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Background: Snakebite is a major poverty-related neglected tropical disease. An integrated scientific approach is needed to understand the dynamics of this important health issue. Our objective was to estimate snakebite occurrence in a tropical area by using a blend of ecological modelling and robust statistical analysis. Methods: The present study used climatic, environmental, and human population density data to determine the area with snakebite occurrence-probability for the first time in Bangladesh. We also analysed a large, 16-year dataset of hospitalized snakebite cases to reveal the epidemiology of snakebite in the south-eastern zone of the country. Findings: Our results show that cobra bite is the most commonly occurring venomous snakebite in humans (around ~12% of the total yearly snakebite records), and men are more frequently bitten than women (2/3 of human victims are men). Most bites occur during the rainy season for cobra and green pit viper, while krait bites are not restricted to any particular season. As snakebite incidents are closely related to climate conditions, we can model snakebite risk using temperature and precipitation variables. Whereas there is a lack of snakebite reports from several parts of the study area in official records, our models predict that the entire study area is favourable for snakebite incidents. Based on the combined evidence we estimate that about 200,000 snakebite events occur every year in the south-eastern part of Bangladesh alone. Considering future global climate change, our model projections show that snakebite incidence in Bangladesh might not significantly decrease in the future (- 2070-); however, the distribution of probabilities might change, with a predicted increase of snakebite incidence in the hilly areas of the country. Conclusions: Using climatic data to predict snakebite incidence in Bangladesh allowed us to provide estimations of the total annual number of snakebite cases in the study area. As in most countries, the scarcity of accurate epidemiological data in official records might have masked the real magnitude of this problem. Our analysis suggests that the problem of snakebite envenoming in Bangladesh might be worse than currently perceived. A long-term sustainable snakebite program plan should be designed and institutionalized, considering climatic, geographical and human demographic variables, to obtain better data and facilitate the implementation of accurate snakebite management programs for this country. Author summary: Snakebite envenoming is an important health problem in Bangladesh. A community-based survey conducted in 2009 indicated that around 700,000 snakebites/year may occur in this country. However, until now, there is no study estimating the incidence of snakebite in Bangladesh from the aspect of ecology. Considering the climatic, environmental, and human population variables, a large, 16-year clinico-epidemiological dataset of snakebite patients was analysed to portray snakebite occurrence probability in Chattogram Division, which comprises the south-eastern part of Bangladesh. Five species distribution models were used to map snakebite-prone areas. We found that the study area has large differences in the predicted incidence of snakebite. Our predictions indicate that around 200,000 snakebite cases per year might occur in the study area, where the latest estimate on 2009 estimated less than half that number for this division. Further, predictions for the year 2070 provide us with similar numbers, independent of the global increase in temperature. As snakebite will remain a major health problem for this country in the next 50 years, we propose the development of a sustainable management plan aiming to limit human-snake conflicts and their consequences while safeguarding also snakes and the ecosystem services they provide especially to agriculture. [ABSTRACT FROM AUTHOR]

Snakebite envenoming is a common but neglected public health problem, particularly in impoverished rural regions of sub-Saharan Africa, Asia and Latin America. The only validated treatment for this condition is passive immunotherapy with safe and effective animal-derived antivenoms. However, there is a long-lasting crisis in the availability of these life-saving medications, particularly in sub-Saharan Africa and parts of Asia. We herein advocate a multicomponent strategy to substantially improve the availability of safe and effective antivenoms at the global level. This strategy is based on: (i) preparing validated collections of representative venom pools from the most medically dangerous snakes in high-risk regions of the world; (ii) strengthening the capacity of national antivenom manufacturing and quality control laboratories and their regulatory authorities and establishing new facilities In developing countries through technology transfer, as an integral part of efforts to develop their biological products industry; (iii) getting established laboratories to generate antivenoms for various regions of the world; and (iv) getting governments and relevant organizations to give snakebite envenoming due recognition within national and international public health policy frameworks. These ways of making antivenom available should be complemented by actions to improve health information systems, the accessibility of antivenoms, the training of medical and nursing staff, and community-based education. Such a multicomponent strategy involving stakeholders on many levels could help consolidate sustainable improvements in antivenom availability worldwide. L'envenimation par morsure de serpent est un probleme de sante publique frequent, mais neglige, en particuller dans les regions rurales pauvres de l'Afrique subsaharienne, de l'Asie et de l'Amerique latine. Le seul traitement valide pour solgner cet etat est l'immunotherapie passive avec des serums antivenimeux d'origine animale surs et eficaces. Cependant, une crise durable limite actuellement la disponibilite de ces medicaments vitaux, surtout en Afrique subsaharienne et dans certaines parties de l'Asie. Nous preconisons ici une strategie a composants multiples pour ameliorer considerablement la disponibilite des serums antivenimeux surs et eficaces a l'echelle mondiale. Cette strategie repose sur: (i) la preparation de collections validees de groupes representatifs de venins preleves sur les serpents les plus dangereux sur le plan medical dans les regions a haut risque du monde; (ii) le renforcement de la capacite de production nationale des serums antivenimeux, des laboratoires de controle qualite et de leurs organismes de reglementation, et la creation de nouvelles installations dans les pays en developpement partransfert de technologies, en tant que partie integrante de la strategie de developpement de leur industrie de produits blologiques; (iii) la production par les laboratoires deja etablis de serums antivenimeux pour les differentes regions du monde; et (iv) la reconnaissance officielle par les gouvernements et les organisations competentes de l'envenimation par morsure de serpent dans le cadre des politiques de sante publique nationales et internationals. Ces facons de rendre disponibles les serums antivenimeux devraient etre completees par des actions visant a ameliorer les systemes d'informations sanitaires, l'accessibilite des serums antivenimeux, la formation du personnel medical et infirmier et les programmes communautaires d'education. Une telle strategie a composants multiples impliquant des acteurs a differents niveaux pourrait contribuer a consolider les ameliorations durables en matiere de disponibilite des serums antivenimeux dans le monde entier. El envenenamiento por mordedura de serpiente es un problema de salud publica comun pero desatendido, especialmente en las regiones rurales mas pobres de Africa subsahariana, Asia y America Latina. El unico tratamiento reconocido contra estas mordeduras es la inmunoterapia pasiva con sueros antiofidicos de origen animal seguros y eficaces. Sin embargo, la disponibilidad de estos medicamentos esenciales para salvar vidas lleva mucho tiempo en crisis, en particular en Africa subsahariana y en algunas zonas de Asia. En el presente documento, abogamos por una estrategia multicomponente para mejorar de forma sustancial la disponibilidad de sueros antiofidicos seguros y eficaces en todo el mundo. La estrategia se basa en: (i) preparar colecciones reconocidas de sueros antiofidicos representativos de las serpientes mas peligrosas en zonas de alto riesgo del mundo; (ii) reforzar la capacidad nacional de produccion de sueros antiofidicos y la calidad de los laboratorios de control y sus autoridades normativas, asi como crear instalaciones nuevas en los paises en desarrollo por medio de la transferencia de tecnologia como parte integral de los esfuerzos por desarrollar su Industria de productos biologicos; (iii) conseguir que los laboratorios consolidados fabriquen sueros antiofidicos para varias regiones del mundo; y (iv) conseguir que los gobiernos y las organizaciones pertinentes otorguen al envenenamiento por mordedura de serpiente el reconocimiento debido dentro del marco de las politicas nacionales e internacionales de salud publica. Estas tareas dirigidas a facilitar el suero antiofidico deben complementarse con acciones para mejorar los sistemas de informacion sobre la salud, la accesibilidad de los antiofidicos, la formacion del personal medico y de enfermeria, y la educacion comunitaria. Una estrategia multicomponente de ese tipo, que incluye a los interesados a varios niveles, podria ayudar a consolidar mejoras sostenibles en la disponibilidad de antiofidicos en todo el mundo., Introduction Envenoming following snakebite is a very common but globally neglected public health problem that primarily affects poor agrarian and pastoralist communities of Africa, Asia, Latin America and Oceania. (1-5) [...]