Serum, serothrapy Antivenin : quality, limitations and preservation

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Serum, serothrapy Antivenin quality,
limitations and preservation

• Dr Hossein Zolfagharian
• Razi Vaccine and Serum Research Institute
• 1386

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Prevention of snake bite

• 1-Be cool
  
  2-Do not put your hand leg in
  suspicion site
  3-Do not stay in shadow before checking
  4-Do not
  sit on the stone, or trees before checking
  
• 5-Do not collect wood after sunset
  6-Do
  not stroll with sleeper
  7-Do not
  sleep near cave, well
  8-Do not
  swim
  9-Do not
  climb tree or wall before checking
  10-Do not walk on grass
  
  11-Do not wear shoes before
  checking
  12-Keep first aid-snake bite kit

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Control of distribution

• Poison
• Hunt

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Serotherapy

• HistoryHeterologous, Homologous ,
• 
  
  The principles of serotherapy
  were based on two researchers
• 1-Albert calmette- Naja
  
  
• 2-Vital Brazil- monovalent
• This serotherapy used
  worldwide for over hundred years
  
• Serotherapy, microbial toxin- viral-animal
  toxin
• Antivenin Antivenin production dates from
  1897 by RDG Theakston, using crude equine immune
  serum.
• Three types of antivenin may be present IgG,
  F(ab)2 and Fab.
• F(ab)2 and Fab are produced by enzymatic
  digestion pepsin at PH-2and papain at PH- 7.5
  respectively.

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cond

• Adverse effects of IgG (30) , F(ab)2(10) and
  Fab (0.8)
• Data suggest that F(ab)2 is better than the
  others since it has better distribution rate and
  neutralization capacity.
• Finally WHO committee(2003) agreed that F(ab)2 is
  more reliable than others.

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• PRODUCTION OF HETEROLOGOUS SERUM
• 
  
  
  
• Hyper immunization of animal - increasing
  dose -
• Blood collection in 2 to 3 stage
  interval 48
• plasma separation
  
• purification of plasma _ pepsin
  digestion _ (Fab)2 fragment

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Production of serum in Iran

• Anti diphtheria serum
• 
  Anti tetanus
  serum
  
• Antisnake serum polyvalent
  
• Antiscorpion serum - polyvalent

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Treatment Antivenin polyvalent heterologe
liquid , 10ml Ampoule
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Treatment (cont.)

• 1- Antivenins should not be given unless
  
• There is evidence of significant
  poisoning e. g vomiting , nausea, positive
  laboratory findings, coagulation defect
  
  
• 2- History of patient e. g suffered reaction
  in the past
• 3 -Breath problem

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Test Allergy

• skin test
  
  A-skin scrape one droplet
  
  
• ( hundred percent diluted) ? scrape skin
  (after 30 min) observation (negative)

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Reaction of serum

• Anaphylaxis ! Hypersensitivity reaction
• Serum sickness
• 1-Type III hyper sensitivity reaction
• 2-Injection heterologous serum or foreign protein
• 3-Complex antigen-antibody effected vascular wall
  which cause activated proteolytic enzymes ,damage
  vascular wall, inflammatory

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Antivenin future

• Very low to zero allergenicity
• Sheep and rabbit immunoglobulin
• Avian yolk immunoglobulin (Igy)

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• Out of 21 manufacturer of Antivenin all used
  horse as host, except one that used sheep
• Most antivenin are in liquid form with shelf life
  of 3 years
• Some antivenin are in lyophilized form with shelf
  life of 5 years.

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• Antivenin is quite stable if preserved in dark
  place at 4-8C?.in this situation it can be
  preserved for at least 3 years.
• If Antivenin if left at room temp. for more than
  15 days in front of light it gradually gets
  turbid and the turbidity indicated the loss of
  activity.

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• When the antivenin is transported from one region
  to the other the cold chain transport should be
  followed strictly.
• Freezing of antivenin also cause it to denature.

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