Diphtheria Antitoxin Administration, Outcomes, and Safety: Response to a Diphtheria Outbreak in Cox's Bazar, Bangladesh. (27th November 2020)

• Record Type: Journal Article
• Authors: Eisenberg, Nell; Panunzi, Isabella; Wolz, Anja; Burzio, Chiara; Cilliers, Anna; Islam, Md Ariful; Noor, Waqar Mohammad; Jalon, Oren; Jannat-Khah, Deanna; Gil Cuesta, Julita
• Is Part Of: Clinical infectious diseases. Volume 73:Number 7(2021)
• Page Start: e1713
• Page End: e1718
• Publication Date: 2020-11-27
• Subjects: diphtheria -- antitoxins -- disease outbreaks -- angladesh -- drug-related side effects and adverse reactions; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciaa1718
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: Diphtheria has re-emerged over the past several years. There is a paucity of data on the administration and safety of diphtheria antitoxin (DAT), the standard treatment for diphtheria. The 2017–2018 outbreak among Rohingya refugees in Bangladesh was the largest in decades. We determined the outcomes of DAT-treated patients and describe the occurrence and risk factors associated with adverse reactions to DAT. Methods: We conducted a retrospective study at the Médecins Sans Frontières Rubber Garden Diphtheria Treatment Center from December 2017–September 2018. Diphtheria was diagnosed based on the World Health Organization clinical case criteria. High-acuity patients were eligible for DAT. Safety precautions were meticulously maintained. We calculated the presence of adverse events by age, duration of illness, and DAT dosage using bivariate comparisons. Results: We treated 709 patients with DAT; 98% (n = 696) recovered and were discharged. One-fourth (n = 170) had at least 1 adverse reaction. Common reactions included cough (n = 115, 16%), rash (n = 66, 9%), and itching (n = 37, 5%). Three percent (n = 18) had severe hypersensitivity reactions. Five patients died during their DAT infusion or soon afterwards, but no deaths were attributed to DAT. Conclusions: Outcomes for DAT-treated patients were excellent; mortality was <1%. Adverse reactions occurred in one-quarter of all patients, but most reactions were mild and resolved quickly. DAT can be safely administered in a setting with basic critical care, provided there is continuous patient monitoring during the infusion, staff training on management of adverse effects, and attention to safety precautions. Abstract : During the 2017–2018 diphtheria outbreak in Bangladesh, one-fourth (n = 170) of patients receiving diphtheria antitoxin had adverse reactions: 97% mild and 3% severe hypersensitivity reactions. Antitoxin can be safely administered using basic critical care with trained staff and meticulously maintained safety precautions.