29/01/2025
A recent documentary on the shortage of antivenom for serious snakebites on Carte Blanche has resulted in a great deal of debate on social media as well as a fair share of misinformation.
Polyvalent antivenom is manufactured by the South African Vaccine Producers, part of our National Health Laboratories. They are currently in a process of upgrading their facilities and are not producing any antivenom, nor do they have any stock. They hope to be back in production by April this year.
There is an alternative product called Pan African Premium - an effective antivenom imported from India and with World Health Organisation endorsement. This product is imported under Section 21 of the South African Health Products Regulatory Authority and required paperwork and permission before it can be purchased and used.
Several hospitals have stock of antivenom, and it is usually the least of your concerns in any snakebite. The victim needs to be taken to the nearest hospital with an emergency room where, in serious neurotoxic envenomation, it may be necessary to intubate and ventilate the victim if breathing is compromised. Antivenom is only administered in a hospital environment and by a medical doctor and nine out of ten snakebite victims that are hospitalised do not receive antivenom as it is not required. But in serious bites, the sooner a patient is treated with antivenom, the better the outcome.
In serious cytotoxic bites patients initially receive around 5-6 vials of Polyvalent antivenom (or double that if Panaf is used) and around 10-12 vials of Polyvalent antivenom for mamba and cobra bites (and again double that if Panaf is used). Doctors will then carefully monitor the patient and may have to give more at a later stage. For Boomslang bites there is a Monovalent Boomslang antivenom and patients usually get two vials initially.
Antivenom is the correct treatment for serious snakebite envenomation and saves lives and limits tissue damage.
It is a myth that a patient cannot get antivenom a second time and there are several people who have been treated with antivenom multiple times.
The danger with antivenom is that some patients have an allergic reaction when treated with antivenom and this may result in anaphylaxis. We have no idea when a patient will go into anaphylaxis and there is no way to test whether it will happen or not. In such an event, doctors immediately stop administering the antivenom and stabilise the patient. Once stabilised, they will slowly start administering antivenom again.
In the event of a potentially serious snakebite, get to a hospital. The doctors will stabilise the patient and administer antivenom if necessary and if the hospital does not have antivenom, arrangements will be made with other hospitals or the patient may be transferred.
We are often asked if it is advisable to purchase antivenom in case of an emergency. That can be done provided you do not administer it yourself. Fifteen vials of antivenom - enough for a single serious bite, will cost close to R40,000 and the antivenom lasts three years in a fridge, then it expires.
