@article{fdi:010088753,
  title = {{R}eal life condition evaluation of {I}noserp {PAN}-{AFRICA} antivenom effectiveness in {C}ameroon},
  author = {{C}hippaux, {J}ean-{P}hilippe and {N}tone, {R}. and {B}enhammou, {D}. and {M}adec, {Y}. and {N}o{\¨e}l, {G}. and {P}erilhou, {A}. and {K}arl, {F}. and {A}mta, {P}. and {S}anchez, {M}. and {M}atchim, {L}. and {C}lauteaux, {P}. and {E}teki, {L}. and {N}difon, {M}. and {B}oum, {Y}. and {N}kwescheu, {A}. {S}. and {T}aieb, {F}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {S}nakebites is a serious public health issue but remains a neglected tropical disease. {D}ata on antivenom effectiveness are urgently needed in {A}frica. {W}e assessed effectiveness of {I}noserp {PAN}-{AFRICA} ({IPA}), the recommended antivenom available in {C}ameroon. {M}ethodology/{P}rincipal findings {W}e enrolled 447 patients presenting with snakebite in 14 health facilities across {C}ameroon. {A}t presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. {W}e administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. {W}e renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. {W}e defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. {M}edium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. {A}fter hospital discharge, a home visit was planned to assess long-term outcomes. {B}etween {O}ctober 2019 and {M}ay 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. {T}he median [{IQR}] age was 25 [14-40]. {E}nvenomation was diagnosed in 369 (82.6%) participants. {T}he antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. {A}mong these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. {T}wo hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. {C}omplete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. {S}equelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection.{M}ethodology/{P}rincipal findings {W}e enrolled 447 patients presenting with snakebite in 14 health facilities across {C}ameroon. {A}t presentation, cytotoxicity, coagulation troubles and neurotoxicity were graded. {W}e administered two to four vials of antivenom to patients based on hemotoxic or neurotoxic signs. {W}e renewed antivenom administration to patients with persistence of bleedings or neurotoxicity 2 hours after each injection. {W}e defined early improvement as a reduction of the grade of envenomation symptoms 2 hours after first injection. {M}edium-term effectiveness was investigated looking at disappearance of symptoms during hospitalization. {A}fter hospital discharge, a home visit was planned to assess long-term outcomes.{B}etween {O}ctober 2019 and {M}ay 2021, we enrolled 447 (93.7%), including 72% from the savannah regions. {T}he median [{IQR}] age was 25 [14-40]. {E}nvenomation was diagnosed in 369 (82.6%) participants. {T}he antivenom was administered to 356 patients (96.5%) of whom 256 (71.9%) received one administration. {A}mong these patients, cytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxicity in 23 (6.5%) participants. {T}wo hours after the first administration of antivenom, we observed a decrease in coagulation disorders or neurotoxicity in 75.2% and 39.1% of patients, respectively. {C}omplete cessation of bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively. {S}equelae have been observed in 9 (3%) patients at the home visit 15 days after hospital admission and 11 (3%) died including one before antivenom injection. {C}onclusions/{S}ignificance{W}e confirmed good effectiveness of the {IPA} and highlighted the rapid improvement in bleeding or neurotoxicity after the first administration. {S}equential administrations of low doses of antivenom, rigorously assessed at short intervals for an eventual renewal, can preserve patient safety and save antivenom. {T}rial registration {NCT}03326492. {S}nakebite envenomation is a public health issue in all sub-{S}aharan countries. {T}heir management remains a challenge due to the high cost of antivenom and complex treatment-seeking behavior.{T}he objective of this study was to evaluate the tolerance and effectiveness of a commonly used antivenom in {C}ameroon, in 14 sites representative of the diversity of common epidemiological situations in sub-{S}aharan {A}frica. {T}he treatment protocol was that recommended by the {C}ameroonian {M}inistry of {H}ealth. {W}e reported in the present manuscript results on antivenom effectiveness. {A}dministration of {IPA} (at least two vials) was decided in all patients presenting with any symptoms of envenomation (cytotoxicity, bleeding, neurotoxicity) regardless of severity. {T}wo to four vials of antivenom were administered to patients depending on whether they had coagulopathy or neurotoxic disorders, respectively. {W}e repeated the administration of antivenom at the same dose to patients if hemorrhagic or neurotoxic signs persisted 2 hours after each injection. {D}uring 20 months, we examined 477 patients and enrolled 447 (94%). {T}hree hundred fifty-six patients presenting envenomation signs have received at least one dose of antivenom. {E}nvenomation was diagnosed in 369 (83%) participants, out of which, 9 (3%) kept sequelae of varying severity, and 11 (3%) died, including one before the antivenom injection. {C}ytotoxic symptoms were observed in 336 (94.4%) participants, coagulation disorders in 234 (65.7%) participants and neurotoxic syndrome in 23 (6.5%) participants. {A} single antivenom administration was performed for 256 (71.9%) patients. {T}wo hours after the first administration of antivenom, coagulation disorders and neurotoxicity decreased in 75.2% and 39.1% of patients, respectively. {C}omplete stop bleedings and neurotoxicity occurred in 96% and 93% of patients within 24 hours, respectively.{W}e confirmed the good effectiveness of {IPA} and highlighted the rapid improvement in bleedings or neurotoxicity after its first administration.},
  keywords = {{CAMEROUN} ; {ZONE} {TROPICALE}},
  booktitle = {},
  journal = {{PL}o{S} {N}eglected {T}ropical {D}iseases},
  volume = {17},
  numero = {11},
  pages = {e0011707 [22 p.]},
  ISSN = {1935-2735},
  year = {2023},
  DOI = {10.1371/journal.pntd.0011707},
  URL = {https://www.documentation.ird.fr/hor/fdi:010088753},
}