Background: Understanding the burden of snakebite is crucial for developing evidence-informed strategies to pursue the goal set by the World Health Organization to halve morbidity and mortality of snakebite by 2030. However, there was no such information in the Association of Southeast Asian Nations (ASEAN) countries. Methodology: A decision analytic model was developed to estimate annual burden of snakebite in seven countries, including Malaysia, Thailand, Indonesia, Philippines, Vietnam, Lao PDR, and Myanmar. Country-specific input parameters were sought from published literature, country’s Ministry of Health, local data, and expert opinion. Economic burden was estimated from the societal perspective. Costs were expressed in 2019 US Dollars (USD). Disease burden was estimated as disability-adjusted life years (DALYs). Probabilistic sensitivity analysis was performed to estimate a 95% credible interval (CrI). Principal findings: We estimated that annually there were 242,648 snakebite victims (95%CrI 209,810–291,023) of which 15,909 (95%CrI 7,592–33,949) were dead and 954 (95%CrI 383–1,797) were amputated. We estimated that 161,835 snakebite victims (69% of victims who were indicated for antivenom treatment) were not treated with antivenom. Annual disease burden of snakebite was estimated at 391,979 DALYs (95%CrI 187,261–836,559 DALYs) with total costs of 2.5 billion USD (95%CrI 1.2–5.4 billion USD) that were equivalent to 0.09% (95%CrI 0.04–0.20%) of the region’s gross domestic product. >95% of the estimated burdens were attributed to premature deaths. Conclusion/Significance: The estimated high burden of snakebite in ASEAN was demonstrated despite the availability of domestically produced antivenoms. Most burdens were attributed to premature deaths from snakebite envenoming which suggested that the remarkably high burden of snakebite could be averted. We emphasized the importance of funding research to perform a comprehensive data collection on epidemiological and economic burden of snakebite to eventually reveal the true burden of snakebite in ASEAN and inform development of strategies to tackle the problem of snakebite.

Antivenom is an essential treatment for snake envenomation; however, early adverse reactions (EARs) are major limitations to its use. We performed a retrospective cross-sectional study using Ramathibodi Poison Center data (January 2016 to December 2017) to clarify the incidence and severity of EARs following different F(ab’)₂ antivenoms. Among 1006 envenomed patients, 684 (68%) received antivenom therapy with a total of 1157 doses, mostly green pit viper antivenom. The overall EAR incidence and rate were 22. 5% (154/684) and 15% (173/1157), respectively. The EAR rate following each type of antivenom was >10%, except for Russell’s viper antivenom (2.9%); the severe reaction rate was 2.6% (30/1157). Malayan pit viper bites caused a high incidence of EARs (37.8%) and the highest EAR rate (22.3%). Fifty-two cases developed anaphylaxis. All EARs occurred within 2 h after treatment initiation. No deaths were attributed to EARs. The duration of administration was significantly different between doses of antivenom that induced EARs and those that did not. In conclusion, all types and every dose of antivenom should be infused for 30–60 min. Preparation of resuscitation equipment and continuous clinical observation are crucial for at least 2 h after administration, and prompt treatment should be provided when EARs occur.

The morphological variation, extended distribution, and sequence divergence of a recently described of cobra Naja fuxiShi et al., 2022 captured from mountainous areas in Thailand are evaluated by using molecular and morphological analyses. We investigated the genetic variation and affinities of 72 specimens in the genus Naja by using mitochondrial DNA (cytochrome b and control region) and the nuclear DNA gene, C-mos. Morphological examination was conducted for 33 cobra specimens obtained from the northern, western, and north-eastern regions, and data on their natural history were gathered during field surveys. A high degree of genetic differentiation was shown to exist between the cobras collected from lowlands and those from mountainous areas. N. fuxi occurs in uplands bordering Thailand’s Central Basin, whereas the similar looking N. kaouthia Lesson, 1831 is more or less restricted to the lowlands. All phylogenetic and network analyses supported a distinct clade of N. fuxi from north, west, and, north-east regions. In addition, N. fuxi seems to exhibit a split between the north-eastern population and those from the north and west. The range of N. fuxi probably extends far into the mountainous areas of the neighbouring countries Myanmar, Laos, and Vietnam. Morphologically, N. fuxi in Thailand can be distinguished from all other cobra species in the adjacent Oriental Region. The speciation of cobras in Thailand likely reflects key events in the region’s geographical, climate and environmental history.

The two venomous pit vipers, Trimeresurus macrops and T. hageni, are distributed throughout Thailand, although their abundance varies among different areas. No species-specific antivenom is available for their bite victims, and the only recorded treatment method is a horse antivenom raised against T. albolabris crude venom. To facilitate assessment of the cross-reactivity of heterologous antivenoms, protein profiles of T. macrops and T. hageni venoms were explored using mass-spectrometry-based proteomics. The results show that 185 and 216 proteins were identified from T. macrops and T. hageni venoms, respectively. Two major protein components in T. macrops and T. hageni venoms were snake venom serine protease and metalloproteinase. The toxicity of the venoms on human monocytes and skin fibroblasts was analyzed, and both showed a greater cytotoxic effect on fibroblasts than monocytic cells, with toxicity occurring in a dose-dependent rather than a time-dependent manner. Exploring the protein composition of snake venom leads to a better understanding of the envenoming of prey. Moreover, knowledge of pit viper venomics facilitates the selection of the optimum heterologous antivenoms for treating bite victims.

Protobothrops kelomohy sp. nov. is described from dry evergreen forest in Chiang Mai Province, northern Thailand, based on morphology and a molecular phylogeny. It differs from congeners by the following combination of characters: 1) relatively large body size (total length up to 1,310 mm); 2) dorsal scale rows 23–23–17, all keeled; 3) ventral scales 231–234; 4) subcaudal scales 80–84, paired; 5) supralabials 8–9; 6) infralabials 12–13; 7) typical lance-pattern on upper head surface; 8) three bold vertical facial stripes; and 9) dorsal and tail brown, each scale with dark reddish-brown transverse blotches, edged in black, somewhat fused together as a median zigzag line on dorsum, a row of large ventrolateral blotches on each side, each darker marking edged by a narrow yellow line. The new discovery and other recent findings suggest that further herpetological research is required in the montane forest of northern Thailand and adjacent Myanmar and Laos. Data on the natural history of the new species and an updated key to the species of Protobothrops are provided. This is the second species of Lance-headed Pit Viper recorded from Thailand after P. mucrosquamatus.