Endemic- occurrence of expected number of cases among a group of 1) Prepare for field work- Research disease, prepare to travel,
are to travel, make
people over time arrangements with personal contacts Incidence- # of new cases in a population 2) Establish the existence of an outbreak- compare current number of Prevalence- # of cases in a population (per 10,000 or 100,000) cases to previous cases, use health records, documents, etc. Outbreak- more cases of a particular disease than expected in a given 3) Verify diagnosis- Review clinical and laboratory results for the cases, area over a given time interview patients Epidemic- large numbers of people over geographic area distribution 4) Define and identify cases- establish case definition, have clinical info, affected with the same disease characteristics of the people, place, time, etc. Pandemic- an epidemic spanning a very wide area 5) Describe and orient the data in terms of person, place, and time- use Vector- an animal intermediate that transmits a pathogen to humans epi curve to describe how many cases at what time 6) Develop hypotheses- consider disease, interview people who are ill, Virulence- Degree or intensity of pathogenicity of an organism try and notice what certain characteristics make people have the Compromised host- host with lowered resistance to infection disease Nosocomial infection- an infection that is traced back to a hospital 7) Evaluate hypotheses- compare with established fact, use statistics, use Infectivity - capacity to cause infection in a susceptible host case-control or cohort studies Pathogenicity - capacity to cause disease in a host 8) Refine Hypotheses- study environment, use data for more insight Virulence - severity of disease that the agent causes to host 9) Control and Prevention measures- immunization, medicine, isolation, Case definition- The onset of ____ (symptoms) in a _____ (person) at carry out as soon as possible ____ (time and place) 10) Communicate findings- Oral briefing for local health authorities, Confirmed- diagnosis by lab verification written report for archives Probable- many factors point to diagnosis, but no lab verification Suspected- some factors point to diagnosis ____________________________________________________________ Reservoir- site that harbors pathogenic organisms (human, animal, soil) Cohort Study- used for outbreaks in small, well-defined populations, moves Morbidity rate- # sick divided by # exposed forward or backward from exposure Mortality rate- # dead per 100000 population Case Fatality rate- # dead divided by # sick Disease? Yes No Modes of transmission: droplet (through air, flu, TB, SARS, Exposed (A) (B) hantavirus), blood (sexual or injected, HIV, hepatitis), direct contact Unexposed (C) (D) (touching, leprosy, chicken pox), oral-fecal (contaminated water, Attack Rate- exposed A/(A+B) cholera, giardia), vector (spread by animal, malaria, lyme disease) unexposed C/(C+D) AIDS- acquired immunodeficiency syndrome, spread by blood/ Relative Risk- [A/(A+B)]/[C/(C+D)] sexually, attacks immune system Relative Risk> 1: more likely Tuberculosis- caused by bacteria, cough, fever, fatigue, weight loss, Relative Risk<1: possible protective effect treated by antibiotics, attacks respiratory system or other parts of body 0-----------------------1------------------------ Malaria- caused by protozoan, spread by mosquitoes (anopheles), Possible protective effect More likely Case control Study- used when groups are not well-defined compares cyclic fever and chills people with the disease to people without, works backward 2 Triads: Person, Place, Time; Agent, Host, Environment Exposed Case Controls Index Case: The first case in an outbreak ↓ Patients Virus: Viruses are small, much smaller than bacteria. They are not Yes (A) (B) composed of cells. Viruses have 2 basic components: DNA or RNA No (C) (D) covered in protein. Viruses can only reproduce inside the cells of other living organisms (rabies, AIDS, SARS, ebola, measles) Odds ratio: (A x D)/(B x C) A= number of case patients exposed Bacteria: Bacteria have 1 cell and no nucleus. DNA and ribosomes B= number of control people exposed float in the cell. They have flagella to help them swim. They have no C= number of case patients unexposed cell organelles. Gram + bacteria have a strong cell wall with D= number of control people unexposed peptidoglycan and a capsule. Bacteria also have pili that help stick. (E. coli, streptococcus, diptheria, MRSA, lyme disease) Cholera- Vibrio Cholerae (oral-fecal) Shapes: spherical (cocci) Arrangements: staph (clumps) Campylobacter Enteritis- campylobacter jejuni (oral- fecal) Rod (bacilli) Strep (chain) Chicken Pox- varicella zoster (droplet and direct contact) Spiral (spirilla or spirochete) Chlamydia- Chlamydia trachomatis (sexually) E. coli- Escherichia coli (oral-fecal) Immunity Inherited-develops before birth, inborn Malaria-plasmodium (vector, anopheles mosquito) Acquired-Active/natural-exposed to antigen naturally MRSA- staphylococcus aureus (direct contact) Passive/natural-milk, placenta SARS-coronavirus (droplet) Active/artificial-injections, vaccines of antigens Leprosy-mycobacterium leprae (direct contact) Passive/artificial-injections of antibodies Schistosomiasis- schistosoma (oral/contact with water) Lines of defense Shingles-herpes zoster (contact, droplet) 1. Skin and secretions- acts as initial barrier, mucus catches pathogens, Strep throat-streptococcus(droplet) enzymes kill pathogens Tuberculosis- mycobacterium tuberculosis (droplet) 2. Inflammatory response- injury/tissue damage releases chemical signal, Tetanus-clostridium tetani (contact) blood flow increases: heat, redness, pain, swelling Ebola-filoviridae (contact/blood) 3. Phagocytosis- ingests and destroys microorganisms: neutrophils, Athlete’s foot- tinea pedis (contact) macrophages Jakob- Cruztfelt- prion(ingestion) 4. Natural killer cells- kills tumor cells and infected cells with viruses Tapeworm- nematode (ingestion) 5. Interferon- infected cell makes protein and releases into bloodstream, Hepatitis- hepatitis a, b, c virus (a: oral fecal, b: sexually) interferes with reproduction Giardia- giardia lamblia (direct contact) Epidemiology Study of health of population Uses scientific method Studies distribution and causes of disease in human populations Attempts to control these diseases investigates health concerns in relation to disease Study design Strength Weakness Case-control Good for rare disease or Possible error in long latency, examine recalling past exposure multiple exposures from a (Recall Bias). Possible single outcome; less time-order confusion expensive and quicker to conduct than cohort study Cohort Examining multiple Not good for rare outcomes for a single diseases; costly in time exposure; examine rare and resources; possible exposures (such as asbestos loss to follow up over but not for rare disease); can time; factor, which may calculate the incidence of be many years in the past disease (while case control or may be seen as cannot); best technique for socially (un)desirable an outbreak in a small, well defined population; most accurate observational study Cross- Relatively short duration; Since exposure and sectional can study several outcomes; disease status are least expensive measured at the same point in time, it may not always be possible to distinguish whether the exposure preceded or followed the disease. Experimental Most scientifically sound; Time consuming and or best measure of exposure Expensive; Unethical for Trial Harmful Exposures
Hill’s criteria
1. Strength of Association - relationship is clear and risk
estimate is high 2. Consistency - observation of association must be repeatable in different populations at different times 3. Specificity - a single cause produces a specific effect 4. Alternative Explanations - consideration of multiple hypotheses before making conclusions about whether an Types of epidemic association is causal or not Point source - An epidemic in which all cases are infected 5. Temporality - cause/exposure must precede the effect/outcome at the same time, usually from a single source or exposure. 6. Dose-Response Relationship - an increasing amount of Continuous source - An epidemic in which the causal exposure increases the risk agent (e.g. polluted drinking water, spoiled food) is 7. Biological Plausibility - the association agrees with currently infecting people who come into contact with it, over an accepted understanding of biological and pathological processes extended period of time. 8. Experimental Evidence - the condition can be altered, either Person-to-Person (a.k.a. Propagated) - An epidemic in prevented or accelerated, by an appropriate experimental process which the causal agent is transmitted from person to 9. Coherence - the association should be compatible with person, allowing the epidemic to propagate existing theory and knowledge, including knowledge of past Path of infection Reservoir: cases and epidemiological studies Susceptible Host: Portal of Entry: Portal of exit:
Koch’s postulates
1) Collect samples from different people
2) Grow contents on Petri dishes 3) Look for similar organisms from each of the patients 4) Inoculate suspect organism into healthy animal 5) Wait for symptoms to occur 6) Isolate organism from diseased animals