Essential medicines and health products

WHO issues new recommendation on antivenom for snakebites

The World Health Organization (WHO) has responded proactively to concerns about the low availability of safe, effective antivenom immunoglobulin products for the Sub-Saharan African region by establishing a risk-benefit assessment process to screen antivenom products intended for marketing in Sub-Saharan Africa. The risk benefit assessment followed the WHO assessment and listing of snake antivenoms.

After a comprehensive risk assessment, WHO has issued its first positive recommendation for the use of EchiTAbGTM, an Antivenom to treat snakebites of medical relevance in the northern part of Sub-Saharan Africa, namely the west and east African carpet viper. These snakes are present in about 20 countries in the northern part of Sub-Saharan Africa* and are known to cause the most cases of snakebite deaths in the world.

The recommendations include a number of risk limiting measures, and studies to ensure appropriate dosage and patient follow-up.

Snake bite is a neglected public health issue in many tropical and subtropical countries. About 5.4 million snake bites occur each year, resulting in 1.8 to 2.7 million cases of poisoning. There are between 81 410 and 137 880 deaths and around three times as many amputations and other permanent disabilities each year.

While highly effective treatments exist, antivenoms are not widely available in the regions where they are needed. The main challenge is the preparation of the correct immunogens (snake venoms). At present very few countries have capacity to produce snake venoms of adequate quality for antivenom manufacture, and many manufacturers rely on common commercial sources. These may not properly reflect the geographical variation that occurs in the venoms of some widespread species. In addition, lack of regulatory capacity for the control of antivenoms in countries with significant snake bite problems results in an inability to assess the quality and appropriateness of the antivenoms.

For these reasons, WHO prequalification is paying serious attention to the issue and is evaluating other types of antivenoms. If compliant with WHO standards, these products will be listed for international procurement.

*Benin, Burkina Faso, Cameroon, Central African Republic (west), Chad, Côte d'Ivoire, Ghana, Mali, Niger, Nigeria, Togo, Central African Republic (north-east), Egypt, Eritrea, Ethiopia, Djibouti, Kenya, South Sudan, Sudan, Uganda