Case for a one-health approach to venomous snakebite, using the epidemiological triad model, for mitigation.

Background: Snakebite envenoming (SBE) was listed as a Neglected Tropical Disease (NTD), by the WHO in 2017. SBE kills more victims than all the other NTDs put together. SBE is a condition associated with poverty, inequity, inaccessibility and poor health systems. The major burden of SBE is borne by the countries of South-Asia, led by India, with an estimated 58,000 deaths annually. This as compared with the USA or Australia where deaths due to SBE is in a single digit, despite having equally venomous species. SBE is also a significant cause for loss of livestock in the Tropics. Research in the domain of snakebite has largely been limited to study of venoms and therapeutic aspects, and not as much on snake behaviour and habitats, and the environment. BODY: Snakebite is most often accidental, preventable and treatable. For mitigation of snakebite and the complications thereof, snakebite and SBE need be viewed from a one-health framework. The one-health approach to snakebite factors for the role of the environment, habitats, study of snakes, venom, factors and circumstances contributing to the accident. The current one-health framework proposed using the 'epidemiologic triad' model of agent-host-environment, allows for a better understanding and descriptione of the snake-human/livestock conflict. With snakes being the agent, humans/ livestock the host, and the ecosystem harbouring snakes the environment. This approach helps us to delineate the individual attributes influencing the snake-human conflict, and its outcomes. In the proposed one-health model we expand on the agent-host-environment (proximal factors), to an outer setting of more distal factors which too have an influence on snakebite and SBE. The outer setting includes the social determinants of health, eco climatic factors, socio-cultural factors, health systems, infrastructure and development all of which either directly or indirectly have a bearing on snakebite, and the outcomes resulting from the accident. (Fig. 1).

Conclusion: The one-health model built on the epidemiologic triad model helps encompass most of the factors that influence or lead to the snake-human/ livestock conflict. This model will facilitate preventative measures and help address the steps required to mitigate death and morbidity due to SBE.