Unsuitable antivenoms are being sold in Africa, costing lives

Snakes

But getting accurate statistics is incredibly difficult. Many bites go unreported, with as few as 8.5% of snakebite victims seeking medical treatment. In Africa snakebite probably kills over 30 000 people per year. This is proportionally more than in most other regions around the world. A large percentage of these deaths can be attributed to one genus of snake, Echis.

Also known as the saw-scaled viper, Echis can be found throughout sub-Saharan Africa north of the equator and in parts of Asia and the Middle East. This small viper dominates snakebite statistics and kills more people annually than any other. For example, Echis ocellatus is responsible for as many as 95% of snake bites in northern Nigeria.

Many of the toxins in their venom target the blood to induce clotting. For humans, this causes a potentially lethal condition called “venom-induced consumption coagulopathy”, more commonly called VICC. This disrupts the body’s ability to regulate blood flow and results in severe internal bleeding. Haemorrhage, stroke, and shock are typically the cause of death following VICC. Antivenom is the only effective antidote.

But the continent is experiencing an antivenom crisis. This crisis is a result of the discontinuation of a key antivenom in Africa, Fav-Afrique. Fav-Afrique was very effective at treating snakebites in Africa. Some clinics reported a 100% success rate when using this antivenom. But the antivenom’s manufacturers, Sanofi-Pasteur, stopped production of Fav-Afrique after claiming they were priced out of the market.

The disappearance of Fav-Afrique from African clinics partly explains the exceptionally high rates of snakebite death on the continent. It has seen an increase in the use of cheaper, Indian-produced antivenoms – many of which appear to be largely ineffective.

To investigate the issue further, we conducted a comparison of four antivenoms that are commonly used to treat Echis bites on the continent. Two were made using Indian Echis venoms and two made using African Echis venoms. We tested these antivenoms against venom samples from ten different populations of Echis across their distribution, from Africa to Asia.

Comparing antivenoms

We first added the venom to human blood plasma and measured the rate at which each venom induced a blood clot. We then repeated the experiment, but with an additional step. Before adding the venom to the plasma, we mixed the venom and antivenom. This step was to give the antivenom a chance to bind with the venom toxins and neutralise their harmful activity on the blood. We assessed the effectiveness of the antivenoms by looking at how well they were able to slow the clotting caused by the venom when compared to our first experiment.

What we found was alarming. Despite the antivenoms being marketed as species-specific (that is, able to treat the bite of a given species), we found extreme region-specific variability in their effectiveness. This means that the performance of the antivenoms varied based on the geographical origin of the venoms, even within a single species.

The Indian-made antivenoms, common throughout Africa because they are affordable, showed little-to-no neutralisation of the African Echis venoms. Even the venoms of some Indian Echis populations showed limited response to the Indian antivenoms.

Clinical case statistics support our findings. After switching to an Indian-produced antivenom following the discontinuation of Fav-Afrique, some African clinics have recorded a horrific 7 to 20-fold increase in case death rates.

Why such variability in the antivenoms?

Antivenoms are developed by injecting a small amount of venom from either one or from multiple species (to produce “monovalent” or “polyvalent” antivenom, respectively) into a host animal, such as a horse. The animal’s immune system responds by producing antibodies that recognise and fight those venom toxins, much like what happens in our bodies when we get a vaccine. These antibodies are extracted and purified. The resulting antivenom is then marketed as being able to treat a bite by the species whose venom was used during its production.

This process is effective and reliable when venom composition does not differ much between individual snakes. Antivenoms may even be effective in treating the bite of a closely related snake species. Unfortunately, this is not the case for Echis as their venom composition varies between populations.

This is partly thought to be an evolutionary adaptation linked to diet. A key function of snake venom is to assist in prey capture. The toxins in venom do this by targeting specific parts of the prey’s physiology, such as the blood or the nerves, to disrupt normal body function and immobilise the animal.

Different Echis populations feed on different prey types. For example, some feed mostly on vertebrates such as rodents or lizards, while others prefer invertebrates such as scorpions. The physiology of these prey animals differs, and this dictates what makes a toxin effective for predation. This could be why some populations have evolved different sets of toxins.

From a medical perspective, this means that the antibodies in an antivenom may not be able to adequately recognise and fight all the harmful toxins in the venom. The outcome for patients and clinicians is variable or reduced antivenom effectiveness between regions.

Our results show the failings that come from using a geographically restricted range of antivenoms and marketing them inappropriately. Given the seriousness of snakebite in Africa and around the world, this puts the pressure firmly on antivenom manufacturers to develop, market, and distribute their antivenoms responsibly.

Source: The Conversation

African Innovation Foundation finalists announced

The African Innovation Foundation (AIF) has announced the top 10 nominees who will be contending for the 2017 Innovation Prize for Africa. The winners will be announced in Accra, Ghana on 18th July 2017 and will see innovators from nine African countries including Democratic Republic of Congo, Egypt, Kenya, Liberia, Morocco, Nigeria, South Africa, Uganda and Zimbabwe battle it out for the prestigious Prize.
This year’s innovators have demonstrated incredible proficiency through innovative solutions addressing challenges in agriculture value chain, health care, energy, communications, service industries as well as surveillance using drone technology.
This year’s cream of the crop underwent a rigorous selection process by a renowned panel of judges including corporates, academia, technology and scientific experts representing top African innovation influencers.
The inspiring stories of these nominees remind us that innovation and African-led solutions are indeed the answer to Africa’s growth and prosperity.” said Walter Fust, AIF Chairman of the Board.
The Awards, now celebrating its sixth year under the theme “African Innovation: Investing in Prosperity”, IPA offers contenders a shot at a grand share-prize of US$185 000 and incentives to spur growth and prosperity in Africa through home-grown solutions.
IPA has seen tremendous growth in applications and increasing interest from both innovators and innovation enablers over the years. To date, IPA has attracted more than 7 500 innovators from 52 African countries, making it a truly Pan African initiative. IPA 2017 edition witnessed a record number of entries from over 2 530 innovators across 48 African countries. The Foundation has supported past winners and nominees with approximately US$ 1 million to move their innovations forward. Due to exposure generated by IPA, past winners have gone on to secure over US$30 million in investments to grow and scale their businesses.
“We’re excited for the opportunity to work with our partners to ensure the innovations of the 10 nominees will be available to African markets and beyond. We invite you to join us and unlock the potential of African innovators, starting by investing in these 10 nominees.” said Pauline Mujawamariya Koelbl, IPA Director.
AIF will host the IPA 2017 awards ceremony and its second Innovation Ecosystems Connector on 17 and 18 July in Accra, Ghana. The event will focus on how innovation enablers and businesses can leverage funding streams, investments and resources that are critical to unlock potential of African innovators. Participants at the IPA Awards will get an opportunity to attend the official opening of IPA 2017, experience the innovation marketplace, join high-level roundtable discussions, Zua Hub meet-ups, and networking activities, ending with a celebration of African ingenuity when the IPA 2017 winners will be announced.
The 10 nominees:
Peris Bosire, Kenya: FarmDrive
FarmDrive is a financial technology company that has developed a mobile phone based application that collects data and provides an alternative risk assessment model for small holder farmers.
Nokwethu Khojane, South Africa: Lakheni, Turning Social Capital into Buying Power
Lakheni is a social and business model innovation which seeks to aggregate low-income households into buying-groups in order to negotiate favourable discounts for goods and services supplied to these households.
Omolabake Adenle, Nigeria: Voice Recognition and Speech Synthesis Software for African Languages
This is a software solution that can understand and digitize spoken African languages, and synthesize speech from African languages presented as digitized text.
Nzola Swasisa, Democratic Republic of Congo: Lokole
Lokole, is a device that enables access to efficient email communication anywhere with cellular coverage at a price that is one hundred to one thousand times cheaper than accessing email via regular cellular bandwidth costs.
Badr Idriss, Morocco: Atlan Space
Atlan Space develops software technology that is then deployed to manage the operations of unmanned aerial vehicles (UAVs) or drones.
Aly El-Shafei, Egypt: Smart Electro-Mechanical Actuator Journal Integrated Bearing “SEMAJIB”
The patented innovation (SEMAJIB) presented by Dr. El-Shafei, is a smart bearing which is versatile and can change its characteristics as it operates.
Dougbeh-Chris Nyan, Liberia: New Technology for Rapid Detection of Many Infections Using Only One Test
This is a rapid diagnostic test that can detect and simultaneously differentiate at least three to seven infections at the same time within 10 to 40 minutes.
Olanisun Olufemi Adewole, Nigeria: Sweat TB Test, A non-invasive rapid skin test to detect Tuberculosis Sweat TB Test, is a non-invasive rapid diagnostic test to detect tuberculosis (TB). TB is second only to HIV/AIDS as a leading cause of death in Africa.
Gift Gana, Zimbabwe: Dr. CADx Dr CADx is a software solution that helps doctors and health care workers diagnose medical images more accurately.
Philippa Ngaju Makobore, Uganda: Electronically Controlled Gravity Feed Infusion Set (ECGF) The Electronically Controlled Gravity Feed Infusion Set (ECGF) is medical device designed to accurately administer intravenous (IV) fluids and drugs by controlling the rate of fluid flow based on feedback from a drop sensor.