While we have excellent antivenoms they have their limitations. In a recent study published by Dr George Oosthuizen and colleagues, they showed that up to four out of ten patients treated with SAVP antivenom had a severe allergic reaction. Once a patient goes into anaphylactic shock the administration of antivenom has to be stopped immediately and the patient stabilized. This is done partially by administering adrenaline. Because of the high incidence of anaphylaxis, antivenom is only administered in a high care unit in a hospital where a medical team can provide the necessary treatment.
While some Black Mamba and Cape Cobra bite victims have survived without antivenom, by being intubated and ventilated, the correct treatment for a serious snakebite remains the administration of antivenom. Snake venoms are complex mixtures of toxins and when Black Mamba venom is described as neurotoxic, it is not only neurotoxic but primarily neurotoxic and may contain other toxins that affect other organs.
In serious cytotoxic envenomation there is no other effective treatment – the patient will benefit greatly if enough antivenom is administered. Having said that, the SAVP polyvalent antivenom is not highly effective on Mozambique Spitting Cobra bites and many victims, even those that receive ample antivenom, suffer severe tissue damage and often need corrective surgery over the next few months following a bite.
While the South African Vaccine Producers have had production problems over the years, they ran into serious production problems early in 2022, citing power outages and supply problems as the main contributing factors. For more than six months it has been near impossible to purchase antivenom and this has resulted in some areas having a severe shortage. Veterinarians have been particularly hard hit as they often treat dogs for serious snakebites. The African Snakebite Institute has been inundated with calls from doctors, hospitals and veterinarians desperately wanting to purchase antivenom, but sadly we could not always assist. This has often lead to dogs dying at veterinary practices.
The SAVP antivenom is popular throughout much of Africa and several African countries rely on antivenom purchased from the South African Vaccine Producers. This has been majorly problematic and in many instances, doctors have been reluctant to use the normal dosages of antivenom when treating snakebites – clearly not an ideal situation.
While progress has been made to get production back to normal there is still a massive backlog and many hospitals and veterinary clinics will struggle to obtain sufficient antivenom in months to come.
Would it be an option to establish alternative antivenom producers? Not easily as any new antivenom will have to be subjected to clinical trials and this takes many years and will costs millions of Rands to develop.
We receive many calls from people asking which hospitals stock antivenom. Unfortunately, we do not know as any hospital may have antivenom when we call, use it an hour later and they may not replace it for weeks.
Important! Knowing which hospital has antivenom is not important. In the event of a snakebite, get the person to the nearest hospital with a trauma unit where the patient will be stabilized. Once out of immediate danger, and this may involve intubation and ventilation, doctors can then decide whether antivenom needs to be administered and, if not available, to either transfer the patient or obtain antivenom.