onset of these effects, or the antivenom's inability to reach the site of toxin-mediated injury. Thirdly, antivenom supply is inadequate in certain regions, such as Sub-Saharan Africa, due to challenges with local manufacturing, competition from inferior products, and a lack of confidence in the use of antivenoms among health workers.
Furthermore, the high cost of producing antibody-based antivenoms and their short shelf lives contribute to the challenge of ensuring a stable supply. The World Health Organization (WHO) recognises this issue and has included snakebite antivenom on its List of Essential Medicines. WHO initiatives to address this issue include creating a pathway for the entry of antivenom products into the WHO Prequalification Programme to assure the supply of safe, effective, and affordable antivenoms to markets in Sub-Saharan Africa and Asia. Additionally, WHO aims to establish a stockpile of recommended antivenoms to generate stability of supply and demand and stimulate production growth, leading to increased access to effective treatments for snakebite envenoming victims.
Despite the challenges, antivenom has proven effective in numerous cases. For instance, antivenom has demonstrated clear benefits in preventing neurotoxicity in Australasian elapid bites and systemic effects in scorpion and funnel-web spider envenoming. Additionally, polyvalent antivenom, effective against viper venom from multiple species, has been celebrated by medical journals and recommended as a necessity in first-aid kits. Overall, while there are concerns about the effectiveness of antivenom in certain situations, it remains a critical treatment for envenomation, and efforts are being made to improve its accessibility and efficacy.
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Allergic reactions to anti-venom
Antivenom is the most effective method for treating poisonous snakebites. However, allergic reactions to antivenom have been reported. These allergic reactions can be severe and even fatal. IgE-mediated immediate hypersensitivity is a common allergic reaction to antivenom. This reaction can occur when a patient is treated with the same antivenom for a second time after being bitten by the same type of snake within a short period. In such cases, the antivenom treatment should be stopped immediately, and anti-allergy treatment should be administered.
Skin allergy tests are sometimes performed to predict the allergic response before the second use of antivenom. However, the World Health Organization does not recommend performing skin allergy tests before the first use of antivenom as there is no significant association between the test results and adverse reactions. Nevertheless, skin allergy testing is useful in diagnosing many IgE-mediated immediate hypersensitivities to drugs, toxins, and certain biological products.
Acute and delayed reactions to antivenom can occur. Acute reactions are usually mild but can sometimes lead to severe systemic anaphylaxis, which may develop within an hour of exposure to antivenom. Delayed reactions, also known as serum sickness, typically occur between 5 and 14 days after administering antivenom. Serum sickness was first described in 1905 and is characterised by fever, lymphadenopathy, cutaneous eruptions, and arthralgias.
Pyrogenic reactions to antivenom can be caused by pyrogen contamination during its manufacture and may include chills, rigors, fever, myalgia, headache, tachycardia, and hypotension. In severe cases, intravenous fluids and adrenaline may be required. However, caution must be exercised when administering adrenaline to avoid blood pressure surges, which could lead to intracerebral haemorrhage.
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Hospitals that stock anti-venom
While the World Health Organization includes snakebite antivenom on its List of Essential Medicines, the world is currently facing shortages of antivenom. This is especially true in rural areas where venomous snakes are common and in less-developed nations with housing that allows easier access to venomous snakes. Antivenom can be very expensive, and this problem is made worse when the product expires before it is used. In addition, many hospitals do not have sufficient training in selecting the correct antivenom or administering the treatment, and patients can suffer serious allergic reactions to antivenom. For these reasons, it is important to call ahead to a hospital to check whether they stock antivenom before bringing a snakebite victim there. If the hospital does not have antivenom, they will either arrange to obtain sufficient stock or transfer the patient to a better-equipped hospital.
In the United States, antivenom for North American pit vipers, including rattlesnakes, cottonmouths, and copperheads, is available as CroFab. This medication is a monoclonal antibody antivenom that was developed to reduce the risk of allergic reactions. In Australia, polyvalent antivenom is available and covered under Medicare. However, it is very expensive, costing about $2000 per dose.
While it is important to seek medical attention for a snakebite as soon as possible, it may be helpful to know how to treat a snakebite yourself. For example, it is important not to ice a snakebite as this can cause the body to increase circulation to the area, drawing the venom towards the chest more rapidly.
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Frequently asked questions
Not all hospitals keep anti-venom on hand. It is usually available in the emergency departments of large hospitals. The availability of anti-venom also depends on the region and the type of snake species found in the area.
Anti-venom can be very expensive, and if unused, it goes to waste and needs to be replaced before its expiration date. Additionally, some hospitals may not have sufficient training in administering anti-venom treatment.
Seek medical attention immediately. If possible, identify the snake species by taking a picture of it, but do not delay treatment or put yourself at risk. Go to the nearest emergency room, and if possible, call ahead to ensure the hospital stocks anti-venom.
Anti-venom is a treatment that neutralizes the venom of a snake or other venomous animal. It contains antibodies that prevent the venom from spreading throughout the body, reducing complications such as pain, bleeding, swelling, and tissue damage.
