National Situation

In Pakistan there are 55 known species of snakes. Fortunately only 13 are poisonous (25%) and out of these seven are of medical importance. The snake bite cases in Pakistan are substantially high (second highest in the world after India) with increasing trends especially during the moon soon or in flood season. According to data (WHO 1999 Report) there are about 50,000 snakebite cases reported every year in Pakistan. The routine information sources guess some 35,000 cases of these gain excess to public sector health facilities. The existing management practice confirms administration of at least two ASV vials intravenously at arrival (without confirmation of envenoming by snakes) and a number of vials further till blood clotting time test or other related  tests confirms neutralization of the venom. However irrational and unscientific use of ASV is witnessed elsewhere in Sindh adding shortage to already scanty supplied ASV..

The minimum requirement of ASV for the country as expressed by NIH is around 125,000 to 150,000 vials per year. The production record shows the capacity of NIH Islamabad not more than 24000 vials a year (till 2007-08) thus leaving a supply gape of more than 100000 vials a year. The other routine sources are imported ASV mostly from India (30000 to 50000 vials), the smuggled or through informal channels (15000 to 25000 vials) from Iran, Egypt, Saudi Arabia, Germany and even from India through Punjab and Sindh border. Unfortunately nothing system check is put so far for knowing the efficacy or usefulness of this imported or smuggled ASV for neutralizing the venom of local snakes. In absence of any scientific clinical trial of these ASVs nothing can be acknowledged authentically however scientific logic about the ASV production and efficacy do not support the usefulness of these outside ASVs against the venom of local snakes. It is therefore a dual national loss, i.e. loss of human lives and health on one side and on the other side wastage of precious national foreign exchange like draining the blood from our economy veins unnecessarily without any proven benefit.

Among all the four provinces and administrative units of Pakistan Sindh is having the highest number of snake bite cases and requires at least half of the total country demand. The HMIS reports which articulate 1/3rd of the actual data shows an average of around eight thousands snake bite cases during each past five year. Presuming only 30% of the total cases requiring ASV, it needs to arrange ASV for at least eight thousands victims in a year. Each case of snake bite of Saw Scaled Viper “Lundi” and that of Krait “Sangchoor or Pean” needs at least four vials to neutralize an average of 15 mg of venom, where as the cases of Cobra “Karo” and Russell viper “Damin or Koriala” needs as much as 8-10 vials of ASV to neutralize an average of 65 mg of circulating venom. In some severe cases or with less potent or imported outside ASV even 20 to 30 vials or more are being used to save the life. The dose varies with the type of snakes whether Cobra, Saw Scaled Viper, Russell’s viper or Krait as each of them pour different quantities of venom to be neutralized by the anti venom sera. Hence an average of 4 to 10 vials of ASV is usually required for each envenomed case, which shows that the Sindh alone requires an average of 50000 to 60000 vials in a year.