UNIT 7

APPLICATIONS OF EPIDEMIOLOGY
(6 Hours)

INTRODUCTION
The goal of public health is to improve health through the prevention or treatment
of disease. Public health workers use epidemiologic principles as the foundation for
disease surveillance and investigation activities. The importance of epidemiology in
public health cannot be overstated. Epidemiological methods are frequently used to
determine relevant risk factors associated with disease occurrence. Knowledge of these
risk factors is used to direct further research investigation and to implement disease
control measures. Although epidemiology is sometimes viewed as a collection of
statistical tools used to elucidate the associations of exposures to health outcomes, a
deeper understanding of this science is that of discovering causal relationships. This
unit presents a thorough understanding of the basic concepts of epidemiology. Also,
different models of disease causation and steps in outbreak investigation are described.

LEARNING OUTCOMES
At the end of this unit, students will be able to:
✓
Explain epidemiology and the components of its definition.
✓
Elucidate the practical application of epidemiology.
✓
Discuss the epidemiological models of disease causation.
✓
Discuss the role of public health surveillance in disease prevention.
✓
List the steps for conducting an outbreak investigation.

PRE-TEST

Instruction: Read each question carefully, and then circle the answer that BEST fits
the question. There is only one BEST answer for each question.
1. Epidemiology comes from the Greek word epi, demos, and logos which mean?

A. Study of what befalls a population

B. Study of health-related events
C. Study of vital indices in a population
D. Study of population

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2. Epidemiology is concerned about the collective health of the people in a
community or population.

A. False
B. True

3. It refers not only to the number of health incidents in a population but also to
the relation between that number and the size of the population:

A. Pattern
B. Frequency
C. Place
D. Outbreak

4. As the basic science of public health, epidemiology is a quantitative

discipline focused on working knowledge of probability, statistics and sound
methods of analysis.

A. True
B. False

5. Individual has no symptoms or manifestations that indicate the presence

of illness but usually pathogenic changes have started to occur:

A. Prepathogenesis
B. Clinical stage
C. Subclinical stage
D. Recovery stage

6. Epidemiology is the study of the distribution and determinants of disease

frequency in human populations.

A. True
B. False

7. It represents the interaction between an agent, host or persons and

environment or place within a specific time dimension:

A. Web-causation model
B. Epidemiological triangle
C. Wheel model
D. All of the above

8. The frequency of diseases as shown by morbidity and mortality statistics

varies by time, geographic and person.

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 A. True
B. False

9. It is concerned with describing the frequency and distribution of disease in

a given population:

A. Descriptive epidemiology
B. Analytical epidemiology
C. Both
D. Neither

10. Time patterns or dynamics may be annual, seasonal, monthly, regular, hourly,
weekday versus weekend, periodicity, rate of transition of stages of disease or
some other time breakdown that may affect the incidence of illness or injury.

A. False
B. True

TOPIC 1: BASIC CONCEPTS OF EPIDEMIOLOGY

Learning Objectives
At the end of this topic, the students will be able to:
✓
Explain the basic concepts of epidemiology
✓
Describe the application of epidemiology
✓
Explain the different determinants and distribution of disease

Activating Prior Knowledge

The First Word: Generate a short phrase or sentence that begins with each letter of
the vertical work and offers important information or key characteristics about the topic.

E
P
I
D
E
M
I
O
L

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O
G
Y

Epidemiology focuses on the study of the causation of a disease in human

population (identifies and define the factors of causation). It is done by examining the
influences and circumstances affecting those afflicted and unafflicted which will lead to
discovery of factors essential or contributory to the occurrence of the disease which will
ultimately lead to its prevention and control. Because of these it is regarded the Basic
Preventive Medicine. The term epidemiology comes from the Greek word epi, meaning
on or upon, demos, meaning people, and logos, meaning study. Thus, the word has its
roots in the study of what befalls a population. Many definitions have been suggested:

Epidemiology is the study of the distribution and determinants of disease

frequency in human populations (1970).

It is the study of the distribution and dynamic of a disease in human population

as such, it is considered a science, art, philosophy, and methods.

Epidemiology is the study of the distribution and determinants of health-related

states or events in specified populations, and the application of this study to the
control of health problems (CDC, 1988). This definition reflects the
epidemiology's basic concepts and public health spirit.

The underlying premise of epidemiology is that disease does not occur at

random, but rather in patterns that reflect the operation of underlying factors.
Epidemiology is not just “the study of” health in a population. It also requires applying
the knowledge obtained from the studies to community-based practice. Similar to
medicine, the practice of epidemiology is both a science and an art. Epidemiology uses
scientific methods of descriptive and analytical epidemiology, as well as experience,
epidemiological judgment and knowledge of local conditions to 'diagnose' community
health and recommend effective, realistic and reasonable public health strategies to
monitor and prevent disease.

Study

At its foundation, epidemiology is a scientific discipline with sound

scientific investigation method. Epidemiology is data-driven and is based
on a clear and objective approach to data collection, analysis and
interpretation. Basic epidemiological approaches tend to rely on careful
observation and use of appropriate reference groups to determine
whether what has been observed, such as the number of disease cases
in a particular region over a given period of time, or the level of exposure
among people with disease, varies from what would be predicted.

As the basic science of public health, epidemiology is a quantitative

discipline focused on working knowledge of probability, statistics and
sound methods of analysis. It is a method of causal reasoning based on

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 developing and testing hypotheses grounded in scientific fields. It also
provides the foundation for directing practical and appropriate public
health action based on this science and causal reasoning.

Epidemiology is problem solving by looking to explanation of disease

behavior we can exploit the explanation for developing preventive
measures. Epidemiology is not a pure science but applied one and related
to development of other disciplines and vice-versa like advance in clinical
medicines and pathology, knowledge of pathophysiology of diseases,
entomology, parasitology, biochemistry, microbiology, familiarity with
geography, sociology, demography, anthropology, and vital statistics.

Distribution

Epidemiology describes the distribution of disease in terms of sex, age,

race, geography, and the interpretation of the distribution of the disease in
terms of possible etiologic agent of causal factors. It focuses on the
frequency and pattern of health conditions within a population:

a. Frequency refers not only to the number of health incidents in a

population but also to the relation between that number and the
size of the population. The resulting prevalence allows
epidemiologists to assess the occurrence of the disease across
various populations.

b. Pattern refers to the occurrence of health-related events by

time, place, and person.
▪
Time patterns or dynamics may be annual, seasonal,
monthly, regular, hourly, weekday versus weekend,
periodicity, rate of transition of stages of disease or
some other time breakdown that may affect the
incidence of illness or injury.

▪
Place patterns include geographic variation, country,
region, province, town, barangays, and sitio. Could
be urban, rural, plain, mountain, desert, swamp, etc.,
work or school locations.

▪
Personal characteristics include demographic factors
which may be related to risk of illness, injury, or
disability such as age, sex, race, marital status, and
socioeconomic status, as well as behaviors such as
smoking and drinking and environmental exposures.

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 Determinants

Determinants are the causes and other factors that influence the
occurrence of disease and other health-related events. Epidemiologists
use analytic epidemiology or epidemiologic studies to provide the “Why”
and “How” of such events. They determine how groups with different
disease rates vary in their demographic features, genetic or
immunological make-up, attitudes, exposures to the environment or other
so-called potential risk factors.

Health-related states or events

The term health-related states or events may be seen as anything that

affects the well-being of a population.

Specified populations

Epidemiology is concerned about the collective health of the people in a

community or population. It focuses on determining the exposure or
source of the disease; the number of other individuals who may have had
similar exposure; the potential for further population spread; and
measures to avoid new cases or recurrences.

The practical applications of epidemiology as implied by both the definition of

epidemiology are:
1. Assessment of the health status of the community or community diagnosis
2. Elucidation of the natural history of disease
3. Determination of disease causation
4. Prevention and control of disease
5. Monitoring and evaluation of health interventions
6. Provisions of evidence for policy formulation

Epidemiology is an important tool that is applied by the members of community

health management team for performing their roles and functions. Epidemiologic
investigation uses data coming from RHU & BHS records, national census and
statistics and data from the office of City/Municipal Registrar. Epidemiologic techniques
can aid them rank health problems, identify risk factors for such problems, design
targeted health interventions, and monitor and evaluate such interventions.

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 In December 2019, epidemiologists learned of a cluster of cases of respiratory disease
caused by coronavirus infection among residents of Wuhan in China. COVID-19 infection,
transmitted via respiratory droplets, had never before been identified in the said country.
Describe how this information might be used for each of the following:
1. Assessing the community’s health

2. Making decisions about individual patients

3. Documenting the clinical picture of the illness

4. Searching for causes to prevent future outbreaks

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TOPIC 2: NATUTAL HISTORY OF DISEASE AND MODELS OF DISEASE CAUSATION

Learning Objectives
At the end of this topic, the students will be able to:

✓ Explain the natural history of disease

✓ Summarize the different models of disease causation

Activating Prior Knowledge

Mind Map: Use words or simple phrases to create a mind map which displays what
you already know about the topic Natural History of Disease.

Elucidation of the Natural History of Disease

The disease process is a result of the interaction of the agent, environment and
host factors. Disease has an evolution process, passing through the following stages:

1. Stage of Prepathogenesis or Susceptibility

The disease has not developed but the groundwork but the presence of factors
which favour its occurrence is present. Factors whose presence is associated
with an increased likelihood that a disease will develop at a later time are called
risk factors. Primary level of prevention is applicable at this stage to avoid
development of disease.

2. Stages of Pathogenesis

a. Stage of Presymptomatic Disease/Early Pathogenesis/Subclinical disease

Individual has no symptoms or manifestations that indicate the presence of
illness but usually pathogenic changes (below the level of clinical horizon)
have started to occur. Secondary level of prevention can be applied so that
prompt treatment can be initiated to avoid progression of the disease.

b. Stage of clinical diseases

Sufficient anatomic or functional changes have occurred resulting in
recognizable signs or symptoms. Changes may be detected through
sophisticated laboratory test. Tertiary level of prevention is applicable to limit
disability and restore the functional capability of the patient.

c. Stage of Resolution
The patient either recovers completely from the disease or becomes a
chronic case (conditions with a residual defect which leaves the person
disabled; anatomical and functional changes have produced recognizable
signs and symptoms)

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 Primary Prevention Secondary Prevention Tertiary Prevention

Determination of Disease Causation

The epidemiological triad or triangle model represents the interaction between an

agent, host or persons and environment or place within a specific time dimension. Initially
this model was applied for infectious diseases where the agent can be parasites, bacteria,
viruses, fungi or other microbes. The epidemiological triad can also be also applied to non-
communicable diseases where the agent could be unhealthy behaviors, unsafe practices,
or unintended exposures to hazardous substances. The model suggest that the agent and
the susceptible host are interacting freely in a common environment. For as long, as the
balance is maintained or is tilted in favor of the host, disease does not occur. However,
when the balance is tilted in favor of the agent, disease eventually occur. Sometimes,
environmental elements tilt the balance in favor of the agent.

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 Answer the questions below based on your current understanding on the concepts
epidemiology.

1. What are the factors that tilt the balance in favor of the host?

2. What are the factors that tilt the balance in favor of the agent?

3. What are the environmental elements that may affect the balance in favor of the
agent?

The web or network of causation model implies that disease is developed as a result
of chains of causation. This model implies that cutting the chains at different points would
interrupt the disease development, even without complete understanding of causal
mechanisms. It depicts the intricate interrelationships of the various sociodemographic
characteristics and behaviors of the host as well as the numerous environmental factors.

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 Elucidate all possible causes of COVID-19 using the web or network of causation
model.

The wheel model represents the host as the focus, who has genetic make-up as
its core, and is surrounded by the environmental elements. It gives emphasis on the
role of the genetic make-up of the host. The outer core of the hub includes host
characteristics like sex, age, socioeconomic status and behaviors. The rim of the outer
edge represents the biologic, physical, chemical and social environment. relative sizes
of the wheel components vary from one disease to the other. In contrast to the previous
model, the wheel model distinguishes the host from the environmental factors, thus
more useful for epidemiologic analysis.

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 TOPIC 3: DESCRIPTIVE AND ANALYTICAL EPIDEMIOLOGY

Learning Objectives
At the end of this topic, the students will be able to:

✓ Differentiate descriptive epidemiology from analytical epidemiology

✓ Interpret the different epidemic curves

Activating Prior Knowledge

3-2-1: List three (3) things you already know about descriptive and analytical
epidemiology, two (2) things you’d like to know about or learn more about, and one (1)
question related to the key concept or learning.

Things you
3 already
know

Things you’d

like to know

2 about or
learn more
about

1 Question
related to the
key concept

Descriptive Epidemiology

Descriptive Epidemiology is concerned with describing the frequency and

distribution of disease in a given population. Public health worker characterizes the
disease episode by describing the characteristics of the persons affected with the
disease and the pattern of the disease onset in terms of time and place. It begins with
observation and recording of existing patterns of occurrence of disease condition (case
finding and conducting screening activities). It
describes disease as to person, place,
and time characteristics. Lastly, it
analyses the general pattern of
occurrence of the disease or condition.
Characteristic of a person related to
disease occurrence include age, sex,
ethnic group, marital status, occupation
and socio-economic status.
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 Relate how does personal characteristics such as age, sex, ethnic group,
marital status, occupation and socio-economic status influence the occurrence of
COVID-19 infection?

The frequency of diseases as shown by morbidity and mortality statistics varies

by time, geographic location (between countries and within different parts of one
country) and person. The frequency of disease can be related to place in terms of areas
set off either by natural barrier (rivers, mountain ranges, etc.) or by political boundaries,
with the former likely to provide more useful clues than the latter for understanding
disease causation. A place separated from others by natural barriers may differ in
disease incidence because of some particular environmental or climatic condition,
isolation of population group distinguished by genetic inheritance or social customs,
differences in economic activities,

The study of disease occurrence with time is a basic aspect of epidemiological

analysis and like place and person may influence the occurrence and distribution of
disease. Disease occurrence is usually expressed on a weekly, monthly or yearly basis
and is usually related to time and onset rather. Depending on the time scale involved,
the changes of disease frequency with time may be considered under:

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Short time fluctuations (Epidemics)

By plotting the epidemic curve (plotting the cases by date of onset) two principal
types of epidemics can be recognized

a. Common Source Epidemics

This is due to exposure of a group of persons to a common, harmful
material. In point epidemic (exposure is brief and simultaneous) all the
cases develop within one incubation period and resulting epidemic
curve rise and fall rapidly and usually skewed to the right. In a
common source outbreak with a somewhat prolonged exposure (few
days or a week) the epidemic curve usually is symmetrical.

Common Source Epidemic (Point source)

Incubation Period, Food poisoning Cases Laguna, February 1995 (N=68)

This is an example of a histogram of a point source outbreak. The

histogram shows the incubation periods of the illness. This was a food
poisoning outbreak that occurred during a junior-senior prom in one of the
high schools in Laguna. Many students simultaneously ate spaghetti that
contains preformed Staphylococcus toxins. Note that most of the cases
fell within one incubation period of less than eight hours. The curve has a
tall peak although a gradual down slope was not exhibited.

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 Common Source Epidemic (Extended Source)

Date of onset, Cholera Case (N=48) Calima, Pola, Oriental

Mindoro March 20 - April 15, 1995

This is the histogram of an extended common source cholera outbreak

that occurred in Calima Oriental Mindoro. The residents were
continuously getting their drinking water from a contaminated source for
about one month. Many susceptible residents were getting infected in
different periods. The curve has a plateau suggesting a prolonged
exposure of the community to the infecting organism.

b. Propagated or Progressive Epidemics.

This results from transmission (directly/indirectly) of an

infectious agent from an infected person to susceptible one.
The epidemic extends over a number of incubation periods.
There is an increasing number of cases in each successive
time and when all the susceptible are exhausted the
outbreak ends.

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 Measles morbidity rate in evacuation centers in Albay Feb.-May 17 1993

This is a propagated or progressive type of epidemic curve. The Measles

viruses are propagated in the community by passage from person to
person. The histogram shows a less abrupt initial rise in the number of
cases than in point-source epidemics. Furthermore, the curve shows a
series of progressively tall peaks one incubation period apart

A point source outbreak epidemic curve may be affected by continued

exposure to the source or by a long variable incubation period. A propagated
outbreak of a highly infectious disease with a short incubation period
(influenza) may show a rapidly rising ascending limb and a rapidly falling
descending limb, simulating that of a point source. Distinction between the
two may be done by plotting cases in a map which will show a radial spread
in the propagated outbreak.

2. Cyclic variations refer to recurrent alterations of the frequency of disease

which may be in the course of a day (hay fever), week (gonorrhea), a month
(head injuries), a year (malaria), measles outbreak occurs every 2-3 years,
poliomyelitis every 4 years, influenza 2-3 years, or 4-6 years depending on
the type of the virus.

3. Secular variation (trend) refers to changes in disease incidence over a period

of many years – decades, centuries. The enormous population movement
today and the major changes in the way of life will bring with it changes in the
pattern of diseases.

Answer the questions below based on your current understanding on the

descriptive epidemiology.

1. How does the pattern of disease vary over time in a population?

2. How does the place in which the population lives affect the disease pattern?

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 Using data from the internet on COVID-19 cases (Philippines, January-April), graph the
cases by time of onset of illness, to create an epidemic curve. Label the axes and add an
appropriate title.
1. Identify the type of epidemic curve drawn
2. What does this epidemic curve tell you? What might you learn from the outliers?

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Analytical Epidemiology

Analytical Epidemiology attempts to identify the possible factors associated with

disease occurrence. Using the concepts of causality and association, it seeks to
establish the risk of developing specific disease or condition among people exposed to
known factors or situations. It consists of hypothesis testing of causal association using
different epidemiological study designs. Case control and cohort studies are employed
in investigating patterns of disease and cause in individuals. Correlational or ecological
studies are utilized in analyzing patterns of disease and cause in population. Analytic
studies employ measures that show strength of association between a purported health
condition or factor to increase risk of disease. The measures, also called risk estimates
and relative risk ratio (RRR), odds ratio (OR) and attributable risk.

Analytic Study Designs

a. Cohort Study
The epidemiologist records whether or not each study participant is
exposed, and then monitors the participants to see whether the disease of
interest progresses. investigator observes rather than determines the
participants’ exposure status. The investigator compares the disease rate
in the exposed group with that in the unexposed group after a period of
time.

Illustration of a Cohort Study Design

Source: https://bit.ly/3d76SWn

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 1. Follow-up or Prospective Cohort Studies
Participants are enrolled as the study begins and are then
followed prospectively over time to identify occurrence of the
outcomes of interest. The measure of disease frequency to be
used will be the incidence rate.

2. Retrospective Cohort Study

Both the exposure and the outcomes have already occurred. It
uses the prevalence rate as a measure of disease frequency.
The relative risk and attributable risk are used to measure
strength of association between disease and suspected factor.

b. Case-control Study
The study population’s disease status will be ascertained first. Those with
the disease are considered as cases and those who do not have disease
are considered in the control group. The presence of suspected exposure
factor for both groups will be then determined. The incidence and
prevalence rate cannot be computed in case control-study design. The
odds ratio will be the measure of disease association.

Illustration of a Case-Control Study Design

Source: https://bit.ly/2VULCx8

c. Cross-sectional Study
A number of populations is enrolled and their exposures and health
effects are assessed at the same time. The cross-sectional analysis
appears to assess the presence (prevalence) of the health outcome at
that stage, regardless of the period

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 Illustration of a Cross-sectional Study
Source: https://bit.ly/2ye7rPs

TOPIC 4: OUTBREAK INVESTIGATION

Learning Objectives
At the end of this topic, the students will be able to:
✓ Discuss the steps in conducting outbreak investigation

Activating Prior Knowledge

Concept Map: Use words or simple phrases to create a concept map which
displays your understanding on the concept:

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 The first action of a health agency when it receives a report of a case or a cluster
of cases of a disease is to investigate. An outbreak is commonly defined as the
occurrence in a community or region of cases of an illness with a frequency clearly in
excess of normal expectancy. The number of cases indicating presence of an outbreak
will vary according to the infectious agent, size and type of population exposed,
previous experience or lack of exposure to the disease, and time and place of
occurrence. Therefore, the status of an outbreak is relative to the usual frequency of the
disease in the same area, among the same population, at the same season of the year.
Outbreaks may be detected when routine, timely analysis of surveillance data reveals
an increase in reported cases or an unusual clustering of cases.

Basic Steps in an Outbreak Investigation include:

1. Operationally, define what constitutes a case.

2. Based on the operational definition, identify the cases.
3. Based on the number of identified cases, verify the existence of an outbreak.
4. Establish the descriptive epidemiologic features of the cases.
5. Record the clinical manifestations of cases.
6. Formulate a hypothesis regarding the probable etiologic agent, the sources of
infection, the MOT, and the best approach for controlling the outbreak.
7. Test the hypothesis by collecting relevant specimens from the patients and from
the environment.
8. Implement prevention and control measures to prevent recurrence of a similar
outbreak.
9. Disseminate the findings of the investigation through media and other forms to
inform the public.

Outbreak investigations may be considered as opportunities to study disease

events and are training exercises for those conducting the investigation. The primary
reason for conducting outbreak investigations is to identify the source in order to
establish control and to institute measures that will prevent future episodes of disease.
Whether an outbreak investigation will be conducted may also be influenced by the
severity of the disease, the potential for spread, the availability of resources, and
sometimes by political considerations or the level of concern among the general public.

As a health officer of your municipality, you received reports of 4 cases of COVID-19

from one barangay over a ten-day period. List the steps you would take to determine whether
there has been a common source outbreak of the disease.

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 CASE ANALYSIS
st th
Between December 21 and 29 , 2019, a 67-year old woman was on vacation in Hong
st
Kong with her husband. Upon her return home to the Philippines, on December 31 she developed
a fever, myalgia, sore throat and a cough. She was cared for by her family at her home. Over the
th
next 10 days, her condition deteriorated and she died at home on January 13 .
th
On January 17 , this woman’s 36-year old son (Case A) became ill with fever and
th
respiratory symptoms. On January 25 , 2020, he presented to the emergency room (ER) of
nd
Hospital A and was admitted to the Intensive Care Unit (ICU) where he died on February 2 .
th th
Between January 27 and February 11 , four more family members developed similar
th
symptoms. The doctor who provided care to this family on January 19 developed respiratory
th
symptoms on January 29 .
th
By February 4 , several nurses who worked in the ER and ICU of Hospital A reported ill
with fever and one or more of these symptoms: cough, malaise, myalgia, and headache. They
were told to isolate themselves at home and to wear masks. The local public health department
was notified of this hospital cluster.
As a Field Epidemiologist placed with the local public health department, you are called
in to assist.

Based on the above case, answer the following questions.

1. Is this an outbreak? Why or Why not?

2. What source(s) of routine surveillance data could help you confirm the existence of an
outbreak in this investigation?

3. List the types of pathogens (bacterial, viral etc.) that could be considered in the
differential diagnosis in an outbreak of respiratory illness.

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4. List the different samples that could be taken during outbreaks of respiratory illness
caused by an unknown pathogen.

5. In this investigation, what kind of samples should be collected? What materials will you
need?

6. From whom should you obtain samples?

7. In this situation, would you consider testing i) individuals not meeting the outbreak case
definition or ii) healthy contacts of ill individuals? If so, why?

8. How many individuals should you sample? Why?

9. What are the ethical considerations in testing these contacts?

10.How do you ensure confidentiality in a high-profile outbreak?

11.What personal precautions should be taken when interacting with possible cases
infected with an unknown infectious respiratory pathogen?

12.What biosafety level do you think is appropriate for SARS?

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SUMMARY

▪
Epidemiology is the study of the distribution and determinants of health-related
states or events in specified populations, and the application of this study to the
control of health problems.

▪
The different models of disease causation include the epidemiological triad, the
wheel model and web causation model.

▪
Descriptive epidemiology is concerned with describing the frequency and
distribution of disease in a given population while Analytical epidemiology
attempts to identify the possible factors associated with disease occurrence.

▪
Outbreak investigations is necessary to identify the source in order to establish
control and to institute measures that will prevent future episodes of disease.

POST-TEST

Instruction: Read each question carefully, and then circle the answer that BEST
fits the question. There is only one BEST answer for each question.

1. The primary reason for conducting outbreak investigations is to identify the

source in order to establish control and prevention measures.

A. True
B. False

2. It uses concepts of causality and association to establish the risk of developing

specific disease or condition among people exposed to known factors or
situations.

A. Outbreak
B. Analytical epidemiology
C. Descriptive epidemiology
D. Epidemiology

3. The epidemic extends over a number of incubation periods:

A. Secular variation
B. Point-source outbreak
C. Propagated outbreak
D. Common source outbreak

4. The cases develop within one incubation period and resulting epidemic curve
rise and fall rapidly and usually skewed to the right:

A. Propagated outbreak

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 B. Common source outbreak
C. Progressive outbreak
D. Extended source outbreak

5. The study of disease occurrence with time is a basic aspect of epidemiological

analysis and like place and person may influence the occurrence and distribution
of disease.

A. True
B. False

6. It represents the host as the focus, who has genetic make-up as its core, and is
surrounded by the environmental elements:

A. Epidemiological triad
B. Web-causation model
C. Wheel model
D. All of the above

7. Occurrence of a disease is dependent on which of the following factors?

A. Host
B. Agent
C. Environment
D. All of the above

8. The epidemiological triad is only applicable for communicable diseases.

A. False
B. True

9. Epidemiologist characterizes the disease episode by describing the

characteristics of the persons affected with the disease and the pattern of the
disease onset in terms of time and place.

A. True
B. False

10. Sufficient anatomic or functional changes have occurred resulting in recognizable

signs or symptoms. What level of prevention can be applied at this stage.

A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. All of the above

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REFERENCES

1. CDC. (2012).Principles of Epidemiology in Public Health Practice. Third Edition.

Atlanta, GA 30333. Retrieved from
https://www.cdc.gov/csels/dsepd/ss1978/SS1978.pdf

2. Famorca, Z. U., et al. (2013). Nursing Care of the Community.

Elsevier, Singapore.
3. Maglaya, A. S. (2009). Nursing Practice in the Community.
Argonauta Corporation, Marikina City.

4. Mohamed El-Sobky. Lectures in Epidemiology for medical students. Retrived from

COMMUNITY & OCCUPATIONAL & ENVIRONMENTAL
MEDICINEhttp://mu.menofia.edu.eg/PrtlFiles/Faculties/MED/Portal/Files.pdf

5. UP, Manila , Module in Community and Public Health

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 LEARNING FEEDBACK

NAME: _____________________________________________________________DATE:________________
COURSE/YEAR/SECTION:_____________________________________________SCORE:
SCHEDULE:__________________________________________________________

UNIT 7: EPIDEMIOLOGY
Instruction: Answer the following questions briefly but concisely.

1. Discuss the importance of Epidemiology to disease prevention and control.

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2. What are the roles and responsibilities of an Epidemiologist? Discuss their similarities
and difference with that of a Physician.

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3. A disease outbreak can be detected by examining the different sources of data. Give and discuss the
sources of data used for epidemiologic studies.

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4. Explain the applicability of Epidemiology to other branches of science.

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5. Name and discuss the three important variables in performing descriptive epidemiology
that may lead to the identification of risk factors or agent of the disease under investigation.

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6. Explain the two (2) models of disease causation.

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7. Discuss the Natural History of Disease timeline.

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8. Explain the etiology of coronavirus disease (COVID-19), malaria, and amoebic
dysentery / amoebiasis by applying the epidemiologic model.

Coronavirus disease (COVID-19)

Agent

Host

Environment

Malaria
Agent

Host

Environment

Amoebic dysentery / amoebiasis

Agent

Host

Environment

9. Give examples of each type of prevention – primary, secondary, and tertiary – for
coronavirus disease (COVID-19), acquired immunodeficiency syndrome (AIDS),
and salmonellosis

Levels of Prevention
Diseases
Primary Secondary Tertiary

Coronavirus disease
(COVID-19)

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 Acquired
immunodeficiency
syndrome (AIDS)

Salmonellosis

10. Name 2 examples of a disease spread from person to person, and suggest five (5)
methods for the control of such disease in the community.

DISEASE METHODS OF CONTROL

1.
2.
3.
4.
5.

1.
2.
3.
4.
5.

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 REFLECTION

Referring to the previous section, fill in the following statements:

▪ The most important thing I learned was…

▪ What I found difficult was…

▪ What I enjoyed most was…

▪ What I have learned that is new is…

▪ I would like to learn more about…

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