WHO Snake Antivenoms Website

WHO Essential Medicines List World Health Organization WHO Essential Medicines List 8 November 2018 Animal (equine) derived blood products Snake anti-venom immunoglobulins Anti-rabies imunoglobulins Anti- tetanus immunolglobulins Anti-diphtheria immunoglobulins

A - Collection of venoms POOR QUALITY AND POOR REGULATORY CONTROL: Technology in the public domain A - Collection of venoms B – Horse Immunization Protocols C – Starting material of animal derived sera D – Fractionation & Purification process

WHO Guidelines and Databases ANIMAL DERIVED BLOOD PRODUCTS (2008-10) WHO Guidelines on production, control and regulation of snake antivenom immunoglobulins WHO Database: clinically important venomous snakes species and its worldwide geographical distribution together with antivenoms for treatment of snakebite envenomings WHO website hosting both the Guidelines and database (maps, pictures, products, manufacturers) http://www.who.int/bloodproducts/snake_antivenoms/en/

WHO Guidelines www.who.int/bloodproducts/snakeantivenoms WHO Database: Medically Important Snakes Distribution maps, pictures & antivenoms www.who.int/bloodproducts/snakeantivenoms WHO Guidelines

Data Sources: Distributions Primary species lists derived from information in the WHO Antivenom Guidelines Annex 1. Accurate distribution limits in countries determined from reference to: Published literature in books and journals; Herpetological specimen collections in more than 60 major Natural History Museums worldwide; If necessary, photographs of specimens and taxonomic data requested from Museum curators to validate ID; WHO Snake Antivenoms Website | November 8, 2018

Red or orange question marks (?) WHO Database: Medically Important Snakes Distribution maps, pictures gallery Red or orange question marks (?) (Indicates expected presence not yet confirmed due to lack of exploration Allocation to CATEGORY 1 shown in red (Indicates common, widespread species that causes numerous snake bites with high morbidity, disability or mortality) Allocation to CATEGORY 2 shown in orange (Indicates highly venomous and capable of causing morbidity, disability or mortality, but exact country data lacking, or less frequently implicated in these countries) www.who.int/bloodproducts/snakeantivenoms

Data Sources: Antivenoms An antivenoms database was created using data verified by individual manufacturers, providing: Manufacturer data (address and contacts) Product data (venoms used for immunization, label claims of species coverage) Production registration/licensing data sought from 62 NRA’s in AFRO, EMRO, SEARO & WPRO Available literature on preclinical/clinical efficacy and clinical safety reviewed 8 WHO Snake Antivenoms Website | November 8, 2018

Photography Used a wide network of sources to obtain very high quality images of each species, often representing several different regional, sexual or age-related colour variations. Aim is to provide users with images that illustrate features that may aid visual identification. Objective is to illustrate every species account. Photographers donate images. 9

WHO web site: Target Audiences Central information source for data on the current availability of antivenoms for specific species. Aimed at a wide audience, that includes: National Regulatory Agencies Ministries of Health Antivenom Manufacturers Medical Professionals, Health Workers Procurement Personnel in Industry and NGO’s Objective is to use the web site to distribute accurate data that can be used to plan improvements to existing supply and distribution.

World Health Organization Achievements 8 November 2018 WHO made a "landmark" step in facilitating validated information with regard to production, control and regulation of snake antivenoms and the appropriate antivenoms to be used in the different countries and regions

Two measures are essential: World Health Organization Two measures are essential: 8 November 2018 a) the implementation of a global framework to assess the quality, safety and efficacy of existing products and b) a procurement mechanism that will stabilize the market for antivenoms and enhance access for patients in need

Next steps in the process of capacity building World Health Organization Next steps in the process of capacity building 8 November 2018 Extension of the WHO prequalification programme to snake antivenoms and other animal derived specific immunoglobulins (e.g tetanus, rabies, diphteria) needed.

Venoms production: Basic problems Venoms used for production need to be representative of the snake populations in the territories where the antivenoms will be distributed Technical capacity needs to be generated to assess the neutralizing potency of antivenoms (preclinical assessement) Venoms reference preparations may be a key component in any global strategy aimed at increasing the production and use of effective and safe antivenoms.

Consequences… The antivenoms produced using low quality, or non- representative venoms are deficient in terms of neutralizing potency and extent of coverage. The capacity to prepare high-quality venoms is a key component in any global strategy aimed at increasing the production and use of effective and safe antivenoms.

World Health Organization Web site addresses 8 November 2018 http://www.who.int/bloodproducts http://www.who.int/bloodproducts/snakeantivenoms http://www.who.int/bloodproducts/catalogue