Natural History of

Disease

Background

Infectious disease epidemiology

the occurrence of infectious disease in a
given host is dependent on the presence
of disease in other members of the
population and the length of time that
infected hosts are able to transmit
disease to others
understanding these characteristics of a
disease allow us to develop rational
measures to control disease

Definition & Stages

Definition ; The course of a disease from onset
(inception) to resolution.
Stages
Progress to a fatal termination

Stage of
pathologic
onset

Pre-symptomatic
stage

Risk Factors

Precursors

Clinically
manifest disease

Remission and relapses

Regress spontaneously,
leading to recovery

Effect of Treatment

Prognostic factor

Risk factor
Risk factor; An aspect of personal behavior or life style, an

environmental exposure, or an inborn or inherited characteristic,

that, in the basis of epidemiologic evidence, is known to be
associated with health-related condition (s) considered important
to prevent.
Risk marker; increased probability of a specified outcome; not
necessarily a causal factor
Determinant; can be modified by intervention, thereby
reducing the probability of occurrence of disease or other
specified outcomes

The Natural history of disease in a

patient
Preclinical Phase

(A)

(P)

Clinical Phase

(S)

(M)

A ; Biologic onset of disease

P ; Pathologic evidence of disease if Sought
S ; Signs and symptoms of disease
M ; Medical care sought
D ; Diagnosis
T ; Treatment
Gordis L. Epidemiology. WB Saunders Company. 1996

(D)

(T)

THE NATURAL HISTORY OF A DISEASE

STIMULUS to
the HOST
interrelation of
Agent, Host and
Environmental
factors
PREPATHOGE
NESIS
Health
Promotion
Specific
Protection

HOST REACTION
Latent Period (Presymptomatic)

Symptoms,
Signs(Clinical)

RECOVERY
with or without Defects,
Disability

PERIOD OF PATHOGENESIS

Early Diagnosis and Prompt

Treatment,

Disability Limitation
Rehabilitation

PRIMARY
SECONDARY
TREATMENT
TERTIARY PREVENTION
PREVENTION
PREVENTION
(Leavell's Level of Application of Preventive Medicine)

TIME
Death
Clinical disease

Infection
Susceptible
host

Recovery
No infection

Incubation period
Latent
Exposure

Non-infectious

Infectious
Onset

Latent period
the time interval from infection to development
of infectiousness
Infectious period
the time during which time the host can infect
another susceptible host
Non-infectious period
the period when the hosts ability to transmit
disease to other hosts ceases
Incubation period
the time interval between infection to
development of clinical disease

 e.g

: Chicken pox

an

infectious disease caused by the

varicella-zoster virus
the latent period for chicken pox is shorter
than the incubation period, so a child with
chicken pox becomes infectious to others
before developing symptoms

TIME
Death
Infection

Clinical disease

Susceptible
host

Recovery
No infection

Incubation period
Latent
Exposure

Infectious

Non-infectious
Onset

 Other
HIV

examples?
(AIDS)

latent

period relatively short

infectious period occurs (many years) before the
onset of symptoms

TIME
Death
Infection

Clinical disease

Susceptible
host

Recovery
No infection

Incubation period
Latent
Exposure

Infectious
Onset

e.g : Malaria
caused

by protozoan parasites of the genus

Plasmodium
the stages of the parasite that are infective to
mosquitoes occur about 10 days after the
development of symptoms
latent period is around 10 days longer than the
incubation period, so early treatment of
symptoms could have an important effect on
transmission

Natural history of disease

TIME
Death
Infection

Clinical disease

Susceptible
host

Recovery
No infection

Incubation period
Latent
Exposure

Infectious
Onset

Latent Period of Chronic

Disease

Definition; "Interval between exposure to a diseasecausing agent and the appearance of manifestations of
the disease"
cf. incubation period in infectious disease
1) brief exposure
Two conditions
2) prolonged or continuous exposure

Primary Prevention

'Preventing

the occurrence of disease or injury by

modifying risk factors.'
'Various aspects are considered to produce effective
primary prevention program. Especially, advancing
knowledge of disease causation must be required.

Primary Prevention
** Guidelines for effective prevention programs(RB
Wallace, GD Everett,1986)
Programs must be based on scientific evidence.
Prevention programs should be supported by effective
data system.
Programs should be flexible.
Programs must be sensitive to ethical issues.
Programs should be targeted to the recipients most in
need.
Programs should muster a variety of community
resources.
Effective prevention requires legislative action and
social policy decisions.
Programs should be continuous.

Primary Prevention

General health promotion

'Proper nutrition, mental hygiene, adequate housing, and appropriate

balance between work and play, est and exercise, and useful and
productive place in society, are among the best recognized factors
ontributing to maintenance of optimum health.(Commission on
Chronic illness, USA, 1957)

Specific protection
Health Promotion

'Health promotion is any combination of educational, organizational,

economic, and environmental supports for behavior and conditions of
living conducive to health (LW Green, 1992).'

Criteria for the Development of Health

Promotion and Education Programs
A health promotion program should address one or more risk

factors which are carefully defined, measurable, modifiable,

and prevalent among the members of a chosen group, factors
which constitute a threat to the health status and the quality of
life of target group members.
A health promotion program should reflect a consideration of

the special characteristics, needs, and preferences of its target

groups(s)

From APHA Technical Report

Criteria for the Development of Health

Promotion and Education Programs
health promotion programs should include interventions which will

clearly and effectively reduce a targeted risk factor and are appropriate
for a particular setting
A health promotion program should identify and implement

interventions which make optimum use of available resources.

From the outset, a health promotion program should be organized,

planned, and implemented in such a way that its operation and effects
can be evaluated.

Secondary Prevention

'Early detection and intervention, preferably before the

condition is clinically apparent, and has the aim of
reversing, halting, or at least retarding the progress of a
condition.

'It sometimes happens that a patient first becomes aware

of a disease when it is already too late for it to be
successfully treated.

Tertiary Prevention
'Minimizing

the effects of disease and disability by

surveillance and maintenance aimed at preventing
complications and premature deterioration'

Medical
Social

rehabilitation

rehabilitation