Snakebite envenoming in India: it is time we look beyond the concept of the Big Four species.

Abstract

India faces substantial challenges from snakebite envenoming secondary to the high morbidity, mortality and financial burden, particularly in rural communities. While concentrated on the 'Big Four' venomous species, recent research indicates a necessity to expand the focus to encompass additional medically relevant species. This review emphasizes the geographic heterogeneity in venom among these snakes, which impacts antivenom effectiveness and necessitating region-specific formulations. This analysis highlights the shortcomings of current antivenoms and identifies non-Big Four species involved in snakebite envenoming, advocating for an urgent shift to inclusive antivenom strategies that integrate local venom profiles to enhance treatment effectiveness and thereby reduce snakebite-related morbidity and mortality. Improved training for healthcare providers and enhancements in anti-snake venom quality are essential for meeting the World Health Organization's 2030 Sustainable Development Goal objective of halving snakebite-related fatalities and disabilities. Incorporating snakebite management into national health programs and conducting epidemiological research systematically are crucial to mitigating this preventable health concern.