Current challenges for confronting the public health problem of snakebite envenoming in Central America

Snakebite envenoming is a serious public health problem in Central America, where approximately 5,500 cases occur every year. Panama has the highest incidence and El Salvador the lowest. The majority, and most severe, cases are inflicted by the pit viper Bothrops asper (family Viperidae), locally known as ‘terciopelo’, ‘barba amarilla’ or ‘equis’. About 1% of the bites are caused by coral snakes of the genus Micrurus (family Elapidae). Despite significant and successful efforts in Central America regarding snakebite envenomings in the areas of research, antivenom manufacture and quality control, training of health professionals in the diagnosis and clinical management of bites, and prevention of snakebites, much remains to be done in order to further reduce the impact of this medical condition. This essay presents seven challenges for improving the confrontation of snakebite envenoming in Central America. Overcoming these challenges demands a coordinated partnership of highly diverse stakeholders though inter-sectorial and inter-programmatic interventions.蛇咬伤中毒（Snakebite envenoming）是中美洲地区严重的公共卫生问题，该区域每年约发生5500例病例。其中巴拿马的发病率最高，萨尔瓦多最低。绝大多数且病情最为危重的病例由巨蝮（Bothrops asper，蝰科Viperidae）造成，当地俗称"terciopelo""barba amarilla"或"equis"。约1%的咬伤由珊瑚蛇属（Micrurus，眼镜蛇科Elapidae）的物种引发。尽管中美洲在蛇咬伤中毒的研究、抗蛇毒血清生产与质量控制、医护人员咬伤诊断与临床管理培训以及蛇伤预防等领域已开展多项卓有成效的工作，但仍有大量工作亟待推进，以进一步降低这一医学病症的健康影响。本文提出了针对改善中美洲蛇咬伤中毒应对工作的七大挑战。克服这些挑战，需要通过跨部门、跨项目的干预举措，构建由多元利益相关方参与的协同伙伴关系。