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

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.

The role of the Deki Reader™ in malaria diagnosis, treatment and reporting: findings from an Africare pilot project in Nigeria.

BACKGROUND: The Deki Reader is a diagnostic device used with rapid diagnostic tests (RDTs) and linked to an online database for real-time uploads of patient information and results. This is in contrast to visual interpretation of malaria RDTs recorded on the District Health Information System (DHIS). This paper compares records for use of the Deki Reader with DHIS records of visual interpretation of RDTs. RESULTS: A total of 4063 patient encounters/tests were recorded on the Deki Reader database between June 1st and December 31st, 2016. These tests were for 2629 persons who presented with fever and had RDT done. In comparison, data from DHIS 2.0 for same period recorded 7201 persons presenting with fever. 2421 out of the 2629 persons (92.1%), received RDT using Deki Reader compared to 6535 out of 7201 persons (90.4%) recorded on DHIS (p = 0.04). From DHIS records, malaria positivity rate was 51.6% (3375 out of 6535 persons) compared to Deki Reader records of 23.6% (572 out of 2421 persons). The difference between these two rates was significant (p < 0.001). The odds ratio (95% CI) for the association between use of Deki Reader and having a positive malaria result was 0.29 (0.26-0.32). DHIS showed that 4008 persons received Artemisinin-based combination therapy (ACT) while 3989 persons tested positive with RDT or microscopy, compared to 691 out of 705 persons (98.0%) using Deki Reader. Finally, Deki Reader identified 618 processing and manufacturers errors with an error rate of 15.3%. CONCLUSION: The Deki Reader is likely a useful tool for malaria diagnosis, treatment, and real-time data management. It potentially improves diagnostic quality, reduces wastage in ACT administration and improves data quality.