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Epidemiology
Terminologies
Epidemiology (epi means upon, demos means population, logy means study)
is the science that deals with occurrence, determination, distribution and
control of a disease.
When a disease occurs occasionally and at irregular intervals in a human
population is known as sporadic disease. e.g. typhoid.
A disease maintaining a steady, low level frequency at a regular interval is
called endemic disease. e.g. common cold.
A sudden increase in occurrence of a disease beyond a limit is called
epidemic.
If the occurrence of a disease increases within a large population over a wide
region, it is called pandemic (pan means all).
Frequency of a Disease
The infectious diseases have characteristic signs and symptoms. Signs are objective
changes in body, for example fever.
Symptoms are the subjective changes for example pain, loss of appetite, etc.
A disease syndrome includes a set of signs and symptoms due to a particular disease;
for example an AIDS patient experiences disease syndrome.
The characteristic symptoms of a disease develop during certain phases. The knowledge
of the phases helps in recognition of a disease.
Incubation period is the time required after Infection to the appearance of
signs/symptoms. Incubation period varies organism to organism.
Second is the prodromal stage is the period during which there is onset of signs and
symptoms of a disease. It cannot be clearly found out.
Third, the period of illness during which the disease gets fully established and becomes
most severe with characteristic signs and symptoms. The immune system is triggered.
The last characteristic phase is the period of decline when signs and symptoms
disappear and the disease is recovered gradually. This stage is known as convalescence.
Herd Immunity
Disease Cycle
The infectious disease cycle is the chain of events that includes epidemiological story of
the infectious agents. Knowledge of disease cycle helps in control of the disease.
The following aspects are linked with disease cycle.
Sources of Disease: A source is the site or location where the pathogens spread to a new
host either through environmental factors such as soil, water, air, food or indirectly
through animals or humans.
Reservoirs: Reservoirs are the natural environment such as soil, water or air or
susceptible animal hosts where pathogens survive.
Carriers: Carriers are the individuals already infected with pathogens. Humans are the
most important carriers of certain pathogens.
Four types of carriers have been recognised: active carriers (who have an overt clinical
case of disease), convalescent carriers (who have recovered from the infectious disease
but contain pathogens in sufficient number), healthy carriers (who harbour pathogens
without being affected), and incubatory carriers (who incubate pathogen into a large
number without falling ill).
Etiological agent
Nonhuman hosts
Transmission to
humans
Anthrax
Bacillus anthrocis
Cattle, horse,
sheep, goat, cats,
dogs, birds
Direct contact
ingestion /
inhalation of
spores
Encephalitis
Arbovirus
Birds, rats
Mosquito
Giardiasis
Giardia lamblia
Rodents, cats,
dogs, cattle
Contaminated
water
Glanders
Pseudomonas mallei
Horses
Skin contact,
inhalation
Plague
Yersinia pestis
Domestic rats
Flea bite
Rabies
Rabies virus
(Rhabdovirus
group)
Bite of rabid
animals
Q Fever
Coxiella burnetii
Inhalation of
infected soil or
dust
Tuberculosis
Mycobacterium
bovis
Milk, direct
contact
Transmission of Pathogens
Transmission from one host to other occurs by any of four main routes:
Air borne Transmission,
Contact Transmission,
vehicle Transmission and
vector-borne Transmission.
Air-borne Transmission: The pathogens remain suspended in air and are
transmitted through droplet nuclei of small particles (1 - 4 micro metre
diameter) left from evaporation of large particles (10 micro metre diameter).
The droplet nuclei remain in air for hours or days and carried to individuals
because the pathogens cannot grow in air.
Examples of some air borne diseases are chickenpox, flu, measles, mumps,
viral pneumonia, diphtheria, pneumonia, tuberculosis, meningitis, etc.
Contact Transmission: Some of the pathogens are spread when contact of host is done
with the reservoir of pathogen. Contact refers person-to-person contact through
touching, kissing, or sexual contact.
Examples herpes and boils (through contact of oral secretions or body lesions),
infection of staphylococci (by nursing mothers), and AIDS and syphilis (through
placenta or blood to blood contact).
Immunization of Individuals:
For increasing the level of herd immunity, mass immunization programmes
are launched. At International level several programmes have been launched
by the World Health Organisation (WHO), for example AIDS, etc.
Methods of Disinfection
Physical Method
1). Disinfection by heat (It is costly to do Pasteurization)
2). Disinfection by light (UV radiation / Gamma radiation). It is an
excellent disinfectant and does not leave any known chemical residual.
Efficiency of disinfectant depends on
Depth of penetration
Time of contact
Turbidity or suspended solid that may reduce the effective depth
of penetration
Chemical Disinfectants
Oxidising Chemicals These comprises of
i.
The Halogens Chlorine, Bromine and Iodine
ii.
Ozone
iii. Other oxidants like Hydrogen Peroxide and Potassium
Permanganate
Metal ions Silver ions are bactericidal. Copper ions are strongly
algicidal.
Properties of Disinfectants
Harmless
Unobjectionable taste
Economical
Easily measurable
Should maintain a residual
Should not react with all normal
constituents
Should be easy to handle and operate
Common Methods
Exposure to Sun
Boiling
Halogens (Cl2 , I2 , Br2)
Ozone
Excess lime
Potassium Permanganate
Silver
Boiling
15 20 minutes
Not immediate
No residual
Costly
U V Rays
1000 4000 m
Sunlight
Hg vapour bulbs
5 cm depth of water
Better efficiency
Removal of Turbidity & color essential
No residual
Costly
Ozone
Unstable produces nacsent oxygen
Very powerful oxidizing agent
2-3 ppm produces a residual of 0.1 ppm
after 10 15 min.
Also removes color, odor, and taste
Needs skilled labour
Excess Lime
pH > 9.5 kills most m.o.
Slight excess after softening
Requires reduction in pH before
consumption
KMnO4
Silver
Very costly
Ag ions introduced by silver elcetrodes
at 1.5 V DC.
Dose 0.05 0.1 mg/L ; 15 180 min
contact
Necessary to remove organic matter
and H2S.
CHLORINE
Action unclear
By nascent Cl liberated from Hypochlorous
acid and oxidation?
By chemically reacting with the protoplasm?
Inactivation of enzyme system in cells ?
by penetrating the cel walls and attacking the
enzymes?
by reaction of hypochlorous acid with enzymes?
Chloramines
(Combined Chlorine)
NH3 + HOCl NH2Cl + H2O ( pH > 7.5)
Dosage of Chlorine
Depends on pH
Acidity in water
Temperature
Contact time ( 10 20 minutes)
Interfering chemicals
Normal dosage 0.3 11 mg/L
A residual of 0.1 0.2 mg/L required
Applications
As Liquid Cl2
Liquefies at 7.kg.cm2.
Available in cylinders of 50 100 kg.
Temp. to be maintained > 10 0C, other wise
crystallizes
Safe, Non explosive ( explosive if mixes with
CO2)
Causes irritation to lungs and nose if > 10 mg/L
Easy to store, transport, economical. Non
skilled, very effective, uniform application, no
sludge formation
Applications ( Contd.)
Hypochlorites ( Calcium or Sodium)
CHLORINATION PRACTICE
1. PLAIN CHORINATION
Only chlorine added, no other treatment, usually 0.5 mg/L
To treat relatively clean water
3.
4.
5.
6.
7.
Contact Time:
One of the most important variables in the disinfection
process in contact time.
Working in England in the early 1900s, Harriet Chick
observed that for a given concentration of disinfectant,
the longer the contact time, the greater the kill. This
observation was first reported in the literature in 1908
(Chick, 1908). In differential form, Chicks law is
dNt = - kNt ------------------------(1)
dt
where,
dNt /dt = rate of change in the concentration of
organisms
with time
k= inactivation rate constant, T-1
Nt= number of organisms at time t
T= time
Concentration of Disinfectant
In the early 1900s, Herbert Watson reported that the
inactivation rate constant was related to the concentration as
follows (Watson, 1908):
k = kCn --------------------(4)
where,
k = inactivation rate constant
k= die-off constant
C = concentration of disinfectant
n = coefficient of dilution
Combining the expressions proposed by Chick and Watson in
differential form yields (Hass and Kara, 1984)
dNt = - kCnt ------------------(5)
dt