Kerala notifies snakebite envenomation as a disease of public health importance

Kerala has notified snakebite envenomation as a disease of utmost public health importance under Section 28 of the Kerala Public Health Act, 2023, enabling better documentation, data gathering, research and data-driven management of snakebite cases in the State.

The gazette notification regarding the same was issued on Friday. Tamil Nadu and Karnataka have also recently made snakebites a notifiable disease.

Snakebite envenoming is a condition that poses a serious threat to life. Lack of timely and appropriate treatment can result in death or serious permanent disabilities.

30 cases

Kerala reported 34 deaths due to snakebites in 2023–24 and 30 cases in 2024-25, according to the Health Department. This may seem tame in comparison to some parts of the country like Bihar, where several hundred snakebite deaths are reported annually.

But, snakebites, classified as one among the neglected tropical diseases by the World Health Organization, are often a reflection of poverty, inequality and inadequate access to health care and are a priority for the State.

Snakebite envenomation management in the country has seen several significant developments and initiatives over the past two years.

In March 2024, the Government of India launched the National Action Plan for Prevention and Control of Snakebite Envenoming (NAPSE), aiming to halve snakebite mortality by 2030, by integrating prevention, early treatment, research, and surveillance across health, forest, wildlife, agriculture sectors. In November 2024, the Centre made snakebite envenomation notifiable.

“Now that the State has formally issued the notification, all cases of snakebite envenomation in Kerala that come to any hospital would have to be reported on the Integrated Disease Surveillance Programme platform,” says a senior Health official.

Technical difficulties

Though NAPSE speaks about making anti-snake venom (ASV) available at primary health centres (PHC), there are some technical difficulties with regard to the administration of the ASV in the primary health centres in the State now. The ASV can be administered only in cases of envenomation, which has to be determined through the nature of the bite and blood parameters, for which the PHCs may not be currently equipped.

But this scenario would change as Kerala is gearing up for the implementation of a State-level action plan for snakebite envenomation, using the One Health approach, as guided by NAPSE, for which funds have already been sanctioned. Systematic reduction of the risk of snakebite envenomation through sustained ASV supply, health system strengthening, particularly emergency response services, and creating public awareness and education are part of the plan.

The polyvalent ASV produced in the country is standardised for the treatment of four species of snakes- the Indian cobra, common krait, Russell’s viper and saw-scaled viper- which are said to be responsible for the majority of snakebite envenomation cases.

However, the ASV available now cannot neutralise the venom of the hump-nosed pit viper (Hypnale hypnale), which is now emerging as a species causing significant loss of lives in Kerala. Apart from ineffective treatment and unnecessary ASV administration, this may cross-react with the snake venom triggering a cascade of complications too.

2016 study

A study done in Kerala in 2016, which evaluated the clinical profile of snakebite casualties presented at a tertiary care hospital in Kerala, reported that among the 47.3% of cases with known snake species, D. russelii accounted for 23.1% and H. hypnale for 15.4%

This highlights the critical importance of developing region-specific antivenoms for better treatment outcomes for snakebite cases and making it widely available. Improved medical training of doctors to identify snakebites, clinical symptoms of envenomation and its management is another critical area where the State plans to focus on.