Page 73 - JSOM Summer 2020

b. HEMOTOXIC = 1–2 vials First line (INDOPACOM–TAIWAN/SOUTHEAST CHINA/
c. CYTOTOXIC = 1–2 vials NORTH VIETNAM/LAOS): First line treatment option for
4. Additional dosing: Additional 1 vial JSI-AYA may be given at Sharp-nosed viper envenomations (Deinagkistrodon acutus).
hours 2, 4, 6, 12, and 24 if needed. Feasibility of use in austere environments: CONDITIONALLY
5. Preparation and administration: Dilute the entire dose of anti- RECOMMENDED for operational settings during short excur-
venom in a single 100 mL bag of isotonic solution and admin- sions. Lyophilized but requires cold chain refrigeration below 10° C
ister by intravenous infusion over 10 minutes. (50° F); however, testing by Taiwanese CDC showed no loss of
a. If a mild or moderate reaction occurs, slow the infusion and potency after 30 days of incubation at 35° C/95° F and also after
treat symptomatically with antihistamines, steroids, and/or it was returned to refrigerated storage for 4 months thereafter.
antiemetics as needed. Recommend carrying full dose into field on extended operations
b. If a severe reaction such as anaphylaxis occurs, stop the in- in austere environments and storing larger quantities at regional
fusion and treat according to the anaphylaxis protocol listed Role 2 & 3 facilities.
elsewhere in the CPG. Reassess the patient once the reaction
has been controlled and resume the infusion at a slower rate Adverse reactions: High efficacy and low incidence of serious ad-
if any of the specific criteria for antivenom treatment listed verse reactions based on current publications.
elsewhere in the CPG have not completely resolved. 1. Indications: Monovalent antivenom directly indicated for the
treatment of hemotoxic and cytotoxic envenomation syn-
INDOPACOM – EAST CHINA dromes caused by Deinagkistrodon acutus.
FREEZE-DRIED/REFRIGERATED 2. Pretreatment: NOT ROUTINELY INDICATED unless patient
Korea Vaccine, Korea: Agkistrodon Mamushi Antivenom is unstable, asthmatic/atopic, known hypersensitivity or other
(KOVAX-AKA) 229–234 pretreatment criteria met. Low risk of severe allergic reactions
First line (INDOPACOM–NORTH KOREA/SOUTH KOREA): and other EARs.
First line treatment option for Mamushi envenomations in North 3. Initial dosing by syndrome:
and South Korea. a. NOT INDICATED FOR NEUROTOXIC
b. HEMOTOXIC initial dose = 2 vials
Feasibility of use in austere environments: NOT RECOM- c. CYTOTOXIC initial dose = 2 vials
MENDED for operational settings. Lyophilized but requires cold
chain refrigeration below 10° C (50° F); likely to retain efficacy 4. Additional dosing: Additional 1 vials NIPM-SNV may be
given at hours 2, 4, 6, 12, and 24 if needed.
for short excursions lasting several weeks in the field but should
be disposed of and replaced after extended time outside refrig- 5. Preparation and administration: Dilute the entire dose of an-
tivenom in a single 100 mL bag of isotonic solution and ad-
eration. Recommend storing several vials at a small number of
strategically located Role 2 & 3 facilities. minister by intravenous infusion over 10 minutes.
a. If a mild or moderate reaction occurs, slow the infusion and
Adverse reactions: High efficacy and low incidence of serious ad- treat symptomatically with antihistamines, steroids, and/or
verse reactions based on current publications. antiemetics as needed.
1. Indications: Directly indicated for the treatment of hemotoxic b. If a severe reaction such as anaphylaxis occurs, stop the in-
and cytotoxic envenomation syndromes caused by the major fusion and treat according to the anaphylaxis protocol listed
species of Mamushi in the Korean Peninsula (Gloydius brevi- elsewhere in the CPG. Reassess the patient once the reaction
caudus, G. ussuriensis, G. intermedius). May neutralize other has been controlled and resume the infusion at a slower rate
related species. if any of the specific criteria for antivenom treatment listed
2. Pretreatment: NOT ROUTINELY INDICATED unless patient elsewhere in the CPG have not completely resolved.
is unstable, asthmatic/atopic, known hypersensitivity or other
pretreatment criteria met. Low risk of severe allergic reactions INDOPACOM – SEA SNAKE BITES/
and other EARs. MARINE ENVIRONMENTS LIQUID/REFRIGERATED
3. Initial dosing by syndrome: Commonwealth Serum Laboratories, Australia: Sea Snake (CSL-SS)
a. NOT INDICATED FOR NEUROTOXIC First Line (INDOPACOM–MARINE ENVIRONMENTS ONLY):
b. HEMOTOXIC = 1–2 vials Neurotoxic envenomation in INDOPACOM by sea snakes or un-
c. CYTOTOXIC = 1–2 vials known species occurring in a strictly marine environment.
4. Additional dosing: Additional 1 vial KOVAX-AMA may be Feasibility of use in austere environments: NOT RECOMMENDED
given at hours 2, 4, 6, 12, and 24 if needed.
5. Preparation and administration: Dilute the entire dose of an- for operational settings. Requires cold chain refrigeration between
2–8° C (35.6–46.4° F). Recommend storing several vials at a small
tivenom in a single 100 mL bag of isotonic solution and ad- number of strategically located Role 2 & 3 facilities. Likely to retain
minister by intravenous infusion over 10 minutes. efficacy for several weeks in the field but should be disposed of after
a. If a mild or moderate reaction occurs, slow the infusion and that duration of time outside refrigeration.
treat symptomatically with antihistamines, steroids, and/or
antiemetics as needed. Adverse reactions: High-quality product with low rates of reac-
b. If a severe reaction such as anaphylaxis occurs, stop the in- tions anticipated.
fusion and treat according to the anaphylaxis protocol listed 1. Indications: This polyvalent can be used to treat neurotoxic en-
elsewhere in the CPG. Reassess the patient once the reaction venomations by most major species of sea snakes in Australasia.
has been controlled and resume the infusion at a slower rate 2. Initial dosing by syndrome:
if any of the specific criteria for antivenom treatment listed a. Neurotoxic syndrome initial dose = 3 vials
elsewhere in the CPG have not completely resolved. b. NOT INDICATED for hemotoxic envenomations
c. NOT INDICATED for cytotoxic envenomations
INDOPACOM – SOUTHEAST CHINA/NORTH VIETNAM/ 3. Additional dosing: Additional doses of 1 vials CSL-SS may be
LAOS FREEZE-DRIED/REFRIGERATED given at hours 2, 4, 6, 12, and 24 if needed.
National Institute Preventative Medicine, Taiwan: Sharp-nosed 4. Pretreatment: NOT ROUTINELY INDICATED unless patient
Viper Monovalent (NIPM-SNV) 229–234 is unstable, asthmatic/atopic, known hypersensitivity or other

Global Snake Envenomation Management | 71