MLT503 - L1 - Introduction To Cli. Virology

MLT503 LECTURE 1
By:
Mohd Fahmi Mastuki
Department of Medical Laboratory Technology
Faculty of Health Sciences, UiTM
1
Learning Outcomes
At the end of the session, you should be able to:
• Overview of virus epidemiology

• Discovery of viruses
2
EPIDEMIOLOGY
Epidemiology describes the occurrence of illness

in populations and, by means of specific study
designs, facilitates analysis of the risk factors that
determine its distribution
Epidemiology also provides experimental

approaches for evaluating the efficacy of
interventions such as vaccines to prevent or
drugs to treat disease
3
Epidemiological approaches may also be required to
evaluate some of the basic characteristics of infectious
agents in humans, such as the infectious dose, which is
important in terms of both the amount of pathogen
required to initiate infection and the ease and likelihood of
transmission
They are essential when no animal model is available.

When animal models are available, many of these
variables can be estimated. Results may or may not be
applicable to humans, so epidemiological studies are
needed for confirmation.
4
Virology….
• Viral Epidemiology
– Epidemiology describes the occurrence of illness in
populations.
• Viral Pathogenesis
– Pathogenesis deals with the interaction between a
virus and its host.
5
QUANTIFICATION OF CHARACTERISTICS OF VIRAL INFECTION
Epidemiology provides definitions that help to

quantify the occurrence of infection and disease in a
population.
Two terms used are:
 Infectious Dose
 Secondary Attack Rate
6
Infectious Dose
To calculate the infectious dose required to initiate
infection in animals, a 50% infectious dose (ID50) is
determined by inoculation of serial dilutions of virus
suspension into an animal population.
The dilution at which 50% of animals show disease is the

ID50 (In cell culture this is the TCID50)
Except for certain self-limited infections such as those

caused by the rhinoviruses, such experimental studies
cannot be carried out in humans
7
Secondary Attack Rate (SAR)

The epidemiological measure used to approximate the
infectivity of an agent in humans is the secondary attack rate
(SAR).
It is more than a measure of infectivity: it describes

numerically the communicability of a contagious disease,
which is in part related to the ID50 of the virus but is also
affected by loss of viability during transmission and the
susceptibility of the recipient.
8
Pathogenicity and virulence
Pathogenicity – able to cause disease
compares the capacity of different

viruses to cause disease
In the epidemiological sense, ‘Pathogenicity' is the

proportion of total infections that produce overt disease,
which varies from virus to virus and may be affected by
host factors (e.g. prior infection with the agent).
9
‘Virulence' compares the severity of disease caused by

different strains of the same organism.
'Virulence' here indicates the capacity of a pathogen to

produce severe disease.
The likelihood of a fatal outcome is calculated as the

case-fatality rate. Case fatality is high in many hantavirus
and filovirus infections and it still is 100% in clinical cases
of rabies.
10
Polio is an illustration of the relative independence of

pathogenicity and virulence.
The disease shows only 0.1-1% of infections are

symptomatic but is very severe if it occurs.
Therefore the virus would be considered of relatively

low pathogenicity but of relatively high virulence.
11
OBSERVATIONAL EPIDEMIOLOGY
Generally, descriptions of infections or diseases

are made in terms of their occurrence in person,
place and time.
Personal factors important in viral illness:-
 Age and gender

 Position in family – birth order
 Education
 Crowding
 Socioeconomic status
 Occupation – exposures
 Genetic and related factors
 Immune status
 Nutrition
12
Viral infections in person, place and time
Factors related to place:
Place of occurrence of viral infection may be related to

purely local biological or physical factors. Regional
characteristics such as climate and resident flora and
fauna determine whether transmission can take place
Other physical or biological environmental factors

determine whether common source outbreaks, such
as those produced by hepatitis A or E from
contaminated water, can occur at a particular
location. (outflow of sewage).
13
Factors related to time:
Time of occurrence is usually the most systematically evaluated of

the 3 factors. Much of the terminology used in epidemiology has a
temporal component.
The terms epidemic, endemic and sporadic do not have any

statistical definitions but simply mean, respectively:
Epidemic: occurrence of an infection at a higher than expected

frequency,
Endemic: Occurs at the expected frequency,
Sporadic: Occurs only rarely and in seemingly unconnected fashion.
Another term frequently used, Pandemic, meaning an epidemic
appearing in many geographic locations at about the same time.
14
Factors related to time:
Two critical terms used in epidemiology that have

temporal definitions are incidence and prevalence.
Incidence is the number of new (acute) cases of a disease

arising during a fixed period in a population of given size.
Prevalence does not deal with acute illness, but with existing
cases that are identified at a given (arbitrary) point in time.
eg. - All cases of AIDS existing in the population of interest at one
time, whatever their date of onset = prevalence rate
15
EPIDEMIOLOGICAL CHARACTERISTICS OF VIRUSES
Epidemiological implications for some specific virus:
• Respiratory viruses
• Gastrointestinal viruses
• Blood-borne viruses
• Zoonoses and vector-borne viruses
• Viruses and chronic disease
16
Respiratory viruses
Viruses are responsible for the bulk of respiratory

infections.
Being surface infections (mucosa), they do not produce

long-lasting immunity. Instead they have the capacity to
reinfect, even without antigenic change.
Parainfluenza and RSV, may cause severe disease in

infants and young children on initial infection and mild or
inapparent infection indistinguishable from the common
cold in older people
17
Respiratory viruses (cont..)
Rhinoviruses and coronaviruses produce only cold-like

symptoms regardless of whether they infect children or
adults.
Rhinoviruses, as the principal agents of the common cold,

and can infect individuals many times throughout life.
Influenza is potentially serious in all individuals who develop

disease. Infection rates are highest in children and adults who
are sufficiently ill to seek medical advice.
The elderly and those with chronic illnesses experience the

most severe respiratory disease,
18
Viruses infecting the gastrointestinal tract
Rotaviruses
Rotaviruses are the main cause of dehydrating

diarrhoeal disease in young children throughout the
world.
Although infants and young children in developing

countries may die of these infections if they are not
rehydrated with salt-containing solutions (orally or
sometimes intravenously), the disease is rarely so
severe in the developed world, mainly because of such
factors as better nutrition
19
Viruses infecting the gastrointestinal tract
Enteric viruses
The enteroviruses are generally transmitted by the faecal-

oral route
Polio is the best known of the enteroviruses, producing a

serious disease in a small proportion of those infected.
Hepatitis A is an enterovirus. Spread in the developed

countries typically occurs from person to person in the
family
or in settings such as day care centres for children,
especially when they are not toilet trained
20
Viral infections with blood-borne transmission
HIV & HCV are the most extensively studied blood-borne

pathogens.
Hepatitis B transmission is most likely during periods of

high levels of viraemia (early acute or chronic hepatitis).
Hepatitis B is transmissible not only through blood and

blood products but also through sexual contact.
21
Viral infections with blood-borne transmission
When human immunodeficiency virus (HIV) was first

described, its epidemiology was found to be remarkably
similar to that of hepatitis B.
Differences are related to the far lower transmissibility of HIV

under most conditions.
Whereas persistent high levels of viraemia allows hepatitis B virus

transmission to occur with relative ease, transmission of HIV is
most likely early in the infectious process when there is viraemia of
high titre, or later in the development of AIDS itself when the level
of viraemia increases again.
22
Zoonoses and Vector-borne virus infection
Zoonoses
The zoonoses are human infections in which the

principal reservoirs of the viral agent are wild and
domestic mammals, birds and possibly other species
such as reptiles
Rabies is an example of a zoonosis not involving

vectors. In most of the world, rabies is widely distributed
in a variety of mammals, the predominant species
varying from region to region.
23
Zoonoses not involving arthropods are typical of infections

produced by arenaviruses and hantaviruses.
With both, rodents and other wildlife hosts are responsible

for transmission and maintenance of infection.
Sometimes the rodents become diseased, but in most

cases the infections are inapparent.
Humans become involved incidentally and have no further

role in maintenance of the chain of transmission.
24
Arboviruses
The principal vector is the mosquito, although there are

important infections involving ticks and other arthropods.
Many are also zoonoses, in which the infection is maintained in

wild or domestic animals (the reservoirs), humans being
involved only occasionally as dead-end hosts.
Two important infections, both transmitted preferentially by the

mosquito Aedes aegypti, which can be spread from human to
human by the vector, are yellow fever an
25
Other Arboviruses
The most important arbovirus of eastern and southeast Asia is

Japanese encephalitis virus(JEV).
It is responsible for large numbers of cases of severe encephalitis in

humans.
This disease is mosquito-transmitted and occurs in rice-growing

regions which generally have a high mosquito density.
The principal reservoir is pigs, which are also common in the region.
Because vector control in these areas has been difficult, emphasis
has been placed on vaccination.
26
VIRUSES AND CHRONIC DISEASES
Persistent infection is well documented for many DNA

viruses and some RNA viruses.
The herpesvirus group is well known for producing

persistent infections (recurrent cold sores or genital
ulcers caused by herpes simplex virus and herpes
zoster due to varicella-zoster virus).
The retroviruses, including HIV, are also characterized

by long-term chronic infection.
27
VIRUSES AND CHRONIC DISEASES
Various chronic conditions have been related to viral

infections by the application of epidemiological studies.
 HBV, HCV - hepatocellular carcinoma
 Papilomavirus - cervical carcinoma
 EBV - Burkitt’s lymphoma

- Nasopharyngeal carcinoma
28
29

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MLT503 LECTURE 1

• Overview of virus epidemiology

Epidemiology describes the occurrence of illness

Epidemiology also provides experimental

They are essential when no animal model is available.

Epidemiology provides definitions that help to

Two terms used are:

 Secondary Attack Rate

The dilution at which 50% of animals show disease is the

Except for certain self-limited infections such as those

Secondary Attack Rate (SAR)

It is more than a measure of infectivity: it describes

Pathogenicity and virulence

Pathogenicity – able to cause disease

compares the capacity of different

In the epidemiological sense, ‘Pathogenicity' is the

Pathogenicity and virulence

‘Virulence' compares the severity of disease caused by

'Virulence' here indicates the capacity of a pathogen to

The likelihood of a fatal outcome is calculated as the

Pathogenicity and virulence

Polio is an illustration of the relative independence of

The disease shows only 0.1-1% of infections are

Therefore the virus would be considered of relatively

Generally, descriptions of infections or diseases

Personal factors important in viral illness:-

 Age and gender

Viral infections in person, place and time

Factors related to place:

Place of occurrence of viral infection may be related to

Other physical or biological environmental factors

Viral infections in person, place and time

Factors related to time:

Time of occurrence is usually the most systematically evaluated of

The terms epidemic, endemic and sporadic do not have any

Epidemic: occurrence of an infection at a higher than expected

Viral infections in person, place and time

Factors related to time:

Two critical terms used in epidemiology that have

Incidence is the number of new (acute) cases of a disease

Epidemiological implications for some specific virus:

Viruses are responsible for the bulk of respiratory

Being surface infections (mucosa), they do not produce

Parainfluenza and RSV, may cause severe disease in

Respiratory viruses (cont..)

Rhinoviruses and coronaviruses produce only cold-like

Rhinoviruses, as the principal agents of the common cold,

Influenza is potentially serious in all individuals who develop

The elderly and those with chronic illnesses experience the

Viruses infecting the gastrointestinal tract

Rotaviruses are the main cause of dehydrating

Although infants and young children in developing

Viruses infecting the gastrointestinal tract

The enteroviruses are generally transmitted by the faecal-

Polio is the best known of the enteroviruses, producing a

Hepatitis A is an enterovirus. Spread in the developed

Viral infections with blood-borne transmission

HIV & HCV are the most extensively studied blood-borne

Hepatitis B transmission is most likely during periods of

Hepatitis B is transmissible not only through blood and

Viral infections with blood-borne transmission

When human immunodeficiency virus (HIV) was first