Enhancing Mass Vaccination Programs with Queueing Theory and Spatial Optimization.

Background: Mass vaccination is a cornerstone of public health emergency preparedness and response. However, injudicious placement of vaccination sites can lead to the formation of long waiting lines or queues, which discourages individuals from waiting to be vaccinated and may thus jeopardize the achievement of public health targets. Queueing theory offers a framework for modeling queue formation at vaccination sites and its effect on vaccine uptake. Methods: We developed an algorithm that integrates queueing theory within a spatial optimization framework to optimize the placement of mass vaccination sites. The algorithm was built and tested using data from a mass canine rabies vaccination campaign in Arequipa, Peru. We compared expected vaccination coverage and losses from queueing (i.e., attrition) for sites optimized with our queue-conscious algorithm to those obtained from a queue-naive version of the same algorithm. Results: Sites placed by the queue-conscious algorithm resulted in 9-19% less attrition and 1-2% higher vaccination coverage compared to sites placed by the queue-naïve algorithm. Compared to the queue-naïve algorithm, the queue-conscious algorithm favored placing more sites in densely populated areas to offset high arrival volumes, thereby reducing losses due to excessive queueing. These results were not sensitive to misspecification of queueing parameters or relaxation of the constant arrival rate assumption. Conclusion: One should consider losses from queueing to optimally place mass vaccination sites, even when empirically derived queueing parameters are not available. Due to the negative impacts of excessive wait times on participant satisfaction, reducing queueing attrition is also expected to yield downstream benefits and improve vaccination coverage in subsequent mass vaccination campaigns.

Optimizing the location of vaccination sites to stop a zoonotic epidemic.

Mass vaccinations are crucial public health interventions for curbing infectious diseases. Canine rabies control relies on mass dog vaccination campaigns (MDVCs) that are held annually across the globe. Dog owners must bring their pets to fixed vaccination sites, but sometimes target coverage is not achieved due to low participation. Travel distance to vaccination sites is an important barrier to participation. We aimed to increase MDVC participation in silico by optimally placing fixed-point vaccination locations. We quantified participation probability based on walking distance to the nearest vaccination site using regression models fit to participation data collected over 4 years. We used computational recursive interchange techniques to optimally place fixed-point vaccination sites and compared predicted participation with these optimally placed vaccination sites to actual locations used in previous campaigns. Algorithms that minimized average walking distance or maximized expected participation provided the best solutions. Optimal vaccination placement is expected to increase participation by 7% and improve spatial evenness of coverage, resulting in fewer under-vaccinated pockets. However, unevenness in workload across sites remained. Our data-driven algorithm optimally places limited resources to increase overall vaccination participation and equity. Field evaluations are essential to assess effectiveness and evaluate potentially longer waiting queues resulting from increased participation.

A rare presentation of scrub typhus: myocarditis, acute liver failure and leukemoid reaction.

Scrub typhus is a mite borne zoonosis, caused by Orientia tsutsugamushi, a gram-negative intracellular organism. This infection usually presents in high prevalence in the rural areas of East Asia and Western pacific islands. It usually presents with fever, chill, myalgia, headache, skin rashes, having pathognomonic and skin lesion i.e. eschar in ~10% cases in Indian subcontinent. It can present with life-threatening complications on occasional. The simultaneous presentation of more than two complications is uncommon, rarely reported in literature. Here we report a case of 37-year-old woman with acute febrile illness, complicated with myocarditis, acute liver failure and leukemoid reaction. She was diagnosed promptly and successfully treated with doxycycline with full recovery of the complications.

Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India.

INTRODUCTION: Childhood obesity, dental caries, and periodontal disease are major public health problems due to their adverse impact on the growth and development of children. Obesity and oral health are associated as both share some common risk factors. AIM: The specific aim of the study was to determine the correlation, if there is any, between obesity and oral health in children. MATERIALS AND METHODS: A cross-sectional survey was conducted in five districts of West Bengal, India. A total of 1,227 school-going children of 6 to 12 years were examined from the districts of Howrah, Hooghly, West Midnapore, South 24-parganas, and North 24-parganas. Following indices were analyzed: Decayed-missing-filled teeth (DMFT), decayed, extracted, filled teeth (deft), simplified oral hygiene index (OHI-S). Depending on their nutritional status, subjects were categorized as being normal weight, overweight, and obese. Logistic regression analysis were applied to the study to find out the association between the above-mentioned dental indices and independent variables: Gender and nutritional status. RESULT: A positive association was found between obesity and oral health status in children. CONCLUSION: Considering the results of this study, it was concluded that obesity is related to oral hygiene status of children. In order to improve oral hygiene status in children, dietary modifications need to be done.How to cite this article: Halder S, Kaul R, Angrish P, Saha S, Bhattacharya B, Mitra M. Association between Obesity and Oral Health Status in Schoolchildren: A Survey in Five Districts of West Bengal, India. Int J Clin Pediatr Dent 2018;11(3):233-237.

Evaluation and comparison of white mineral trioxide aggregate and formocresol medicaments in primary tooth pulpotomy: clinical and radiographic study.

AIM: The primary aim of the following study is to evaluate and secondary aim is to compare clinically and radiographically the success of using white mineral trioxide aggregate (MTA) versus formocresol (FC) medicament for primary tooth pulpotomy. MATERIALS AND METHODS: A total of 100 teeth were selected for pulpotomy; of which 50 teeth underwent FC pulpotomy and 50 teeth underwent pulpotomy with white MTA. Out of 100 treated teeth, 82 teeth (42 FC and 40 MTA teeth) were available at the end of 24 months for evaluation. 4 failures were found in FC group at 1 st month evaluation and no failures were found in white MTA group. A statistical analysis was performed to evaluate the overall success rate of study and individual success rates of medicaments. Overall success rate of the study was 95%, success rate of FC group was 90.48% and success rate of MTA group was 100%. RESULTS: MTA produced better results as pulpotomy medicament in comparison to FC. The superior success obtained in the present study was matching other studies mentioned in the literature. CONCLUSION: MTA seems to be a promising pulpotomy medicament for future use.

Comparative evaluation of different forms of calcium hydroxide in apexification.

BACKGROUND: One out of every two children sustains a dental injury most often between 8 and 10 years of age. Majority of these teeth subsequently become non-vital and most often with immature apex. Management of these teeth is an enormous challenge for lack of apical stop. Calcium hydroxide in various formulations has maximum literature support in favor of successful apexification or induced apical closure. AIM: The aim of the following study is to determine the efficacy of calcium hydroxide in a different formulation to induce apexification. MATERIALS AND METHODS: The present study was undertaken on 51 children of 8-10 years of age (both sexes) at Dr. R Ahmed Dental College and Hospital from April 2006 to March 2007. All children had one or two maxillary permanent central incisor (s), non-vital and apices open. In all the cases, apexification was attempted with either calcium hydroxide mixed with sterile distilled water, or calcium hydroxide plus iodoform in methyl cellulose base, or calcium hydroxide plus iodoform in polysilicone oil base. The success of apexification was determined on the basis of clinical and radiographic criteria. RESULTS: In the pre-operative asymptomatic cases (72.55%), failure occurred in only 5.45% cases and pre-operative symptomatic cases failure rate was as high as 35.71%. Success rate was 94.6% in cases with narrow open apices, whereas 64.28% in wide open apices. In cases with pre-existing apical radiolucencies, successful apexification occurred in 63.63% and success rate was 92.5% in the cases without pre-existing apical radiolucencies. Average time consumed for apexification was minimum with calcium hydroxide plus iodoform in polysilicone oil base. CONCLUSION: The overall success rate observed to be 86.27%, which is in close proximity to the findings of most of the previous studies across the globe.

Correlation of total salivary secretory immunoglobulin A (SIgA) and mutans specific SIgA in children having different caries status.

BACKGROUND: Relation between secretory immunoglobulin A (SigA) and dental caries still imprecise. Studies have been conducted either for total SIgA or mutans specific SIgA with bizarre results. AIM: The aim of this study is to find out the relationship between mutans antigen specific SIgA and total salivary SIgA and its influence in caries status in children. MATERIALS AND METHODS: A total of 45 children aged between 6-14 years were divided based on their caries index (decayed, missing, filled, extracted tooth) score in high moderate and no caries group and their saliva were analyzed with enzyme linked immunosorbent assay for total SIgA and mutans specific SIgA. RESULTS: High caries group showed high mutans specific SIgA, but less total SIgA, whereas low caries group showed the reverse. CONCLUSION: The mutans specific SIgA and total SIgA has a weak, but negative correlation in children potentiating caries inhibitory action of SIgA.