EPIDEMIOLOGY y Study of disease origin and spread of disease; pattern of disease development y Is the study of occurrences & distribution

of diseases as well as the distribution & determinants of health states or events in specified population, & the application of this study to the control of health problems. y Is the backbone of the prevention of the disease. y Concerned w/ the study of distribution of disease (age, gender, race, geography, time & etc) & the search for determinants/causes of the disease (explanation). USES OF EPIDEMIOLOGY According to Morris, epidemiology is used to: y Study the history of the health population & the rise and fall of diseases & changes in their character. y Diagnose the health of the community & the condition of people to measure the distribution & dimension of illness in terms of incidence, prevalence, disability & mortality, to set health problems in perspective & to define their relative importance & to identify groups needing special attention. y Study the work of health services w/ a view of improving them. Operational research shows how community expectations can result in the actual provision of service. y Estimate the risk of disease, accident, defects & the chances of avoiding them. y Identify syndromes by describing the distribution & association of clinical phenomena in the population. y Complete the clinical picture of chronic disease & describe their natural history. y Search for causes of health & disease & describe their natural history. y Search for causes of health & disease by comparing the experience of groups that are clearly defined by their composition, inheritance, experience, behavior & environments. EPIDEMIOLOGIC TRIANGLE y A change in any component will alter an existing equilibrium to increase or decrease the frequency of the disease.
Human host of organism Animals are considered only as they relate to human health

Agent transmitted from the source to susceptible body. It s the intrinsic property of microorganisms to survive & multiply

Environment the sum of all external conditions. Affects development of organism w/c can be biological, social & physical. Affects both agents & hosts

CLASSIFICATION OF AGENTS, HOST & ENVIRONMENTAL FACTORS W/C DETERMINE THE OCCURRENCE OF DISEASE IN HUMAN POPULATION 1. Agents of Disease A. Nutritive elements Excess Deficiencies B. chemical agents Poisons Allergens C. Physical agents D. Infectious agents Metazoa Protozoa Bacteria Fungi Rickettsia Viruses E. Mechanical Etiological Factors: (examples)

Cholesterol Vitamins, Proteins Carbon monoxide, Drugs Ragweed, Poison ivy Heat, Light, Ionizing radiation Hookworm, Schistosomiasis Amoeba, Malaria Rheumatic fever, Lobar pneumonia, Typhoid Histoplasmosis, Athletes foot Rocky mountain, Spotted fever Measles, Mumps, Chickenpox, Polio, Rabies stab or trauma

2. Host Factors (Intrinsic Factors) influences exposure, susceptibility or response to agents. A. Genetic Sickle cell disease B. Age C. Sex D. Ethnic group E. Physiologic Fatigue, pregnancy, puberty, stress F. Immunologic Experience Hypersensitivity Types of Immunity: a. Active Immunization antibodies are produced by the body in response to infection. I. Natural antibodies are formed in the presence of active infection in the body. It is lifelong. (e.g. recovery from mumps, chicken pox) II. Artificial antigens (vaccines or toxoids) are administered to stimulate antibody production. Requires booster inoculation after many years. (eg. Tetanus toxoid, oral polio vaccine). b. Passive Immunization antibodies are produced by another source such as animal or human. I. Natural antibodies are transferred from the mother to her newborn through the placenta or in the colostrums. II. Artificial immune serum (antibody) from an animal or another human is injected to a person. (e.g. tetanus immunoglobulin human/TIGH) TYPES OF NATURAL IMMUNITY: Racial inherent to a certain race e.g. blacks against yellow fever Hereditary thru sexual cells or genes Congenital resistance of the baby in the uterus thru placenta Individual to a distinct person

G. Inter current or pre-existing disease H. Human Behavior Personal hygiene, Food handling 3. Environmental Factors (Extrinsic Factors) influences existence of the agent, exposure, or susceptibility to agent. A. Physical Environment is composed of the inanimate surroundings such as the geophysical conditions of the climate. eg. Geology, Climate B. Biological Environment - makes up the living things around us such as plants & animal life. Human Population Density Flora Sources of food, Influence on vertebrates & anthropod as source of agent C. Socio-economic Environment w/c maybe in the form of level of economic development of the community, presence of social disruptions & the like. Occupation Exposure to chemical agents Urbanization Urban crowding, tension & Pressures Disruption Wars, Disasters PHASES OF EPEDIMIOLOGIC APPROACH 1. Descriptive Epidemiology concerned with the disease distribution and frequency 2. Analytical Epidemiology attempts to analyze the causes or determinants 3. Intervention or Experimental Epidemiology answers questions about the effectiveness of new methods for controlling disease or for improving underlying conditions. 4. Evaluation Epidemiology measures the effectiveness of health services program.

DESCRIPTIVE EPIDEMIOLOGY epidemiological approach concerned with disease distribution and frequency Aspects involved in descriptive epidemiology A. Observation and recording of existing patterns of occurrence of disease condition 1. Conducting screening and case finding activities y Screening is the presumptive identification of unrecognized diseases or defects through the application of diagnostic test of laboratory examinations and clinical assessments. y Casefinding looking for previous unidentified cases of diseases y Sensitivity proportions of people who have the disease who test positive on a screening test y Specificity is the proportion of persons without a disease who have negative results on screening tests. 2. Record the disease frequency, risk of exposure as of rates B. Description of a disease as to person, place, time Epidemiological Variables

Time. Refers both to the (1.) period w/c the cases of the disease being studied were exposed to the source of infection & (2.) the period during w/c the illness occurred. a. Short time fluctuations  Common source of epidemics is characterized simultaneous exposure of a large number of susceptible to a common infectious agent.  Propagated epidemic is caused by a person-to-person transmission of disease agent. b. Cyclical variation refers to recurrent fluctuations of disease that may exhibit cycles lasting for certain periods. Ex. Waterborn Disease, Influenza, Leptospirosis, Dengue c. Variable variation changes in disease frequency over a period of many years Persons . Refers to characteristics of the individual who were exposed & who contacted the infection or the disease in question. Persons can be described in terms of their inherent or their acquired characteristics (such as age, race, sex, immune status, & marital status); their activities (form of work, play, religious practice, customs); & the circumstances under w/c they live (social, economic & environmental condition) Place refers to the features, factor or conditions w/c existed in or described the environment in w/c the disease occurred. It is the geographic area described in terms of street, city, municipality, province, region or country. a. Urban - Rural Differences: in general, diseases spreads more rapidly in urban areas than in rural areas primarily because of the greater population density of urban area w/c provides more opportunities to susceptible individual to come into contact w/ a source of infection. b. Socio- economic areas: different communities can be usually divided into geographic areas w/c are relatively homogeneous w/ respect to the socio-economic circumstances of the residents. In viewing the susceptibility of the community as host, the health care team must determine the characteristics of community and its population in terms of the following a. HERD IMMUNITY state of resistance of the community from diseases or pathogens b. PATTERNS OF OCCURRENCE & DISTRIBUTION 1. Sporadic Occurrence is the intermittent occurrence of a few isolated & unrelated cases in a given locality. The cases are few & scattered, so that there is no apparent relationship between them & they occur on & off, intermittently, through a period of time. (e.g. rabies: few cases during certain weeks of the year, while there are no cases at all during other weeks) 2. Endemic Occurrence is the continuous occurrence throughout a period of time, of the usual number of cases in a given locality. The disease is therefore always occurring in the locality & the level of occurrence is more or less constant through a period of time. The level of occurrence maybe low or high (low/high endemic) e.g schistosomiasis is endemic in Leyte & Samar 3. Epidemic Occurrence is of unusually large number of cases in a relatively short period of time. There is a disproportionate relationship between the number of cases & the period of occurrence, the more acute is the disproportion, the more urgent & serious is the problem. (e.g. there has been no case of birds flu in any area of the country, so that the occurrence of few cases in a given area in a given period would constitute birds flu epidemic)

4. Pandemic is the simultaneous occurrence of epidemic of the same disease in several countries. c. EXPOSURE OR CONTACT RATE - represent the opportunities for progressive transfer of an infectious agent; depends on frequency of contact and facility of transmission Point source or common source: Epidemics common vehicle Propagated Source y Person to person propagated contact is needed for transmission of the disease y Vector propagated transmission is through vectors d. CHANCE probability of contact between the source of infection and the susceptible host and depends upon the number of sources of infection, the number of immunes and location of the source of infection.