Health in a changing climate: the dynamic challenge of snake bite in South Asia

气候变化中的健康：南亚蛇咬伤的动态挑战

• 批准号: MR/P024513/1
• 负责人: David Lalloo
• 金额: $ 65.32万
• 依托单位: Liverpool School of Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP024513%2F1
• 关键词: Health; changing; climate; dynamic; challenge

Snakebite is a neglected tropical disease (NTD) and despite being less well publicised and studied, has a far greater impact than many other NTDs such as dengue or leishmaniasis. There are estimates of up to 120,000 deaths per year globally with considerable additional morbidity resulting, for example, from limb damage or renal failure. This burden of disease is relatively hidden as snakebite not only predominantly affects poorer countries in the tropics and subtropics, but it also mainly affects the rural poor, particularly agricultural workers and subsistence farmers in lower-middle income countries (LMICs). In many countries, snakebite is seasonal and is distributed unevenly across a country because of complex interactions between human behaviour, climate, varying geography and other factors affecting snake distributions. This means that there are substantial challenges in estimating the number of deaths and complications of snakebite. National surveys are rare because they are so difficult to carry out. The variation in numbers of snakebite across countries and over any one year means that it is difficult to estimate national and regional numbers from time-limited small local studies. This absence of accurate numbers for many countries and regions means that the problem does not get the international attention that it requires and makes it extremely difficult for local public health authorities to plan appropriate health services. Improved methodological approaches for mapping snakebite risk are therefore urgently needed, particularly when considering the potential for global environmental and climate change to exacerbate snakebite impacts. Examples such as the peak of snakebite deaths in India during the monsoon and in Bangladesh during floods illustrate the potential for environmental factors to influence disease. In Sri Lanka, bite and envenoming patterns also vary between climatic zones, with bite and envenoming incidence changing with altitude and rainfall. Climate change is thus likely to be an important yet currently unrecognised contributor to altering snakebite risk in affected areas, potentially impacting on snakebite incidence by altering snake abdundance, distributions and behaviour, altering human abundance and behaviour or both. This study aims to improve the ways in which the epidemiological burden of snakebite can be estimated and mapping risk using modelling of the interactions between snake and human distributions, behaviours and environmental factors and to investigate the extent to which climate and land-use change will impact upon this burden. The study will develop and validate methodologies using data from Sri Lanka and, in future, use these approaches to improve estimations of the snakebite burden and map risk over wider geographical areas in South Asia, and predict how they may change in the future. This approach will facilitate the diversion of appropriate resources towards addressing this major problem and will provide accurate information about the distribution of the snakebite burden at relevant scales to help health managers target resources appropriately and explore interventions that will help manage this risk and its associated socio-economic impacts in LMICs.

蛇咬伤是一种被忽视的热带疾病（NTD），尽管宣传和研究较少，但其影响远远大于许多其他NTD，如登革热或利什曼病。据估计，全球每年有多达120 000人死亡，另外还有相当多的发病率，例如肢体损伤或肾衰竭。这种疾病负担相对隐蔽，因为蛇咬伤不仅主要影响热带和亚热带的较贫穷国家，而且主要影响农村穷人，特别是中低收入国家的农业工人和自给农民。在许多国家，蛇咬伤是季节性的，并且由于人类行为、气候、不同的地理和影响蛇分布的其他因素之间的复杂相互作用，全国分布不均匀。这意味着在估计蛇咬伤的死亡人数和并发症方面存在重大挑战。全国性的调查很少，因为它们很难进行。不同国家和任何一年内蛇咬伤数量的变化意味着很难从有时间限制的小型地方研究中估计国家和区域的数量。许多国家和区域缺乏准确的数字，这意味着这一问题没有得到它所需要的国际关注，使地方公共卫生当局极难规划适当的卫生服务。因此，迫切需要改进绘制蛇咬伤风险的方法，特别是在考虑全球环境和气候变化可能加剧蛇咬伤影响的情况下。例如，印度在季风期间和孟加拉国在洪水期间蛇咬伤死亡人数达到高峰，说明环境因素可能影响疾病。在斯里兰卡，咬伤和毒液蛰入模式也因气候带而异，咬伤和毒液蛰入的发生率随海拔和降雨量而变化。因此，气候变化可能是改变受影响地区蛇咬伤风险的一个重要但目前尚未认识到的因素，可能通过改变蛇的丰度、分布和行为，改变人类的丰度和行为或两者兼而有之来影响蛇咬伤的发生率。本研究旨在改进估计蛇咬伤流行病学负担的方法，并利用蛇与人类分布、行为和环境因素之间相互作用的模型绘制风险图，并调查气候和土地使用变化对这一负担的影响程度。该研究将利用斯里兰卡的数据制定和验证各种方法，并在今后利用这些方法改进对蛇咬伤负担的估计，绘制南亚更广泛地理区域的风险图，并预测它们今后可能如何变化。这种方法将有助于将适当的资源转用于解决这一重大问题，并将提供有关蛇咬伤负担在相关规模上分布的准确信息，以帮助卫生管理人员适当地确定资源目标，并探索有助于管理这一风险及其在中低收入国家的相关社会经济影响的干预措施。

项目成果

Evaluating temporal patterns of snakebite in Sri Lanka: the potential for higher snakebite burdens with climate change.

• DOI: 10.1093/ije/dyy188
• 发表时间: 2018-12-01
• 期刊: International journal of epidemiology
• 影响因子: 7.7
• 作者: Ediriweera DS;Diggle PJ;Kasturiratne A;Pathmeswaran A;Gunawardena NK;Jayamanne SF;Isbister GK;Dawson A;Lalloo DG;de Silva HJ
• 通讯作者: de Silva HJ

A mechanistic model of snakebite as a zoonosis: Envenoming incidence is driven by snake ecology, socioeconomics and its impacts on snakes.

蛇咬伤作为人畜共患疾病的机制模型：中毒发病率是由蛇生态、社会经济学及其对蛇的影响驱动的。

• DOI: 10.1371/journal.pntd.0009867
• 发表时间: 2022-05
• 期刊: PLoS neglected tropical diseases
• 影响因子: 3.8

Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample.

• DOI: 10.1371/journal.pntd.0009447
• 发表时间: 2021-06
• 期刊: PLoS neglected tropical diseases
• 影响因子: 3.8
• 作者: Ediriweera DS;Kasthuriratne A;Pathmeswaran A;Gunawardene NK;Jayamanne SF;Murray K;Iwamura T;Isbister G;Dawson A;Lalloo DG;de Silva HJ;Diggle PJ
• 通讯作者: Diggle PJ

Integrating snake distribution, abundance and expert-derived behavioural traits predicts snakebite risk

• DOI: 10.1111/1365-2664.14081
• 发表时间: 2021-11-19
• 期刊: JOURNAL OF APPLIED ECOLOGY
• 影响因子: 5.7
• 作者: Martin, Gerardo;Erinjery, Joseph;Murray, Kris A.
• 通讯作者: Murray, Kris A.

Focus on snake ecology to fight snakebite.

关注蛇生态，对抗蛇咬伤。

• DOI: 10.1016/s0140-6736(19)32510-3
• 发表时间: 2020
• 期刊: Lancet (London, England)
• 作者: Murray KA