Every year, snakebites claim the lives of tens of thousands in India, and is one of the leading causes of accidental death in rural areas. Agricultural workers, tribal communities, and residents of remote villages bear the brunt of this crisis, which often leads to death, permanent disability, and lasting psychological trauma. In many ways, snakebite is the “poor man’s disease,” disproportionately affecting the country’s most vulnerable populations.
To address the lack of a comprehensive surveillance system for tracking snakebite incidents, the Union Health Ministry has urged health authorities of all the States to declare snakebite cases and deaths as notifiable diseases. This directive mandates that all healthcare facilities, including private ones, report both suspected and confirmed snakebite cases and fatalities.
In her letter dated November 27, Punya Salila Srivastava, Union Health Secretary, said this initiative will help stakeholders gain a clearer understanding of the true burden of snakebites, identify high-risk areas, and pinpoint the factors leading to fatalities, ultimately improving clinical management of snakebite victims.
Just weeks earlier, on November 6, 2024, the Tamil Nadu government took a crucial step by officially declaring snakebite envenoming a notifiable disease under the Tamil Nadu Public Health Act of 1939. This move is aimed at reducing the rising burden of snakebites in the State by enhancing data collection, optimising resource allocation, and improving treatment strategies.
Underreporting of snakebite cases
Historically, snakebites have been underreported in India, including in Tamil Nadu, which has hindered effective public health interventions and accurate assessment of anti-snake venom (ASV) needs. A study based on the Million Death Study (2001–2014) estimated that nearly 58,000 people die from snakebites each year — much higher than official figures reported by hospitals. This underreporting calls for better data collection, which the new notification system aims to facilitate.
Under the new regulation, all hospitals — public and private — are now required to report snakebite cases to the State health authorities. This data will be integrated into the State’s Integrated Health Information Platform as part of the Integrated Disease Surveillance Program.
Supriya Sahu, Additional Chief Secretary to the Department of Health and Family Welfare, Government of Tamil Nadu, says that mandating the reporting of every case ensures real-time data collection. This is crucial for understanding the scale and distribution of snakebite incidents across the State. Improved surveillance will allow for quicker medical responses, better resource allocation, and identification of high-risk areas, ultimately reducing fatalities and long-term disabilities, she adds.
“Beyond public health, this decision also bolsters snake conservation efforts. By addressing snakebites systematically, it promotes awareness about the ecological importance of snakes, reduces fear-based killings, and fosters coexistence. Accurate data can help differentiate between venomous and non-venomous incidents, dispelling myths and educating communities about the role of snakes in controlling pests and maintaining biodiversity,” she explains.
Understanding envenoming
Snakebite envenoming occurs when venom is injected by certain species of snakes, including the common krait, Indian cobra, Russell’s viper, and saw-scaled viper — collectively known as the “big four.” These snakes are responsible for approximately 90% of snakebite cases in India.
Treatment typically involves the administration of polyvalent ASV, which contains antibodies for these common venomous snakes. When administered promptly, ASV can reverse life-threatening effects in up to 80% of cases. However, gaps in healthcare infrastructure, such as a shortage of trained medical personnel, inadequate medical supplies, and inconsistent access to ASV, contribute to the high mortality rate.
The shortage of trained healthcare professionals, especially in rural areas, is a key factor. Many snakebite victims do not receive timely treatment, particularly in the critical hours following a bite. Additionally, ASV is often not available when it is most needed, especially during peak snakebite seasons.
National plan, State action
To address these challenges at the national level, the Indian government introduced the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE). This plan aims to halve the number of snakebite-related deaths by 2030 through a comprehensive, multi-sectoral approach. NAPSE advocates for a “One Health” framework that integrates human, animal, and environmental health interventions, focusing on preventive measures, improved healthcare infrastructure, and public awareness.
NAPSE outlines a clear roadmap for State governments to tackle the snakebite crisis, with specific roles assigned to healthcare, veterinary, and wildlife sectors. Key components of the action plan include ensuring the availability of ASV, strengthening referral mechanisms for timely treatment, and establishing targeted public education campaigns. Each State in India is expected to conduct a gap analysis to assess the local burden of snakebite envenoming, identify high-risk areas, and evaluate healthcare facilities that can manage snakebite cases.
This tailored approach will help prioritise interventions in regions with the highest incidence and ensure that resources are allocated where they are most needed. For example, Tamil Nadu, with its significant snakebite burden, will focus on strengthening its healthcare system and increasing awareness in rural areas. “The initiative [notifying snakebites] will remain incomplete unless we frame the State action plan for Tamil Nadu. We are in the process of setting up an expert committee to do the same,” says Ms. Sahu.
Challenges ahead
There exists a significant gap between ground reality and the data available on snakebites. While the recent notification of snakebites is a welcome first step, the reporting mechanisms need to be significantly expanded to be truly effective, says Gnaneswar Ch, Lead, Snakebite Mitigation Project at the Madras Crocodile Bank Trust.
Currently, only basic data, such as death and survival rates, are recorded, which does not provide sufficient insight into the underlying causes or circumstances of snakebites. Referring to a pilot project conducted in Tamil Nadu in 2019, where detailed data was collected across 20 parameters, Mr. Gnaneswar says this data helped identify specific behaviours in a village that were contributing to the high incidence of snakebites. After community outreach was initiated, based on this information, the behaviour was modified, leading to a reduction in snakebite incidents in that area.
Freston Marc Sirur, from Department of Emergency Medicine at KMC Manipal, says many snakebite victims, especially those from rural areas, seek traditional or home remedies rather than formal healthcare, meaning these cases often go unreported in the official health system. As a result, the true number of snakebite cases remains unclear.
In Karnataka, which became the first State to declare snakebites a notifiable disease earlier this year, progress has been made by classifying snakebites as a reportable injury. However, challenges remain in accurately tracking the data. Patient transfers between different healthcare facilities, as well as decisions to seek private care, can complicate data collection, says Mr. Sirur, adding that all States will face similar challenges.
Mr. Gnaneswar points out that while Karnataka has declared snakebites a notifiable disease, the State’s reporting system remains largely unchanged. It still collects limited data, primarily related to death and survival, which restricts the potential for meaningful interventions. To make the move truly effective, there is a need for a comprehensive data collection system, one that includes additional information, such as the circumstances of the bite (e.g., where it occurred, how the victim was transported to the hospital, and the timing of medical intervention). This detailed data would help health authorities identify patterns and risk factors and allow for targeted outreach programmes to prevent future incidents, he adds.
Highlighting the complexity of implementing a comprehensive data collection system for snakebite cases, Mr. Sirur notes that the volume of diseases requiring notifications and data entry is vast, making it difficult to manage efficiently. While basic data on snakebite numbers and deaths can be collected, the real value lies in understanding the impact of various interventions. By examining the data, it is possible to see how factors like climate change, human interaction with snakes, or stronger healthcare systems influence snakebite outcomes. This data will help identify specific problems and guide resource allocation to reduce snakebite incidents and deaths, he says.
Published – November 28, 2024 02:26 pm IST
