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.

Snakebite是一种被忽视的热带疾病（NTD），尽管宣传和研究的次数较低，但其影响远大于许多其他NTD，例如登革热或利什曼病。估计全球每年最多12万人死亡，例如肢体损害或肾衰竭，导致了相当大的发病率。这种疾病的负担相对隐藏，因为蛇咬人不仅主要影响热带和亚热带的贫困国家，而且还主要影响农村贫困人口，尤其是农业工人和中低级收入国家（LMICS）的农业工人和生存农民。在许多国家，由于人类行为，气候，不同的地理位置和影响蛇分布的其他因素，蛇咬伤是季节性的，并且由于人类行为，气候，不同的地理位置与其他因素之间的复杂相互作用而在一个国家 /地区分布不均匀。这意味着估计蛇咬的死亡人数和并发症的数量存在重大挑战。国家调查很少，因为它们很难进行。在任何一年中，各国蛇咬数量的变化意味着，很难从限时的小型本地研究中估算国家和地区数量。对于许多国家和地区来说，缺乏准确的数字意味着该问题并没有引起其所需的国际关注，并且使当地公共卫生当局难以计划适当的卫生服务。因此，迫切需要改善绘制蛇咬合风险的方法论方法，尤其是在考虑全球环境和气候变化的潜力以加剧蛇咬的影响时。季风期间印度和孟加拉国期间印度蛇咬死亡的峰值的例子说明了影响疾病的环境因素的潜力。在斯里兰卡，咬合和染色的模式在气候区之间也有所不同，咬合和因高度和降雨而变化。因此，气候变化可能是当前重要但目前无法识别的导致受影响地区蛇咬风险的贡献者，从而有可能通过改变蛇的丰富性，分布和行为，改变人类的丰富性和行为或两者兼而有之会影响蛇咬的发生率。这项研究旨在改善蛇咬的流行病学负担的估算方式，并通过对蛇与人分布，行为和环境因素之间的相互作用进行建模，并研究气候和土地利用变化将对这一负担产生影响的程度。该研究将使用来自斯里兰卡的数据开发和验证方法，并在将来使用这些方法来改善蛇咬负担的估计，并将对南亚更广泛地理区域的风险进行地图，并预测它们将来如何改变。这种方法将促进适当的资源转移来解决这一主要问题，并将提供有关在相关尺度上分配蛇咬伤的准确信息，以帮助卫生经理适当地针对资源，并探索将有助于管理这种风险及其相关的LMIC中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

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

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.