Access to antivenoms in the developing world: A multidisciplinary analysis.
Access to antivenoms in the developing world: A multidisciplinary analysis.
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DOI：
10.1016/j.toxcx.2021.100086
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发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
Williams DJ
中科院分区：
文献类型：
--
作者：
Potet J;Beran D;Ray N;Alcoba G;Habib AG;Iliyasu G;Waldmann B;Ralph R;Faiz MA;Monteiro WM;de Almeida Gonçalves Sachett J;di Fabio JL;Cortés MLÁ;Brown NI;Williams DJ
获得针对地方性毒蛇品种的安全、有效、有质量保证的抗蛇毒血清产品是最近为减轻全球蛇咬伤负担而进行的协调努力的一个重要组成部分。多重准入障碍可能影响抗蛇毒血清从制造商到患者床边的旅程。我们的综述描述了不同水平的抗蛇毒血清生态系统，并确定了克服这些挑战的解决方案。在全球一级，制造产量不足以满足临床需求，特别是用于生产者稀少地区的抗蛇毒血清。在国家层面，某些抗蛇毒血清市场的资金不稳定和监管不足可能导致采购不合格的抗蛇毒血清。当生产商未能在应该使用其产品的国家寻求其产品的注册，或者在薄弱的评估框架允许在没有当地临床评估的情况下进行注册时，情况尤其如此。蛇咬伤受害者的自付费用往往是抗蛇毒血清的主要资金来源，这导致抗蛇毒血清使用不足或剂量不足，以及不顾疗效而偏爱低成本产品。在资源有限的农村地区，大多数受害者被咬伤，外围卫生设施的抗蛇毒血清供应往往不可靠。对蛇咬伤治疗的误解很常见，这进一步减少了对抗蛇毒血清的需求，并加剧了到达配备抗蛇毒血清使用设施的延误。在资源有限的环境中，需要采取多方面的干预措施来改善抗蛇毒血清的获取。应特别注意世卫组织预防和控制蛇咬伤战略中提出的综合行动清单。全球抗蛇毒血清市场分散成多个区域特定产品的子市场，导致许多需求未得到满足。国家监管能力的薄弱和一些生产工艺导致采购不合格的抗蛇毒血清。由于缺乏交通工具，在农村地区迅速获得抗蛇毒血清具有挑战性。缺乏资源充足的设施和经验丰富的工作人员来管理抗蛇毒血清是另一个获取障碍。资金充足的地区抗蛇毒血清储备有可能显著改善获取途径。
Access to safe, effective, quality-assured antivenom products that are tailored to endemic venomous snake species is a crucial component of recent coordinated efforts to reduce the global burden of snakebite envenoming. Multiple access barriers may affect the journey of antivenoms from manufacturers to the bedsides of patients. Our review describes the antivenom ecosystem at different levels and identifies solutions to overcome these challenges. At the global level, there is insufficient manufacturing output to meet clinical needs, notably for antivenoms intended for use in regions with a scarcity of producers. At national level, variable funding and deficient regulation of certain antivenom markets can lead to the procurement of substandard antivenom. This is particularly true when producers fail to seek registration of their products in the countries where they should be used, or where weak assessment frameworks allow registration without local clinical evaluation. Out-of-pocket expenses by snakebite victims are often the main source of financing antivenoms, which results in the underuse or under-dosing of antivenoms, and a preference for low-cost products regardless of efficacy. In resource-constrained rural areas, where the majority of victims are bitten, supply of antivenom in peripheral health facilities is often unreliable. Misconceptions about treatment of snakebite envenoming are common, further reducing demand for antivenom and exacerbating delays in reaching facilities equipped for antivenom use. Multifaceted interventions are needed to improve antivenom access in resource-limited settings. Particular attention should be paid to the comprehensive list of actions proposed within the WHO Strategy for Prevention and Control of Snakebite Envenoming. The global antivenom market is fragmented into multiple sub-markets of region-specific products, leaving many needs unmet. Weaknesses in national regulatory capacity and some manufacturing processes lead to procurement of substandard antivenoms. Prompt access to antivenom in rural settings is challenging due to lack of transportation. Scarcity of adequately resourced facilities with experienced staff to administer antivenom is another access barrier. Fully-financed regional antivenom stockpiles have the potential to significantly improve access.
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影响因子：
3.7
作者：
Ahonkhai, Vincent;Martins, Samuel F.;Hartman, Dan
通讯作者：
Hartman, Dan
南亚的蛇咬人：评论。
影响因子：
3.8
作者：
Alirol E;Sharma SK;Bawaskar HS;Kuch U;Chappuis F
通讯作者：
Chappuis F
影响因子：
6
作者：
Alfred, Sam;Bates, David;Peh, Chen Au
通讯作者：
Peh, Chen Au
影响因子：
--
作者：
Bala AA;Jatau AI;Yunusa I;Mohammed M;Mohammed AH;Isa AM;Sadiq WA;Gulma KA;Bello I;Malami S;Michael GC;Chedi BAZ
通讯作者：
Chedi BAZ
影响因子：
3.8
作者：
Alirol, Emilie;Lechevalier, Pauline;Potet, Julien
通讯作者：
Potet, Julien