FCM (Dra.

Collao)
Epidemiology of Infectious Diseases

13 November 08

Objectives:
At the end of the session, the student must be able to:
1. Define the following:
• sporadic, endemic, epidemic, pandemic,
• herd immunity,
• attack rates
2. Differentiate:
• Communicable from non-communicable disease
• Isolation from quarantine
• Mechanical from biological vector
• Incubation from generation period
3. Describe the intrinsic properties of disease agents
4. Discuss the different host agent interaction.
5. Discuss the different pathogenetic mechanism
6. Discuss the different mechanism of transmission.
Infectious Diseases
• Also known as communicable diseases.
• Transmitted directly to man from man (anthropo-
zoonoses) or from animals (zoonoses) to man.
• Characterized by cyclic periodicities and seasonal
predilections
• Genetics only an indirect role = predispositions
The EPIDEMIOLOGIC TRIANGLE
Man
• Endemic:
• Sporadic: occurrence of disease, on and off, cases
seemingly unrelated to each other, low incidence level
• Pandemic: a marked increase in disease incidence of
world-wide or continental distribution, usually of sudden
occurrence
• Herd immunity: resistance of a group to invasion and
spread of an infectious agent
• Secondary attack rate: rate thru which spread of
disease is measured
- number of cases of a disease developing during a
stated time period among those members of a
closed group who are at risk
= # of new cases in a group – initial case(s)_
# of susceptible persons in the grp –initial cases
EPIDEMICS
• Also called outbreaks
• Occurrence of a disease over and above its expected
levels of occurrence.
• Should be qualified by the presence of clustering
:chronological and geographic
Establishng Levels of Occurrence
• Taking the averages (over a period of 3-4 years)
• Consider highs and lows
• Use of incidence and prevalence

Environment
Disease Transmission is Affected By:
• Factors intrinsic to man
• Factors intrinsic to the disease
• Role of vectors
EPIDEMICS
Disease agent • Are calamities in themselves
• May result from the occurrence of natural or physical
calamities
• Occurs as a result of environmental sanitation
breakdown, displacement of populations and more
conducive environmental conditions for disease
prevalence and transmission

Necessary…
• Factors intrinsic to the environment
• early detection and management of cases
• surveillance : monitor trends
The study of these factors and their dynamics in disease • identify cause
transmission is EPIDEMIOLOGY

The methodology for this study consists of:

• Data generation • plan preventive measures
• Data analysis
• Evidence-based intervention planning Origin/ Cause of Epidemics:
• New Disease
The main tool used for data generation is o Introduction of disease to the community for the first
DISEASE SURVEILLANCE time
o Dse of lower animals affecting man for the first time
Sources of Data
o Dse discovered for the first time
• field health service information system
• program-based reports • Old Disease
• illness reports o Introduction of new strain of the disease
o Immigration of a large number of susceptible
Terms: individuals
C2 of 1C 1 of 3
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o Decrease resistance of population due to Agent

catastrophe such as famine, earthquakes, floods, - any element, substance, or force whether living or non-
etc living, the presence of which can initiate or perpetuate a
o Increased virulence/ pathogenicity disease process
- Types:
o Living vs non-living
o Physical , mechanical
o Increased agent population o Chemical, nutrients
- Characteristics:
Termination of Epidemic • Inherent: physical features, biologic requirements,
• Exhaustion of susceptibles chemical make-up, viability, resistance
• Elimination of the agent • Those directly related to man: infectivity,
• Closure of secondary transmission pathogenicity, virulence, antigenicity
Differentiate: • Those related to the environment: reservoirs and
• Communicable vs non-communicable disease sources of infection and mode of transmission
• Isolation vs quarantine
• Mechanical vs biological reservoir

Those directly related to man

• Incubation period vs generation period • Infectivity: ability to gain access and adapt to the
human host to the extent of finding lodgment and
Communicable disease: due to a specific infectious agent or its multiplication
toxic products, arising through transmission of that agent or its • Pathogenicity: measures the ability of the agent to
products from reservoir to susceptible host, either directly as from cause a specific reaction
an infected person or animal or indirectly by the agency of an
• Virulence: severity of the reaction, usually measured in
intermediate plant or animal host, a vector, or the inanimate
environment; also includes infestation terms of fatality
• Antigenicity: ability to stimulate a response
Incubation period: from the time the agent enters the host to the
time the disease becomes manifest. Different pathogenetic mechanisms
• Direct tissue invasion
Generation period: period between the receipt of infection by a • Production of a toxin
host and maximal communicability of the host • Immunologic enhancement or allergic reaction leading to
damage to the host
• Describe the intrinsic properties of disease agents • Persistent or latent infection
• Discuss the different host-agent interaction. • Enhancement of host susceptibility to drugs of otherwise
• Discuss the different pathogenetic mechanism minimal toxicity
• Discuss the different mechanism of transmission. • Immune suppression

The Ecologic Model of Disease Causation Different mechanisms of transmission

• Direct transmission
1. 1.The lever or Balance • Indirect transmission:
o Vehicle-borne
Host Agent o Vector-borne:
 Mechanical
Environment  biological
o Airborne: 1-5 um
 Droplet nuclei
Host Agent  Dust

Disease Causation
1. Agent increase in virulence or taken in massive doses
Evironment 2. Agent remains the same but there is a change in the
characteristic of the host-
2. Ecologic Model a. Decrease in host resistance
Host b. Change in the activity of the host – increase in
contact with the diseased person

Isolation & Quarantine

• Isolation – separation during the period of
Agent Environment communicability of infected persons or animals from
others .
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• To prevent the spread of the disease to those who are

susceptible.
a. Hands must be washed after contact with the patient
or potentially contaminated articles and before
taking care of another patient.
b. Articles contaminated with infectious materials
should be appropriately discarded or bagged &
labeled before being sent for decontamination &
reprocessing.

Categories of Isolation : 7 categories

1. Strict Isolation – to prevent highly contagious and virulent
infections that may spread by both air and contact .
• Specification:
• Private room
• Use of mask , gloves & gown for all persons
entering the room.
• Special ventilation requirements with the room at
negative pressure to surrounding areas is desirable

2. Contact Isolation –
• For less highly transmissible or serious infections
• Disease or conditions which are spread primarily by
close or direct contact.
3. Respiratory Isolation – diseases spread through the air
4. Tuberculosis Isolation-
5. Enteric Precaution
6. Drainage Secretion precaution
7. Blood & Body fluid precaution