Diphtheria Antitoxin Administration, Outcomes, and Safety: Response to a Diphtheria Outbreak in Cox’s Bazar Bangladesh

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 WHO 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. Ninety-eight percent (n=696) recovered and were discharged. One-fourth (n=170) had at least one 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 The outcomes for DAT-treated patients were excellent; mortality was less than 1%. Adverse reactions occurred in a 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 that there is a continuous patient monitoring during the infusion, staff training on management of adverse effects, and attention to safety precautions.