Conditions
How common are snakebites in South Africa?
Snakebites are not uncommon in South Africa, particularly in rural areas and during warmer months. While fatalities are relatively rare with prompt medical care, snakebite remains a significant medical emergency and should always be treated as such.
Medically important snakes in South Africa
South Africa has several snake species capable of causing serious envenomation. The most clinically relevant groups include:
Adders (e.g. puff adder):
Venom is primarily cytotoxic, causing severe local pain, swelling, blistering, and tissue damage. Systemic effects can occur.
Cobras and mambas:
Venom is mainly neurotoxic (some are mixed neurotoxic and cytotoxic), leading to progressive muscle weakness, respiratory failure, and potentially cardiovascular collapse. Symptoms may evolve rapidly or over several hours.
Boomslang:
Causes haemotoxic envenomation, leading to delayed but severe bleeding, often developing over 4–48 hours.
Not all bites inject venom
A proportion of snakebites are “dry bites”, where no venom is injected. However, it is not possible to determine this reliably outside a medical setting, and all suspected snakebites require urgent medical assessment.
Factors influencing severity
The clinical effect of a snakebite depends on:
- Snake factors: species, size, venom yield
- Bite factors: location, depth, number of bites
- Time to appropriate medical care
- Victim factors: age, body mass, general health
- Early and appropriate management significantly improves outcomes.
What to do immediately
Assume the bite is serious and seek urgent medical care at the nearest emergency centre.
Watch for any serious signs such as dizziness, difficulty in swallowing and breathing, drooping eyelids, blurred vision, slurred speech and nausea.
Keep the patient calm and still; movement may increase venom spread. Elevation of a limb which has been bitten is not necessary unless there is already significant swelling of the limb which is unlikely initially. Keep the affected area still. You can immobilise the affected limb using a splint if necessary (a straight arm or leg is best). Pressure bandages are only necessary in certain neurotoxic snakebites (cobra or mamba), and it’s best to obtain an experts opinion on whether they are necessary, as they may delay definitive treatment and transport, and require an experienced person to apply the pressure dressing. Pressure bandages are not recommended for puff adder bites, where swelling and tissue injury are prominent.
Remove tight clothing, rings, or bracelets near the bite site.
What NOT to do
- Do NOT attempt to catch or kill the snake. This places others at risk and is unnecessary.
- Do NOT cut, suck, or squeeze the wound.
- Do NOT apply ice, chemicals, electricity, or traditional remedies.
- Do NOT apply a tourniquet.
Tourniquets are not recommended in South Africa as they increase the risk of severe tissue injury and do not improve outcomes.
Antivenom
- Antivenom is a hospital-based treatment only and should never be given outside a medical facility.
- The decision to administer antivenom depends on clinical signs of envenomation, not age alone.
- Puff adder bites may require antivenom if there is significant swelling, pain, systemic involvement, or progression of symptoms.
- Neurotoxic bites (cobra/mamba) often require urgent antivenom and airway support.
Snake venom in the eyes (spitting cobras)
- If venom enters the eyes, immediately irrigate with copious amounts of clean water or saline for at least 15–20 minutes.
- This should be done as soon as possible, even before transport to hospital.
- Further eye care will be provided in hospital. Antivenom is not routinely placed directly in the eyes.
Key take-home messages
- Snakebite is a medical emergency in South Africa.
- Do not use tourniquets.
- Do not attempt snake identification at the scene.
- Immobilise, keep calm, and get to an emergency centre urgently. Call ER24 (084 124) for an ambulance if there are any serious clinical signs.
- Outcomes are generally good with early, appropriate medical care.