DISEASE EPIDEMIOLOGY

Dr . A.K.AVASARALA MBBS, M.D. PROFESSOR & HEAD DEPT OF COMMUNITY MEDICINE & EPIDEMIOLOGY PRATHIMA INSTITUTE OF MEDICAL SCIENCES, KARIMNAGAR, A.P.. INDIA: +91505417

avasarala@yahoo.com

PROMPT
• DISEASE IS STILL A MYSTERY • SOME DISEASES KILL AND SOME WONT KILL • SOME ARE SHORT LIVED WHILE OTHERS ARE LONG LIVED • SOME ARE TREATABLE AND SOME ARE NOT • SOME ARE CURED BY MIRACLES (TO ACHIEVE SAINTHOOD, THERE ARE INSTANCES OF CURING BY MIRACLES)

LEARNING OBJECTIVES
• • • • • • • • THE STUDENT SHOULD LEARN DISEASE PROCESS WHAT IS DISEASE? WHAT ARE THE THEORIES OF CAUSATION OF DISEASE? HOW IS IT INITIATED? HOW IS IT CAUSED? HOW IS IT TRANSMITTED? HOW IT SPREADS? HOW IT IS DISTRIBUTED? AND WHY? HOW IT CAN BE PREVENTED? HOW IT CAN BE ERADICATED?

WHY.PERFORMANCE OBJECTIVE • STUDENT CAN USE EPIDEMIOLOGICAL APPROACH TO PREPARE A LESSON PLAN BY MAKING USE OF VON KIPLING'S SIX HONEST SERVING MEN (WHAT. WHEN. WHOM AND HOW) TO DEVELOP A LECTURE . WHERE.

WHAT EXACTLY IS A DISEASE IS STILL A ? • IS IT A SEQUENCE OF PATHOLOGICAL CHANGES AND THEIR EFFECTS OCCURRING IN THE INDIVIDUAL? • IS IT A COMPOSITE OF EFFECTS DUE TO DISTURBANCE IN MAN’S RELATIONSHIP WITH HIS ENVIRONMENT BY AN AGENT/FACTOR? .

.WHAT IS A DISEASE? DISEASE CAN BE SIMPLY EXPLAINED AS DIS AT EASE OR ILL HEALTH SOME DESCRIBE IT AS DISTURBANCE IN EQUILIBRIUM BETWEEN MAN AND HIS TOTAL ENVIRONMENT.

MULTIFACTORIAL CAUSATION THEORY .HOW THE DISEASE IS CAUSED? 1. SUPERNATURAL THEORY OF DISEASE 2. ECOLOGICAL THEORY 3. GERM THEORY 4.

NO UNANIMOUS OPINION • AT LEAST 10% OF THE PEOPLE IN DEVELOPED COUNTRIES AND 30% IN DEVELOPING COUNTRIES STILL BELIEVE IN SUPERNATURAL ORIGIN • EVEN TODAY SUPERSTITIONS ARE BECOMING MAJOR OBSTACLES IN DISEASE CONTROL • MOST OF THE LITERATES VIEW THAT DISEASE IS THE RESULT OF MICROBES • MOST OF THE UNEDUCATED PEOPLE (90%) BELIEVE THAT DISEASE IS DUE TO BAD PHYSICAL ENVIRONMENT .

. PEOPLE USED TO PLEASE THE GODS BY PRAYERS AND OFFERINGS OR USED TO RESORT TO WITCHCRAFT TO TAME THE DEVILS. THE DISEASE WAS THOUGHT MAINLY DUE TO EITHER THE CURSE OF GOD OR DUE TO THE EVIL FORCE OF THE DEMONS.SUPERNATURAL THEORY OF DISEASE: • IN THE EARLY PAST. ACCORDINGLY.

ECOLOGICAL THEORY • AROUND 463 BC. HIPPOCRATES IS THE FIRST EPIDEMIOLOGIST WHO ADVISED TO SEARCH THE ENVIRONMENT FOR THE CAUSE OF THE DISEASE. .

OTHER LIVING CREATURES. GEOGRAPHY. AND CLIMATE. PLANTS. . ANIMALS. MICRO ORGANISMS.ENVIRONMENTAL INFLUENCE • INTERACTIONS AMONG HUMANS. AND TOPOGRAPHY ARE SO COMPLEX THAT DESPITE MUCH STUDY WE ARE OFTEN UNCERTAIN WHAT IS REALLY HAPPENING. ECOSYSTEMS.

IMPROVED HEALTH OWES LESS TO ADVANCES IN MEDICAL SCIENCE THAN TO THE OPERATION OF NATURAL ECOLOGICAL LAWS .ECOLOGICAL DETERMINANTS OF DISEASE • MCKEOWN HAS POINTED OUT.

ROBERT KOCH . Pasteur. Koch were the strong proponents of microbial theory after they discovered the microorganisms in the patients’ secretions or excretions.GERM THEORY • Germ theory: Microbes (germs) were found to be the cause for many known diseases. Henle.

And that germ can again be isolated from that sick animal experimented with.HENLE-KOCH POSTULATES Henle and Koch have postulated that 1. . that disease can be caused in animals experimentally.Without that germ that disease will not be caused 3.Each disease will be caused by a germ 2.By introducing that germ . 4.

MULTIFACTORIAL CAUSATION THEORY • PETTENKOFFER STATED THAT AGENT. HOST AND ENVIRONMENTAL FACTORS WILL ACT AND INTERACT SYNERGISTICALLY AND ACT AS JOINT INDEPENDENT PARTNERS IN CAUSING THE DISEASE. PETTENKOFFER .

WHEN THE DISEASE OCCURS? Agent (SEED) factors DISEASE OCCURS ONLY WHEN THE HOST FACTORS AND ENVIRONMENTAL FACTORS MAKE THE AGENT SUFFICIENT ENOUGH TO CAUSE THE DISEASE D Host factors (SOIL) Environmental factors (SHOWER) .

CAUSAL CONSTELLATIONS disease ABCDE Causal constellations 1 AFGHJK 2 ALMNPQ 3 ARSTX 4 A = NECESSARY CAUSE B TO X = CAUSAL PARTNERS .

EXAMPLES LUNG CANCER IS CAUSED BY A CONSTELLATION OF CAUSES LIKE • • • • SMOKING UNFILTERED CIGARETTES 10 YEARS DURATION AND HOST SUSCEPTIBILITY .

TISSUE INSULT DUE TO CHRONIC IRRITATION • Chronic irritation of any tissue may lead to disease 1. barbers used to wipe their razors on their forearms frequently while shaving the beards of their clients. MARJOLIN’S ULCER.in the past. This chronic irritation has resulted in squamous epitheliomatous changes and cancers ( Marjolin’s ulcers) in barbers .

MOON ) AND THEIR MOVEMENTS.SUN.PLANETS AND DISEASE • IT IS WELL KNOWN THAT PLANETS (EARTH. THEIR INTER DISTANCES AND RELATIONSHIPS WILL CAUSE SEASONS OF THE YEAR • PLANETS’ INFLUENCE ON ORIGIN OF SEASONAL DISEASES AND THEIR CONTROL IS STILL A PANDORA BOX .

INCUBATION • THE AGENT INCUBATES TO ACQUIRE THE CRITICAL DENSITY TO INITIATE THE DISEASE • IT MULTIPLIES OR INCREASES IN INTENSITY FOR A SPECIFIC PERIOD BEFORE BECOMING OVERT AND CLINICAL .

DISEASE INITIATION THE DISEASE IS INITITED AT THE CELLULAR LEVEL WHEN THE NECESSARY CAUSE (AGENT) BECOMES SUFFICIENT I. COMPLIMENTED BY ITS CAUSAL PARTNERS . E.

HOW IT PROGRESSES? • Natural history of disease Disease initiation at Cellular level Carrier State Incubation Period/Generatio n time Prepathogenic period Death Pathogenic period Convalescent period .

HOW THE DISEASE IS TRANSMITTED? RESERVOIR/ SOURCE OF AGENT MODE OF TRANSMISSION THROUGH SOME VEHICLE OR VECTOR Susceptible Host/Non – Immune/ Poor herd immunity .

SHORT TERM FLUCTUATIONS.DISEASE DISTRIBUTION TIME DISTRIBUTION OF THE DISEASE 1. PERIODIC FLUCTUATIONS. LONG TERM FLUCTUATIONS. SEASONAL. SECULAR TRENDS . 2. 3. CYCLICAL. 4.

• DISEASE OCCURS IN CLUSTERS OR GROUPS AT A PARTICULAR PLACE WHEN THE PEOPLE ARE SUSCEPTIBLE AND ENVIRONMENT IS FAVOURABLE THERE.CLUSTERING • THIS PHENOMENON IS USUALLY ASSOCIATED WITH INFECTIOUS DISEASES. .

• . • INFECTIOUS ONES WILL BE REPLACED BY NON– INFECTIOUS ONES TO BE REPLACED LATER BY PERSONAL AND BEHAVIORAL PROBLEMS.ONION PEEL PHENOMENON OLD DISEASES FADE AWAY GIVING PLACE TO THE NEW ONES • JUST LIKE THE LAYERS OF THE ONION. THE OLD DISEASES WANE AND GIVE PLACE TO NEWONES.

PRIMORDIAL PREVENTION-INTERVENTIONS TAKEN BEFORE THE DEVELOPMENT OF RISK FACTOR 2. SECONDARY PREVENTION-INTERVENTIONS TAKEN AFTER THE DISEASE IS ESTABLISHED4. PRIMARY PREVENTION -INTERVENTIONS TAKEN BEFORE THE DISEASE IS ESTABLISHED 3. TERTIARY PREVENTION -INTERVENTIONS TAKEN TO PREVENT COMPLICATIONS .DISEASE PREVENTION 1.

TRY TO GRASP THE ENTIRE NATURAL HISTORY OF THE DISEASE . ATTENTION AND AUTHORITY 1. SUSPECT UNLESS AND UNTIL IT IS DISPROVED 2. BE ATTENTIVE AND CAUTIOUS 3.DISEASE SURVEILLANCE • WATCHING THE DISEASE WITH SUSPICION.

PUBLIC HEALTH PROBLEM • DISEASE WILL BE A PUBLIC HEALTH PROBLEM WHEN IT CAUSES HIGH MORBIDITY AND MORTASLITY • DEMANDS URGENT HEALTH ACTION EITHER IN THE FORM OF 1. ELIMINATION 3. CONTROL 2. ERADICATION .

DISEASE CONTROL • CONTROL STRATEGY = REDUCING THE MORBIDITY AND MORTALITY • A CONTINGENCY TEMPORARY MEASURE IN CASE OF EMERGENCY .

DISEASE ELIMINATION • NEAR ERADICATION STAGE • INTERMEDIARY BETWEEN CONTROL AND ERADICATION STATUS • LESS PUBLIC HEALTH PROBLEM • BASED MAINLY ON SURVEILLANCE ACTIVITIES .

IN ENTIRETY • ALL OR NONE FORMULA .ERADICATION • RADICLE MEANS MAIN ROOT OF A PLANT • ERADICATION MEANS REMOVING ALONG WITH THE MAIN ROOT i. e.

ELIMINATE THE RESERVOIR/SOURCE OF THE AGENT .CUT OFF THE TRANSMISSION .DISEASE ERADICATION AGEENT IN MODE OF TRANSMISSION SUSCEPTIBLE RESERVOIROR POPULATION SOURCE TO ERADICATE THE DISEASE ONE MUST: .MAKE THE PEOPLE IMMUNE TO THAT DISEASE .

1997) strains credibility with a grand theory based on flimsy factual foundations • Semmelweiss IP: Die Aetiologie. Wien und Leipzig: CA Hartleben. Germs and Steel (New York: Norton. in Rats. in Guns. New York: Doubleday. 1998. pp 8-9. Brown & Co.REFERENCES • Last JM: Public Health and Human Ecology. Pest. Translated by Rex Warner. see for example McNeill W: Plagues and Peoples. pp 123-129 • For a good introduction. Stamford. Chapter 5.Thucydides: The Peloponnesian War. Diamond J. 2nd Edition. CT: Appleton & Lange. Harmondsworth: Penguin Classics. 1954. 1976 • Zinsser H. der Begriff und die Prophylaxis des Kindbettfiebers. Lice and History (Boston: Little. Book 2. 1935) gave a sparkling account of the influence of typhus on the outcome of wars. 1861 .

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