History and Development of Anti Snake Venom Serum, How it is produced in Pakistan
NIH Islamabad produces Anti Snake Venom in Pakistan. NIH is National Institute of Health Islamabad. There are different types of anti snake venom Serum (ASVS). It depends upon the type of snake. Furthermore, venom is different for different types of snake bites. Moreover, anti snake Venom dosage or antivenom dose for snake bites is also different for different snake bites. If the snake type is not known, polyvalent anti snake venom serum is used. These details are available in this article.
ASVS produced in Pakistan is cheaper but its production is in limited quantity. This is due to its lengthy process. There are 5 steps to produce it. Although scientists use different animals in the lab, but mostly horse is preferred. Details of this process are also in this article.
In Pakistan, there are different types of snakes. This is why, NIH prepares venom against 4 snakes. Besides completion production steps, history of anti venom is also available in this article. Lab at NIH for anti Venom.
سانپوں کے عالمی دن پر لاہور چڑیا گھر میں تقریب ۔۔ روزنامہ آفتاب، ویٹرنری میٹرز
بجلی جیسا جھٹکا دینے والی سانپ نما مچھلی کے بارے دلچسپ حقائق، ڈاکٹر مجاہد حسین
سانپ کی دریافت شدہ نئی نسل کو ہیریسن فورڈ کا نام دے دیا گیا
History Anti Snake Venom Serum
The horse plays an indispensable and unsurprising role in the preparation of the life-saving drug Anti-Snake Venom Serum (ASVS), which is used to treat snake-bites in humans or pets, because the horse’s body develops hyper-immunity against snake venom, which is of great importance to the anti-venom industry.
Initially, in the November 1870 Madras Medical Journal, a British major surgeon and ophiologist, Edward Nicholson, wrote that during his posting in Burma, he observed that local snake charmers used to get themselves bitten by cobras for tattooing, but due to lack of knowledge of its immune value, he was careful with his snakes. It was also written that older snakes were less affected by snake bites than young snakes.
In 1894, a French medical researcher, “Albert Calmette”, started giving rabbits 0.03 mg of cobra venom, the amount of which was gradually increased every week, until after eight months the rabbit reached a dose of 35 mg, which was fifteen times more than the lethal dose of that venom in the rabbit, but the rabbit was healthy.
Then the blood serum of that rabbit was given to another rabbit in twice the lethal dose, but that rabbit also remained healthy, and thus, in the event of immunity against the venom being transferred from one rabbit to another, the world’s first anti-venom (which Albert Calmette named antivenin) was prepared and is still prepared today under the same basic principle. However, experiments are also underway to prepare anti-venom with the help of Genetically Modified Bacteria in the future.
Animals used in Anti Snake Venom Serum Production
Donkeys, sheep, goats, rabbits, cats, chickens, camels and even sharks have been used to obtain anti-venom, but horses are generally preferred due to their availability, ability to thrive in any environment, friendly disposition, thick veins, longevity and large body. Especially race horses, which are considered incompetent and are reserved for slaughter (knackery).
Anti-snake venom serum (ASVS) is a sterile drug that contains clear and concentrated immunoglobulins.
Five Stages of Anti Snake Venom Serum Production
The process of preparing ASVS can be divided into five stages.
Stage One
In the first stage, a technician extracts the venom from the fangs of the species of snake against which the drug is intended and stores it at minus 20 degrees Celsius. The process of extracting the venom from the fangs is called snake-milking.
Stage Two
In the second stage, horses in the field are given a small, harmless (distilled) dose of the poison subcutaneously on the back of the neck or hip. How much of the poison to inject and where to inject it to produce an immune response is a well-kept trade secret. The toxins in the poison stimulate the horse’s immune system to produce antibodies against the specific poison.
Stage Three
In the third stage, the horse is given multiple booster shots over a period of about 8-10 weeks, with each dose containing a higher dose of the poison than the previous dose. Eventually, the horse’s body produces enough antibodies against the poison that the horse gains additional immunity to the poison.
Stage Four
In the fourth step, according to World Health Organization (WHO) guidelines, a skilled technician withdraws 3-6 liters of blood from the horse’s jugular vein and then uses a machine to separate the plasma (the part of the blood that contains antibodies) and infuses the remaining blood back into the horse.
Stage Five
In the fifth step, the plasma is sent to the laboratory where the chemist purifies it through various chemical steps to separate the anti-snake venom serum (AVSF) and then packages it in liquid or freeze-dried powder form and delivers it to various hospitals and pharmacies as per the need and demand.
Snake venom can be of different types depending on the sex, age and location, so horses are introduced to the venom of as many types of snakes as possible.
Dosage and Administration of ASVS
The dosage of ASVS depends on the amount of venom in the body. For example, a Russell viper snake injects an average of 63 mg of venom into the body with a single bite and one vial of ASVS neutralizes 6 mg of venom, so 10-25 vials may be required for treatment.
The drug is generally given in isotonic solution and diluted. The amount of this solution can be determined based on 5 ml per kilogram of body weight. The first dose of 10-30 ml is administered intravenously slowly and the second dose can be administered two hours after the first dose or even before it, depending on the patient’s condition and the severity of the symptoms, while further doses can be repeated at six-hour intervals until the symptoms disappear completely.
To prevent gangrene of body parts, especially in the case of viper snake bites, a third of the first dose is administered locally around the wound and the rest is administered intravenously.
In case of anaphylaxis due to the drug, the drug can be stopped and adrenaline or steroids or anti-histamines can be used.
Anti-snake venom serum ASVS is effective against the venom of the same snake from which it is prepared, so the doctor should be consulted first. First, it should be determined which snake bit the patient.
If this cannot be determined and there is a risk of poisoning in the body, anti-snake venom serum ASVS, prepared from a mixture of the venom of snakes found in that area, can be used.
ASVS can save a person’s life, but it cannot reverse the damage caused to the body by the venom, so immediate medical attention should be sought in case of a bite.
Medical Importance of Animal Venoms
Apart from snakes, most terrestrial and marine animals in the world also have the ability to produce venom, which these animals use in hunting, fighting or defense, and their venom is also extracted to prepare anti-venom against them.
The purpose of extracting venom from animals is not only to treat bites, but scientists are investigating the effects of the venom and using it in the treatment of various diseases.
For example, research is underway to use the venom in snake venom that prevents blood from clotting to prevent heart attacks or strokes. Similarly, research is underway to isolate the components of the venom of the black mamba snake that numb the prey and use them as pain killers. Research is also underway to use melittin, which is found in the venom of the martyred fly, against the HIV virus.
In pharmaceuticals, poisons give more lives than deaths, but unfortunately, many poisonous animals are facing the threat of extinction and we may not be able to discover the usefulness of their poison before they become extinct.
Anti Snake Venom in Pakistan and Public Awareness
In Pakistan, ASVS is produced against four venomous snakes, including the Common Cobra (Naja naja), the Common Krait (Bungarus caeruleus), the Russel’s Viper (Vipera russelli) and the Saw-Scale Viper (Echis carinatus).
The shelf life of the medicine is two years provided it is stored at 2-8 degrees Celsius because normal room temperature degrades the protein components of the medicine.
The only and authentic place to make ASVS in Pakistan is the National Institute of Health, Islamabad, whose ASVS costs Rs. 1651 per vial (10 ml), which is two and a half times cheaper and more effective than ASVS imported from India, but due to its limited production in Pakistan (40-50 thousand vials per year), thousands of precious lives die every year due to the unavailability or non-availability of ASVS.
Every year, World Snake Day is celebrated on July 16 and International Snake Bite Awareness Day is celebrated on September 19.
