Epidemiology of Infectious Diseases

-Ma. Eufemia M. Collao, MD DPAFP

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 Communicable from non-communicable disease Isolation from quarantine Mechanical from biological vector Incubation from generation period

2. Differentiate:

Cont’n…
1. Describe the intrinsic properties of disease agents 2. Discuss the different host agent interaction. 3. Discuss the different pathogenetic mechanism 4. 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

ENVIRONMENT

DISEASE AGENT

Disease Transmission is Affected By :

Factors intrinsic to man Factors intrinsic to the disease Role of vectors Factors intrinsic to the environment

The study of these factors and their dynamics in disease transmission is

EPIDEMIOLOGY

The methodology for this study consists of

Data generation Data analysis Evidence-based intervention planning

The main tool used for data generation is

DISEASE SURVEILLANCE

SOURCES OF DATA

FIELD HEALTH SERVICE INFORMATION SYSTEM PROGRAM-BASED REPORTS NESS REPORTS

Terms:
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 worldwide 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

Secondary attack rate: 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

EPIDEMICS
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…
EARLY DETECTION AND MANAGEMENT OF CASES SURVEILLANCE : monitor trends IDENTIFY CAUSE PLAN PREVENTIVE MEASURES

Origin/ Cause of Epidemics: New Disease
Introduction of disease to the community for the first time Dse of lower animals affecting man for the first time Dse discovered for the first time

Old Disease
Introduction of new strain of the disease Immigration of a large number of susceptible individuals Decrease resistance of population due to catastrophe such as famine, earthquakes, floods, etc Increased virulence/ pathogenicity Increased agent population

Termination of Epidemic
Exhaustion of susceptibles Elimination of the agent Closure of secondary transmission

Differentiate:
Communicable vs noncommunicable disease • Isolation vs quarantine • Mechanical vs biological reservoir • Incubation period vs generation period

Communicable disease: due to a specific infectious agent or its toxic products, arising through transmission of that agent or its products from reservoir to susceptible host, either directly as from an infected person or animal or indirectly by the agency of an intermediate plant or animal host, a vector, or the inanimate environment; also includes infestation

Incubation period: from the time the agent enters the host to the time the disease becomes manifest. Generation period: period between the receipt of infection by a host and maximal communicability of the host Isolation vs quarantine Mechanical vs biological vector

Describe the intrinsic properties of disease agents Discuss the different host-agent interaction. Discuss the different pathogenetic mechanism Discuss the different mechanism of transmission.

The Ecologic Model of Disease Causation
1. The lever or Balance

Host agent

Environment

The Ecologic Model of Disease Causation
1. The lever or Balance

Host agent

Environment

Ecologic Model
Host

agent

environment

Agent: any element, substance, or force whether living or non-living, the presence of which can initiate or perpetuate a disease process Types:
Living vs non-living Physical , mechanical Chemical, nutrients

Characteristics:
Inherent: physical features, biologic requirements, chemical make-up, viability, resistance Those directly related to man: infectivity, pathogenicity, virulence, antigenicity Those related to the environment: reservoirs and sources of infection and mode of transmission

Those directly related to man
Infectivity: ability to gain access and adapt to the human host to the extent of finding lodgment and multiplication Pathogenicity: measures the ability of the agent to cause a specific reaction Virulence: severity of the reaction, usually measured in terms of fatality Antigenicity: ability to stimulate a response

Different pathogenetic mechanisms
Direct tissue invasion Production of a toxin Immunologic enhancement or allergic reaction leading to damage to the host Persistent or latent infection Enhancement of host susceptibility to drugs of otherwise minimal toxicity Immune suppression

Different mechanisms of transmission
Direct transmission Indirect transmission:
Vehicle-borne Vector-borne: Mechanical biological Airborne: 1-5 um Droplet nuclei Dust

3. 4. 6. 7.

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

Isolation & Quarantine
Isolation – separation during the period of communicability of infected persons or animals from others . To prevent the spread of the disease to those who are susceptible.

Isolation & Quarantine
Categories of Isolation : 7 categories 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.

Isolation & Quarantine
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

Isolation & Quarantine
Categories of Isolation : 7 categories 2. Contact Isolation – For less highly transmissible or serious infections Disease or conditions which are spread primarily by close or direct contact.

Isolation & Quarantine
Categories of Isolation : 7 categories 3. Respiratory Isolation – diseases spread through the air 4. Tuberculosis Isolation5. Enteric Precaution 6. Drainage Secretion precaution 7.Blood & Body fluid precaution

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