Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs

Introduction: Snakebite envenomation is a public health event of mandatory reporting in Colombia. It is considered a medical emergency in which the government must guarantee antivenom availability. We describe snakebite epidemiological figures in Colombia between 2008 and 2020 and correlate them wit...

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Autores:
Sebastián, Estrada Gómez
Vargas Muñoz, Leidy Johana
Higuita Gutiérrez, Luis Felipe
Tipo de recurso:
Article of investigation
Fecha de publicación:
2022
Institución:
Universidad Cooperativa de Colombia
Repositorio:
Repositorio UCC
Idioma:
OAI Identifier:
oai:repository.ucc.edu.co:20.500.12494/47205
Acceso en línea:
https://doi.org/10.2147/DHPS.S367757
https://hdl.handle.net/20.500.12494/47205
Palabra clave:
snakebite
Colombia
Manufacture
antivenoms
access
availability
Rights
openAccess
License
Atribución
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oai_identifier_str oai:repository.ucc.edu.co:20.500.12494/47205
network_acronym_str COOPER2
network_name_str Repositorio UCC
repository_id_str
dc.title.spa.fl_str_mv Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
title Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
spellingShingle Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
snakebite
Colombia
Manufacture
antivenoms
access
availability
title_short Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
title_full Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
title_fullStr Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
title_full_unstemmed Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
title_sort Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs
dc.creator.fl_str_mv Sebastián, Estrada Gómez
Vargas Muñoz, Leidy Johana
Higuita Gutiérrez, Luis Felipe
dc.contributor.author.none.fl_str_mv Sebastián, Estrada Gómez
Vargas Muñoz, Leidy Johana
Higuita Gutiérrez, Luis Felipe
dc.subject.spa.fl_str_mv snakebite
Colombia
Manufacture
antivenoms
access
availability
topic snakebite
Colombia
Manufacture
antivenoms
access
availability
description Introduction: Snakebite envenomation is a public health event of mandatory reporting in Colombia. It is considered a medical emergency in which the government must guarantee antivenom availability. We describe snakebite epidemiological figures in Colombia between 2008 and 2020 and correlate them with antivenom manufacturing figures to determine rate coverage and the need for antivenom. Methods: We performed an ecological study based on secondary official figures from the National Health Institute, the National Institute for Surveillance of Medicines and Foods, the National Administrative Department of Statistics and the Ministry of Health and Social Protection. Absolute and relative frequencies were calculated with 95% confidence intervals, position measurements, dispersion and central tendency. Results: Through our research, we revealed that in the last 13 years (2008–2020), there were an average of 4467 annual snakebite envenomation cases affecting all the departments in Colombia. Antioquia reported the highest number of snakebites with 647 (95% CI 588–706) cases per year. The population incidence per 100,000 inhabitants was 9.5; the highest rates were found in Vaupés at 116.1 and Guaviare at 79.24. During the last seven years (2014–2020) Colombia produced an average of 21,104 antivenom vials per year, while the annual demand for antivenom is estimated at 54,440 units needed to guarantee access. Discussion: Colombia does not produce sufficient vials to cover their needs, and this is why only 74.4% of accidents (out of the 92% not classified as dry bites) were treated, and even 9.7% of the severe accidents did not receive the specific treatment (8% of the victims were classified as dry bites). Figures support the regular antivenom shortages declared by the Ministry of Health and Social Protection in the last 13 years (11 health emergency declarations). New efforts are needed to: 1) boost the production of GMP-based high-quality antivenom, that covers the national needs and is made availability, 2) a better estimation method to calculate the need for antivenom in Colombia, and 3) implementation of production-distribution chains guaranteeing access in remote communities.
publishDate 2022
dc.date.accessioned.none.fl_str_mv 2022-11-25T18:46:58Z
dc.date.available.none.fl_str_mv 2022-11-25T18:46:58Z
dc.date.issued.none.fl_str_mv 2022-09-29
dc.type.none.fl_str_mv Artículos Científicos
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dc.identifier.issn.spa.fl_str_mv 11791365
dc.identifier.uri.spa.fl_str_mv https://doi.org/10.2147/DHPS.S367757
dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12494/47205
dc.identifier.bibliographicCitation.spa.fl_str_mv Estrada-Gómez, S., Vargas-Muñoz, L.J., Higuita-Gutiérrez, L.F. (2022). Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs [Articulo científico, Universidad Cooperativa de Colombia]. Repositorio Institucional Universidad Cooperativa de Colombia. https://repository.ucc.edu.co/handle/20.500.12494/47205
identifier_str_mv 11791365
Estrada-Gómez, S., Vargas-Muñoz, L.J., Higuita-Gutiérrez, L.F. (2022). Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs [Articulo científico, Universidad Cooperativa de Colombia]. Repositorio Institucional Universidad Cooperativa de Colombia. https://repository.ucc.edu.co/handle/20.500.12494/47205
url https://doi.org/10.2147/DHPS.S367757
https://hdl.handle.net/20.500.12494/47205
dc.relation.ispartofjournal.spa.fl_str_mv Drug, Healthcare and Patient Safety
dc.relation.references.spa.fl_str_mv Longbottom J, Shearer FM, Devine M, et al. Vulnerability to snakebite envenoming: a global mapping of hotspots. Lancet. 2018;392(10148):673–684. doi:10.1016/S0140-6736(18)31224-8
Chippaux J-P. Snakebite envenomation turns again into a neglected tropical disease! J Venom Anim Toxins Incl Trop Dis. 2017;23(1):38. doi:10.1186/s40409-017-0127-6
World Health Organization. Snakebite envenoming; 2018.
Temprano GA, Aprea P, Dokmetjian JC. The public production of antivenoms in the Americas, a key favtor to accesibility. Rev Panam Salud Publica. 2017;41:1. doi:10.26633/RPSP.2017.109
de la Hoz F, Duran ME, García OE, et al. 1. Snakebite, Public Health Surveillance Protocol. Instituto Nacional de Salud; 2017.
León-Núñez LJ, Camero-Ramos G, Gutiérrez JM. Epidemiology of snakebites in Colombia (2008–2016). Rev Salud Publica. 2020;22(3):1–5. doi:10.15446/rsap.v22n3.87005
World Health Organization. Guidelines for the production, control and regulation of snake antivenoms immunoglobulins (WHO); 2018.
Arce V, Rojas E, Ownby CL, Rojas G, Gutierrez JM. Preclinical assessment of the ability of polyvalent (Crotalinae) and anticoral (Elapidae) antivenoms produced in Costa Rica to neutralize the venoms of North American snakes. Toxicon. 2003;41(7):851–860. doi:10.1016/S0041-0101(03)00043-6
Gutierrez JM, Rojas E, Quesada L, et al. Pan-African polyspecific antivenom produced by caprylic acid purification of horse IgG: an alternative to the antivenom crisis in Africa. Trans R Soc Trop Med Hyg. 2005;99(6):468–475. doi:10.1016/j.trstmh.2004.09.014
Otero R, Nunez V, Osorio RG, Gutierrez JM, Giraldo CA, Posada LE. Ability of six Latin American antivenoms to neutralize the venom of mapana equis (Bothrops atrox) from Antioquia and Choco (Colombia). Toxicon. 1995;33(6):809–815. doi:10.1016/0041-0101(95)00009-B
Rojas E, Quesada L, Arce V, Lomonte B, Rojas G, Gutierrez JM. Neutralization of four Peruvian Bothrops sp. snake venoms by polyvalent antivenoms produced in Peru and Costa Rica: preclinical assessment. Acta Trop. 2005;93(1):85–95. doi:10.1016/j.actatropica.2004.09.008
Saravia P, Rojas E, Escalante T, et al. The venom of Bothrops asper from Guatemala: toxic activities and neutralization by antivenoms. Toxicon. 2001;39(2–3):401–405. doi:10.1016/S0041-0101(00)00122-7
Otero R, Gutierrez JM, Nunez V, et al. A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia. The Regional Group on Antivenom Therapy Research (REGATHER). Trans R Soc Trop Med Hyg. 1996;90(6):696–700. doi:10.1016/S0035-9203(96)90442-3
Otero R, Gutierrez JM, Rojas G, et al. A randomized blinded clinical trial of two antivenoms, prepared by caprylic acid or ammonium sulphate fractionation of IgG, in Bothrops and Porthidium snake bites in Colombia: correlation between safety and biochemical characteristics of antivenoms. Toxicon. 1999;37(6):895–908. doi:10.1016/S0041-0101(98)00220-7
Otero R, Leon G, Gutierrez JM, et al. Efficacy and safety of two whole IgG polyvalent antivenoms, refined by caprylic acid fractionation with or without beta-propiolactone, in the treatment of Bothrops asper bites in Colombia. Trans R Soc Trop Med Hyg. 2006;100(12):1173–1182. doi:10.1016/j.trstmh.2006.01.006
Otero-Patino R, Cardoso JL, Higashi HG, et al. A randomized, blinded, comparative trial of one pepsin-digested and two whole IgG antivenoms for Bothrops snake bites in Uraba, Colombia. The Regional Group on Antivenom Therapy Research (REGATHER). Am J Trop Med Hyg. 1998;58(2):183–189. doi:10.4269/ajtmh.1998.58.183
Otero-Patino R, Segura A, Herrera M, et al. Comparative study of the efficacy and safety of two polyvalent, caprylic acid fractionated [IgG and F(ab’)2] antivenoms, in Bothrops asper bites in Colombia. Toxicon. 2012;59(2):344–355. doi:10.1016/j.toxicon.2011.11.017
Alfaro-Chinchilla A, Á Segura, Gómez A, et al. Expanding the neutralization scope of the Central American antivenom (PoliVal-ICP) to include the venom of Crotalus durissus pifanorum. J Proteomics. 2021;246:104315. doi:10.1016/j.jprot.2021.104315
Quintana-Castillo JC, Vargas LJ, Segura C, Estrada-Gómez S, Bueno-Sánchez JC, Alarcón JC. Characterization of the Venom of C. d. cumanesis of Colombia: proteomic analysis and antivenomic study. Toxins. 2018;10(2):85. doi:10.3390/toxins10020085
Saravia P, Rojas E, Arce V, et al. Geographic and ontogenic variability in the venom of the neotropical rattlesnake Crotalus durissus: pathophysiological and therapeutic implications. Rev Biol Trop. 2002;50(1):337–346.
LJ León-Núñez. Snakebite final reportr in Colombia, 2014. Insitituo Nacional de Salud; 2014: 1–28.
proving antivenom availability and accessibility: science, technology, and beyond. Toxicon. 2012;60(4):676–687. doi:10.1016/j.toxicon.2012.02.008
Johnston CI, Ryan NM, O’Leary MA, Brown SG, Isbister GK. Australian taipan (Oxyuranus spp.) envenoming: clinical effects and potential benefits of early antivenom therapy - Australian Snakebite Project (ASP-25). Clin Toxicol. 2017;55(2):115–122. doi:10.1080/15563650.2016.1250903
Wakefield J. Ecologic studies revisited. Annu Rev Public Health. 2008;29(1):75–90. doi:10.1146/annurev.publhealth.29.020907.090821
Morgenstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health. 1995;16(1):61–81. doi:10.1146/annurev.pu.16.050195.000425
Walteros D, Andrea P. Snakebite, Public Health Surveillance Protocol. Insitituo Nacional de Salud; 2014: 1–21.
Dettori JR, Norvell DC. The anatomy of data. Glob Spine J. 2018;8(3):311–313. doi:10.1177/21925682177469
Rojas-Bárcenas AM. Snakebite final reportr in Colombia, 2017. Insitituo Nacional de Salud; 2017: 1–33.
Chippaux J-P. Incidence and mortality due to snakebite in the Americas. PLoS Negl Trop Dis. 2017;11(6):e0005662. doi:10.1371/journal.pntd.0005662
Agricultural National Census, 2014.Departamento Administrativo Nacional de Estadística; 2015: 1–60.
Snakebite final reportr in Colombia, 2011.Insitituo Nacional de Salud; 2011: 1–24.
Snakebite final reportr in Colombia, 2020.Insitituo Nacional de Salud; 2020: 1–3.
Ayala-Garcia J. Health in Colombia. Higher coverage but less access. In: Documento de trabajo sobre Economía Regional Banco de la Republica. 2014:204.
Otero R, Callejas ME, Gutiérrez J, et al. Real needs od antivenoms in Colombia. Products and market. Rev Epidemiol Antioquia. 2002;12(1):49–59.
Gomez JPG, Gomez ML. Antivenoms in Colombia: production and distribution analysis with recommendations to improve the production network. Biosalud. 2017;16:2.
Scheske L, Ruitenberg J, Bissumbhar BB. Needs and availability of snake antivenoms: relevance and application of international guidelines. Int J Health Policy Manag. 2015;4(7):447–457. doi:10.15171/ijhpm.2015.75
Ayerbe SR. Accident by venemous animlas and toxic plants. In: Guia para el manejo de urgencias toxicológicas. Imprenta Nacional de Colombia; 2008:277–308.
World Health Organization. Guidelines for the management of snake-bites; 2010.
Gutiérrez JM. Snakebite poisoning in Latin America and the Caribbean: An integral view from a regional perspective. Bol Malariol Salud Ambient. 2011;51:1–16.
Otero R, Fonnegra R, Jiménez SL, et al. Snakebites and ethnobotany in the northwest region of Colombia: part I: traditional use of plants. J Ethnopharmacol. 2000;71(3):493–504. doi:10.1016/s0378-8741(00)00243-9
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spelling Sebastián, Estrada GómezVargas Muñoz, Leidy JohanaHiguita Gutiérrez, Luis Felipe2022(14)2022-11-25T18:46:58Z2022-11-25T18:46:58Z2022-09-2911791365https://doi.org/10.2147/DHPS.S367757https://hdl.handle.net/20.500.12494/47205Estrada-Gómez, S., Vargas-Muñoz, L.J., Higuita-Gutiérrez, L.F. (2022). Epidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the Needs [Articulo científico, Universidad Cooperativa de Colombia]. Repositorio Institucional Universidad Cooperativa de Colombia. https://repository.ucc.edu.co/handle/20.500.12494/47205Introduction: Snakebite envenomation is a public health event of mandatory reporting in Colombia. It is considered a medical emergency in which the government must guarantee antivenom availability. We describe snakebite epidemiological figures in Colombia between 2008 and 2020 and correlate them with antivenom manufacturing figures to determine rate coverage and the need for antivenom. Methods: We performed an ecological study based on secondary official figures from the National Health Institute, the National Institute for Surveillance of Medicines and Foods, the National Administrative Department of Statistics and the Ministry of Health and Social Protection. Absolute and relative frequencies were calculated with 95% confidence intervals, position measurements, dispersion and central tendency. Results: Through our research, we revealed that in the last 13 years (2008–2020), there were an average of 4467 annual snakebite envenomation cases affecting all the departments in Colombia. Antioquia reported the highest number of snakebites with 647 (95% CI 588–706) cases per year. The population incidence per 100,000 inhabitants was 9.5; the highest rates were found in Vaupés at 116.1 and Guaviare at 79.24. During the last seven years (2014–2020) Colombia produced an average of 21,104 antivenom vials per year, while the annual demand for antivenom is estimated at 54,440 units needed to guarantee access. Discussion: Colombia does not produce sufficient vials to cover their needs, and this is why only 74.4% of accidents (out of the 92% not classified as dry bites) were treated, and even 9.7% of the severe accidents did not receive the specific treatment (8% of the victims were classified as dry bites). Figures support the regular antivenom shortages declared by the Ministry of Health and Social Protection in the last 13 years (11 health emergency declarations). New efforts are needed to: 1) boost the production of GMP-based high-quality antivenom, that covers the national needs and is made availability, 2) a better estimation method to calculate the need for antivenom in Colombia, and 3) implementation of production-distribution chains guaranteeing access in remote communities.https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001501791https://orcid.org/0000-0003-1361-3124https://scienti.minciencias.gov.co/gruplac/jsp/visualiza/visualizagr.jsp?nro=00000000011355luis.higuita@campusucc.edu.cohttps://scholar.google.com/citations?user=zr_ri68AAAAJ&hl=en171-184Universidad Cooperativa de Colombia, Facultad de Ciencias de la Salud, Medicina, Medellín y EnvigadoDove PressMedicinaMedellínsnakebiteColombiaManufactureantivenomsaccessavailabilityEpidemiology of Snake Bites Linked with the Antivenoms Production in Colombia 2008–2020: Produced Vials Do Not Meet the NeedsArtículos Científicoshttp://purl.org/coar/resource_type/c_2df8fbb1http://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionAtribucióninfo:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Drug, Healthcare and Patient SafetyLongbottom J, Shearer FM, Devine M, et al. Vulnerability to snakebite envenoming: a global mapping of hotspots. Lancet. 2018;392(10148):673–684. doi:10.1016/S0140-6736(18)31224-8Chippaux J-P. Snakebite envenomation turns again into a neglected tropical disease! J Venom Anim Toxins Incl Trop Dis. 2017;23(1):38. doi:10.1186/s40409-017-0127-6World Health Organization. Snakebite envenoming; 2018.Temprano GA, Aprea P, Dokmetjian JC. The public production of antivenoms in the Americas, a key favtor to accesibility. Rev Panam Salud Publica. 2017;41:1. doi:10.26633/RPSP.2017.109de la Hoz F, Duran ME, García OE, et al. 1. Snakebite, Public Health Surveillance Protocol. Instituto Nacional de Salud; 2017.León-Núñez LJ, Camero-Ramos G, Gutiérrez JM. Epidemiology of snakebites in Colombia (2008–2016). Rev Salud Publica. 2020;22(3):1–5. doi:10.15446/rsap.v22n3.87005World Health Organization. Guidelines for the production, control and regulation of snake antivenoms immunoglobulins (WHO); 2018.Arce V, Rojas E, Ownby CL, Rojas G, Gutierrez JM. Preclinical assessment of the ability of polyvalent (Crotalinae) and anticoral (Elapidae) antivenoms produced in Costa Rica to neutralize the venoms of North American snakes. Toxicon. 2003;41(7):851–860. doi:10.1016/S0041-0101(03)00043-6Gutierrez JM, Rojas E, Quesada L, et al. Pan-African polyspecific antivenom produced by caprylic acid purification of horse IgG: an alternative to the antivenom crisis in Africa. Trans R Soc Trop Med Hyg. 2005;99(6):468–475. doi:10.1016/j.trstmh.2004.09.014Otero R, Nunez V, Osorio RG, Gutierrez JM, Giraldo CA, Posada LE. Ability of six Latin American antivenoms to neutralize the venom of mapana equis (Bothrops atrox) from Antioquia and Choco (Colombia). Toxicon. 1995;33(6):809–815. doi:10.1016/0041-0101(95)00009-BRojas E, Quesada L, Arce V, Lomonte B, Rojas G, Gutierrez JM. Neutralization of four Peruvian Bothrops sp. snake venoms by polyvalent antivenoms produced in Peru and Costa Rica: preclinical assessment. Acta Trop. 2005;93(1):85–95. doi:10.1016/j.actatropica.2004.09.008Saravia P, Rojas E, Escalante T, et al. The venom of Bothrops asper from Guatemala: toxic activities and neutralization by antivenoms. Toxicon. 2001;39(2–3):401–405. doi:10.1016/S0041-0101(00)00122-7Otero R, Gutierrez JM, Nunez V, et al. A randomized double-blind clinical trial of two antivenoms in patients bitten by Bothrops atrox in Colombia. The Regional Group on Antivenom Therapy Research (REGATHER). Trans R Soc Trop Med Hyg. 1996;90(6):696–700. doi:10.1016/S0035-9203(96)90442-3Otero R, Gutierrez JM, Rojas G, et al. A randomized blinded clinical trial of two antivenoms, prepared by caprylic acid or ammonium sulphate fractionation of IgG, in Bothrops and Porthidium snake bites in Colombia: correlation between safety and biochemical characteristics of antivenoms. Toxicon. 1999;37(6):895–908. doi:10.1016/S0041-0101(98)00220-7Otero R, Leon G, Gutierrez JM, et al. Efficacy and safety of two whole IgG polyvalent antivenoms, refined by caprylic acid fractionation with or without beta-propiolactone, in the treatment of Bothrops asper bites in Colombia. Trans R Soc Trop Med Hyg. 2006;100(12):1173–1182. doi:10.1016/j.trstmh.2006.01.006Otero-Patino R, Cardoso JL, Higashi HG, et al. A randomized, blinded, comparative trial of one pepsin-digested and two whole IgG antivenoms for Bothrops snake bites in Uraba, Colombia. The Regional Group on Antivenom Therapy Research (REGATHER). Am J Trop Med Hyg. 1998;58(2):183–189. doi:10.4269/ajtmh.1998.58.183Otero-Patino R, Segura A, Herrera M, et al. Comparative study of the efficacy and safety of two polyvalent, caprylic acid fractionated [IgG and F(ab’)2] antivenoms, in Bothrops asper bites in Colombia. Toxicon. 2012;59(2):344–355. doi:10.1016/j.toxicon.2011.11.017Alfaro-Chinchilla A, Á Segura, Gómez A, et al. Expanding the neutralization scope of the Central American antivenom (PoliVal-ICP) to include the venom of Crotalus durissus pifanorum. J Proteomics. 2021;246:104315. doi:10.1016/j.jprot.2021.104315Quintana-Castillo JC, Vargas LJ, Segura C, Estrada-Gómez S, Bueno-Sánchez JC, Alarcón JC. Characterization of the Venom of C. d. cumanesis of Colombia: proteomic analysis and antivenomic study. Toxins. 2018;10(2):85. doi:10.3390/toxins10020085Saravia P, Rojas E, Arce V, et al. Geographic and ontogenic variability in the venom of the neotropical rattlesnake Crotalus durissus: pathophysiological and therapeutic implications. Rev Biol Trop. 2002;50(1):337–346.LJ León-Núñez. Snakebite final reportr in Colombia, 2014. Insitituo Nacional de Salud; 2014: 1–28.proving antivenom availability and accessibility: science, technology, and beyond. Toxicon. 2012;60(4):676–687. doi:10.1016/j.toxicon.2012.02.008Johnston CI, Ryan NM, O’Leary MA, Brown SG, Isbister GK. 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