Tamil Nadu Makes Snakebite Envenoming a Notifiable Disease

The Story So Far

The Government of Tamil Nadu made snakebite envenoming a notifiable disease under section 62 of the Tamilnadu Public Health Act 1939. A disease declared “Notifiable” must be reported to public health authorities within a stipulated timeframe. The action is part of a larger effort to reduce snakebite-related mortality in India, which reports a significant proportion of global snakebite deaths. Earlier this year, Karnataka declared snake bite to be a notifiable disease. The move is to ensure India aligns with WHO’s goals to halve global snakebite deaths by 2030.

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Snakebite envenomation causes not only death but also severe medical emergencies such as paralysis, respiratory distress, bleeding disorders and irreversible kidney failure, which can lead to permanent disabilities. Despite its severity, most snakebite deaths and complications are preventable with early access to safe and effective antivenoms, recognized by the WHO as essential medicines.

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Historical Perspective: Evolution of Notifiable Diseases

The concept of “Notifiable disease” traces back to 19th-century sanitary reforms that originated in Britain with Edwin Chadwick’s sanitary report, resulting in the Public Health Act in 1848, advocating improved hygiene in crowded cities to curb disease spread among the working class. This was strengthened by Dr John Snow’s work during London’s 1854 cholera outbreak, where he traced cases to contaminated water, highlighting the need for disease surveillance. British India followed with the 1897 Epidemic Diseases Act. After the Government of India Act 1919, health was shifted to provincial governments. The Madras presidency first enacted the Madras Public Health Act of 1939, which is still functional in Tamil Nadu and Andhra Pradesh. These efforts reflect a shift in public health approach, addressing sanitation and living conditions as key factors in disease prevention, especially for the vulnerable and working class. Initially focused on infectious diseases, the USA widened the notifiable disease conditions to include lead poisoning, recognizing non-communicable diseases in the mid-90s.

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Legal and Constitutional Basis

In India, the power to notify and control diseases is derived from central & state laws and constitutional provisions that enable different levels of government to respond effectively to health threats. The Epidemic Diseases Act of 1897 allows both Central and State Governments to take action to control the spread of dangerous diseases, with Section 2empowering State Governments to enact special measures and Section 2A allowing the Central Government to implement measures affecting multiple states or the whole country. Entry 6 of the State List in the Seventh Schedule of the Indian Constitution makes public health primarily a state responsibility, enabling states to create health regulations tailored to their needs.

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The National Disaster Management Act of 2005 empowers the National and State Disaster Management Authorities to respond to disasters, including epidemics, by coordinating resources and issuing directions for national and state-level responses. Section 6 of the act allows the Central Government to guide states in such emergencies, and Section 35 permits the Central Government to take necessary steps to manage disasters effectively. At the international level, the World Health Organization (WHO) oversees the International Health Regulations (IHR), a legally binding framework for 196 countries to collaborate on global health security. The IHR requires nations always to report even a single case of smallpox, polio caused by wild type, and any new subtype of human influenza and SARS. It also has a list of diseases that are in the list as potentially notifiable (currently), such as cholera, pneumonic plague, yellow fever, West Nile fever, viral haemorrhagic fevers like Lassa fever, Ebola, Marburg and other diseases of regional concern.

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Epidemiology of snake bite

Snakebite envenomation is a neglected tropical disease threatening rural, forest, and impoverished communities in tropical regions. An estimated 5.4 million people experience snakebites annually around the world, with 1.8 to 2.7 million estimated cases of envenomation, resulting in 81,000-138,000 deaths. India contributes nearly 50% of the global burden in snakebite deaths each year. The “Big Four” venomous snakes—cobra, Russell’s viper, common krait, and saw-scaled viper—are responsible for most bites in India. The antivenom is effective in 80% of cases. Challenges in India are limited trained personnel, poor healthcare infrastructure, and a lack of comprehensive data.

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IHIP and IDSP in Disease Notification

India’s Integrated Health Information Platform (IHIP) from the Integrated Disease Surveillance Programme (IDSP) form the backbone of notifiable disease reporting and management. IHIP, a real-time web-enabled electronic health information system that acts as a digital surveillance platform, enables healthcare facilities to log cases and report early detection. It contains real-time information on time, place and person, along with geocoded references. In Tamil Nadu, IHIP will capture snakebite envenoming incidents (and other notifiable diseases), offering insights into case distribution, high-risk areas, and seasonal patterns. The IHIP has collected data on notifiable diseases daily since 2021.

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What would happen after the Gazette notification in a snake bite case?

In Tamil Nadu, healthcare providers (public and private) must report snakebite cases to designated health authorities within the stipulated time after the gazette notification. This will result in better data collection and coordinated response. However, underreporting remains a minor concern, as individuals in rural areas might rely on traditional healers who don’t report to the health system. Traditional healing practices delay access to formal medical care, complicating efforts to provide timely treatment and track the actual burden of snakebites.

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Achieving the 2030 Targets

In 2019, the WHO global strategy for preventing and controlling snakebite envenoming was launched to provide all patients with better overall care so that the number of

deaths and cases of disability is reduced by 50% before 2030. To achieve the WHO’s 2030 targets, India will require a coordinated approach to snakebite prevention, treatment, and post-treatment care. Ensuring that rural health centres maintain sufficient antivenom stocks, robust cold-chain management, and training healthcare workers is vital. Public health campaigns must also educate high-risk communities on snakebite prevention, first aid, and the importance of immediate medical care.

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