Available snake antivenom products in sub-Saharan Africa, as of September 2014.

<p>Available snake antivenom products in sub-Saharan Africa, as of September 2014.</p

List of antivenoms investigated in clinical trials published in peer-reviewed journals or on public registries.

<p>¹ Not all publications mentioned the trial phase, and development status was established based on trial design, primary objectives, and number of subjects. This classification, though, bears some limitations, especially with regards to snake antivenoms development, in which Phase I with healthy volunteers are generally not conducted.</p><p>List of antivenoms investigated in clinical trials published in peer-reviewed journals or on public registries.</p

Flow diagram of the selection process used in this study.

<p>The search was conducted on 15 September 2014. Merging the search results gave a total of 41 clinical trials investigating the efficacy or safety of snake antivenoms, of which four were active. A total of 36 different antivenoms were investigated (see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.t002" target="_blank">Table 2</a>). Based on the trial design (Phase I to IV), ten products were considered still “under development,” although development appears to have stalled for most of them. Our search strategy appears robust; a report conducted in 2010 identified a total of 43 randomized controlled trials on snakebite envenoming, 28 of which investigated antivenom properties [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.ref011" target="_blank">11</a>]. We retrieved all except two of these trials [<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.ref012" target="_blank">12</a>,<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003896#pntd.0003896.ref051" target="_blank">51</a>]; the discrepancy could be due to differences in the criteria used to define clinical trials.</p

Vaccinated and non-vaccinated health areas of the city of Kalemie, Democratic Republic of Congo (base map: Stamen Design).

<p>Vaccinated and non-vaccinated health areas of the city of Kalemie, Democratic Republic of Congo (base map: Stamen Design).</p

Vaccination coverage by age in the areas targeted for vaccination in 2014.

<p>Vaccination coverage by age in the areas targeted for vaccination in 2014.</p

Reasons for non-vaccination in the 2014 campaign (strata 1).

<p>Reasons for non-vaccination in the 2014 campaign (strata 1).</p

Spatial distribution of the vaccination coverage in Kalemie.

<p>Spatial distribution of the vaccination coverage in Kalemie.</p