Definitions

Communicable Disease Concepts

ƒ A communicable disease is one that can be
transmitted from one human to another or from
animals to humans
ƒ Many, but not all are reportable diseases
ƒ Measles is reportable
ƒ Head colds are not

Dona Schneider, PhD, MPH, FACE

Zoonoses

Definitions
ƒ A zoonosis is a type of communicable disease
that is transmissible from a vertebrate animal to
man. Normally it is a disease of animals

Communicable Disease Concepts

Rabies
Plague
West Nile Virus
Eastern Equine
Encephalitis
ƒ Brucellosis
ƒ Anthrax
ƒ Trichinosis
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ƒ Rocky Mountain
Spotted Fever
ƒ Lyme Disease
ƒ Typhus
ƒ Leptospirosis
ƒ Q Fever
ƒ Tularemia
ƒ Hantavirus

9Epidemiologic Triad

9 Epidemiologic Triad
AGENT

ƒ Agent, host, environment

ƒ Chain of Infection
ƒ Modes of Transmission

ƒ Characteristics of Infectious Agents
ƒ Infectivity, pathogenicity, virulence

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Spectrum of Disease
Herd Immunity
Terminology: Incubation, Latency, and Infectious Periods
Levels of Disease

HOST

ENVIRONMENT

ƒ Endemic, Epidemic, Cluster, Pandemic

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sexual practices. puberty. immunocompromised. diet. sex. socioeconomic status Types of Agents ƒ ƒ ƒ ƒ ƒ ƒ ƒ Bacteria Virus Protozoa Parasite Fungi Diet deficiency Diet excess ƒ Radiation ƒ Chemicals ƒ endogenous ƒ exogenous ƒ Heat. fatigue. ethnic group.Definition: Agent A microorganism. preexisting disease 2 . nutritional status. chemical. nutritive element or physical factor whose presence or absence is essential for a particular disease or condition to occur Host Factors Age. drinking. exercise Host Factors Host Factors Immunization status: vaccinated or unvaccinated Physiologic states: pregnancy. cold ƒ Genetic traits ƒ Stress Host Factors Personal behaviors: smoking.

Cluster. availability of health care ƒ Epidemiologic Triad ƒ Agent. and air. environment 9 Chain of Infection ƒ Modes of Transmission ƒ Characteristics of Infectious Agents ƒ Infectivity. flora and fauna Environmental Factors Communicable Disease Concepts Social and cultural . water. host. adequate housing. and Infectious Periods Levels of Disease ƒ Endemic. virulence ƒ ƒ ƒ ƒ Spectrum of Disease Herd Immunity Terminology: Incubation.Environmental Factors Environmental Factors Physical – Weather. sanitation. Epidemic. crowding. presence of vectors. Pandemic 9Chain of Infection Chain of Infection ÆAgent leaves the reservoir/host ÆPortal of exit ÆMode of transmission ÆPortal of entry ÆInfects the new susceptible host 3 . war. Latency.Density.Sources of food. pathogenicity. climate and geology Biological .

bats.plants. water. ƒ Environmental .path by which an agent leaves its human or animal source host ƒ ƒ ƒ ƒ ƒ ƒ ƒ Examples of Portal of Exit – Respiratory ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ Tuberculosis Diphtheria Pneumonia Influenza Measles Chicken Pox Smallpox Mumps Examples of Portal of Exit – Fecal (Alvine diseases) ƒ ƒ ƒ ƒ ƒ ƒ ƒ Examples of Portal of Exit – Skin Lesions ƒ ƒ ƒ ƒ ƒ ƒ Syphilis Gonorrhea Herpes Smallpox HIV Chlamydia Respiratory tract Urine Feces Conjunctiva Skin lesions Percutaneous Placental Typhoid fever Hepatitis Shigellosis Salmonellosis Cholera Amebic Dysentery Giardiasis Communicable Disease Concepts ƒ Epidemiologic Triad ƒ Agent.Chain of Infection Chain of Infection Reservoir . sheep. host. Epidemic. pathogenicity. grows and multiplies ƒ Human . cats. environment ƒ Chain of Infection 9 Modes of Transmission ƒ Characteristics of Infectious Agents ƒ Infectivity. and Infectious Periods Levels of Disease ƒ Endemic. Cluster Pandemic 4 . birds. rodents.cows.persons with symptomatic illness. or may be inapparent or chronic carriers ƒ Animal . dogs. pigs. raccoons. virulence ƒ ƒ ƒ ƒ Spectrum of Disease Herd Immunity Terminology: Incubation.the natural habitat in which an agent lives. etc. soil Portal of Exit . Latency.

ticks or fleas. particles of droplet nuclei and dust suspend in the air ƒ Vehicle borne – food. organs and fomites ƒ Vector borne – Disease transmission by a nonvertebrate host Fomites Inanimate objects capable of transferring infectious material Examples: bedding. pencils. but they may be animals ƒ Vector-borne transmission may be mechanical and/or biological Vector borne Diseases ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ Malaria Yellow Fever WNV Plague Typhus Tularemia Lyme Rabies ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ Salmonellosis EEE Filariasis RMSF Erlichiosis Dengue Fever Hantavirus Sleeping Sickness 5 . combs. skin to skin contact and sexual intercourse. toys. large droplets from coughing sneezing. drinking glasses. or surgical instruments Vector Borne Transmission ƒ Agent is carried by a live non-human carrier (vector) ƒ Most vectors are arthropods (insects) such as mosquitoes. flies. cooking utensils.Chain of Infection Examples of Direct Transmission 9Modes of Transmission – the way in which the agent is transferred to a new host Direct Direct contact Droplet spread Indirect Air borne Vehicle borne Vector borne ƒ Direct contact – kissing. Also refers to direct contact with plants or soil harboring infectious agents ƒ Droplet spread – spray by short range aerosol. talking or singing Examples of Indirect Transmission ƒ Air borne – Microbes. water. blood. tissues. clothing. doorknobs. straws.

to a new location Biological Vector borne Transmission There is no multiplication of the agent within the vector Examples of Biological Transmission ƒ The agent undergoes part of its life cycle within the vector. antennae.Mechanical Vector borne Transmission Mechanical Vector borne Transmission The vector is contaminated through mechanical means Example: The fly lands on Shigella-contaminated items. carries the agent on its legs. etc. multiplying or undergoing physiologic change Malaria Life Cycle WNV Life Cycle 6 .

and infectious periods 9Herd Immunity The decreased possibility of a group or community developing an epidemic because there is a specific level of immunity or resistance to that disease in the population 7 . pathogenicity. latency.the route the agent uses to get into the new host ƒ ƒ ƒ ƒ ƒ Back to the Chain of Infection Respiratory tract Ingestion Dermal Blood borne Mucous membranes 9Characteristics of the Infectious Agent ƒ Infectivity – ability of an organism to invade and infect a host ƒ Pathogenicity – ability to cause disease ƒ Virulence – ability to cause serious complications and/or death Infection of a New Host Depends on 9Characteristics of the Agent – Infectivity. virulence 9Herd Immunity – Ability of the agent to reach a susceptible host 9Spectrum of Disease – Host reaction to the disease • Dose • Immunologic status 9Incubation.Other Examples Include ƒ Rabies ƒ Lassa Fever ƒ Hanta Virus Chain of Infection Portal of Entry .

upper gastrointestinal symptoms ƒ Infections – longer incubation periods. typically lower gastrointestinal symptoms 8 .Herd Immunity ƒ Immunized persons act as a barrier to spread ƒ The entire population does not have to be immunized to prevent the occurrence of an epidemic 9Spectrum of Disease The progress of a disease with no intervention: Exposure Pathological changes Clinical illness Symptoms Recovery. Disability or Death 9Terminology ƒ Incubation period ƒ Time between infection and the onset of clinical illness ƒ Latency period ƒ Time between infection and when the individual becomes infectious to others ƒ Infectious period ƒ Time during which the infectious agent may be shed (host need not be symptomatic) More About the Incubation Period Each infectious disease has a characteristic incubation period dependent upon: ƒ ƒ ƒ ƒ Portal of entry Dosage of the agent Immune response of the host Rate of growth of the agent in the host Example: Measles ƒ Incubation period ƒ Latency period ƒ Infectious period 13-18 days 6-7 days* 6-9 days* *An individual becomes infectious and stays infectious BEFORE they have clinical disease Food borne Disease Incubation Periods ƒ Intoxications – shorter incubation periods.

the subject gets lymphadenopathy ƒ The bite gets gangrenous and necrotic – turning black ƒ The resultant infection causes septicemia and death Plague took a hefty toll over the centuries… ƒ 13th Century Europe ƒ 25 million died ƒ 1855-96 China/India ƒ 12 million died ƒ 1910-11 Manchuria ƒ 60.Salmonella ƒ 6 to 72 hours.000 died of pneumonic plague Example . vomiting. abdominal tenderness. usually 2 to 4 hours ƒ Causes severe nausea. ashes! A Tchoo. but may contain blood or mucus ƒ INFECTION As it rages through a population… ƒ Plague can change to a more virulent form and enter the lungs ƒ Victims cough up blood-spotted mucus and then graduate to coughing bloody froth ƒ The cough spreads the PNEUMONIC PLAGUE through airborne droplets (no longer a zoonosis) Remember This? Ring around the rosies. Ashes. body temperature often drops ƒ INTOXICATION Example – Plague (zoonosis) ƒ In 1-6 days after an infected flea bite. diarrhea. and fever ƒ The diarrhea is usually watery. cramps. usually 12 to 36 hours ƒ Causes gastroenteritis with cramping. often diarrhea ƒ No significant fever. A pocket full of posies. vomiting.Example – Staphylococcus aureus ƒ ½ to 8 hours. A Tchoo! We all fall down. 9 .

one out of every three people died from the "white plague” – King Tutankhamen (1340 BCE) – Cardinal Richelieu (1640) – Robert Louis Stevenson (1894) – Eleanor Roosevelt (1962) – billions of others and… Tuberculosis Today ƒ Approximately 1.Bubonic plague suspected in NYC visitors Friday. 2002 Posted: 12:14 PM EST (1714 GMT) NEW YORK (CNN) -. pathogenicity. In Contrast. Pandemic 10 . virulence ƒ Spectrum of Disease ƒ Herd Immunity ƒ Terminology: Incubation.86 billion people worldwide are infected with TB. said health officials. host. and Infectious Periods 9 Levels of Disease ƒ Endemic. Cluster. environment ƒ Chain of Infection ƒ Modes of Transmission ƒ Characteristics of Infectious Agents ƒ Infectivity. Epidemic. Latency. November 8.A New Mexico couple who traveled to New York have been hospitalized with what is believed to be the first case of bubonic plague in the city in a century. Tuberculosis is a slow plague ƒ TB has killed more people than any other disease in history ƒ In 1800. including – – – – Nelson Mandela Desmond Tutu Tina Turner Tom Jones ƒ One person dies of TB every 15 seconds – WHO 2003 The Entire Bronte Family ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ Mother Bronte Reverend Bronte Maria Elizabeth Branwell Emily Ann Charlotte ƒ ƒ ƒ ƒ ƒ ƒ ƒ ƒ 1821 Carrier – chronic infection 1825 1825 1948 1848 (Wuthering Heights) 1849 (Agnes Grey) 1855 (Jane Eyre) Communicable Disease Concepts ƒ Epidemiologic Triad ƒ Agent.

Epidemic Epidemic or Outbreak ƒ When the level of disease rises significantly above the normal endemic level Types of Epidemics Epidemic 30 CASES 25 20 15 10 5 Endemic 0 TIME Levels of Disease Cluster ƒ An aggregation of cases that are more than expected ƒ Clusters may be based on space (geographical area) or time ƒ A cluster may or may not be an outbreak Levels of Disease Pandemic ƒ A widespread epidemic. usually affecting several countries or continents affecting large numbers of people and sometimes the entire globe 11 .9Levels of Disease Levels of Disease Endemic ƒ A disease or condition persists within a certain geographical area ƒ The baseline or expected level of disease in a community ƒ Does not reflect the preferred level of disease. which is zero Endemic vs.

moving from chickens or ducks to humans Our soldiers shipped out… ƒ They carried the virus to the trenches of Europe where it mutated into a killer ƒ They brought it home again. stinking yellow haze. 1918. kicked up a stinging. there have been 31 influenza pandemics recorded It started at Fort Riley… “On Saturday. pigs. horses and humans ƒ A novel virus is created – When an intermediate host (pig) is infected by both human and bird strains at the same time or – When an avian strain jumps the species barrier. where it killed hundreds of thousands almost instantly 12 . March 9. The dust.” PBS – Influenza 1918 Where Does It Come From? ƒ Type A influenza viruses infect birds. combining with the ash of burning manure.A pandemic occurs because… ƒ Entire populations are susceptible ƒ There are no effective treatments for the outbreak Ever Heard This? I had a little bird Its name was Enza I opened up the window And in-flu-Enza 1918 Influenza is Serious ƒ Hippocrates documented the first influenza pandemic in 412 BCE ƒ Since 1580. The sun was said to have gone dead black in Kansas that day. a threatening black sky forecast the coming of a significant dust storm.

000 cultured specimens Pertussis 5 - 6.487 31 million - Tuberculosis Tuberculosis 2.1 million - 248. and Global Statistics 9Prevalence is 9Incidence is the the the number of existing cases (old and new) Disease (2000) Lower respiratory infections Lung Cancer 160.400 COPD 119.942 Influenza 1.1 million Measles 777.S.000 150 million - Influenza 500.000 24 million - COPD Asthma 4.S.288 - 179. 1998) Patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth" (Starr.My Grandma died of influenza… People would suddenly develop the flu on their way to work and “die within hours” (Henig.S. Prevalence U.000 - >100 million (5 M severe) Pertussis 400.7 million 1.S. 1976) ƒ ƒ 1918-1919 Influenza Pandemic ƒ Was the most rapid and devastating epidemic in recorded history ƒ 1/2 the world’s population was infected and 40 million people died ƒ The strain was incredibly virulent ƒ Mortality was so great that the average life span in the United States was depressed by 10 years Disease (2000) U.000 - 40 million 774 - 8. Mortality U.765 - >10.098 13 .000 - 43.86 BILLION 10.3 million 3 million 600 million - 2.755 Measles 1 - 81 SARS (2003) 0 - 192 SARS (1 Nov 2002 to 30 July 03) number of new cases (usually on an annual or seasonal basis) Global Mortality Global Prevalence Global Incidence 4.460 - 12.2 million Asthma 180. Incidence The world was in shock… ƒ It happened so fast that we ran out of coffins A Perspective on Communicable Disease – U.

Questions? Lunch 14 .