E PID E MIO L O G Y A N D DIS E A S E T R •

A N S MIS SIO N •
Factors that Contribute to the Spread of Disease e.g. air, soil, food, milk, water, and fomites
1V irulence of pathogen 2S usceptibility of the Fomites – contaminated materials e.g. clothing,
population 3 Lack of immunization 5 Mode of bedding, urinals/bedpans, eating and drinking
transmission of the pathogen 4 Inadequate utensils
sanitation procedures Air – contaminated by dust, smoke, and
R e s e r v oir s o f In f e c tio n s respiratory secretions of humans expelled into
• the air by breathing, blowing, sneezing, and
––– coughing
any site where the pathogen can multiply or •••
merely survive until it is transferred to the host Contact transmission Vehicle transmission
Human reservoir Animal reservoir Inanimate Vector transmission M O D E O F T R A N S
reservoir MIS SIO N
• C o n t a c t T r a n s mis sio n
•
• •
principal living reservoir of disease because ••
many human pathogens are specie-specific spread of an agent of disease by direct, indirect
direct transmission - with signs and symptoms or droplet transmission
of disease and transmit the disease carrier – Direct Contact Transmission person to person
harbors the pathogen but have no signs and transmission of an agent by physical contact
symptoms (source to susceptible host)
H u m a n R e s e r v oir C o n t a c t T r a n s mis sio n …
Carrier •
• •
• •
• •
• •
incubatory carrier – transmits the pathogen Indirect Contact Transmission from source to a
during the incubation period convalescent carrier non-living object to a susceptible host
– transmit pathogen during convalescence or Droplet Transmission Microbe spread in droplet
recovery period active carriers – completely nuclei that travels only a short distance (<1
recovered from disease but continue to harbor meter) i.e. coughing, sneezing. Laughing or
the pathogen indefinitely passive carriers – carry talking
the pathogen without ever having the disease •
• •
• •
• •
• •
zoonoses- infectious diseases that humans •
acquire from animal sources   Routes: Direct transmission of disease agent by a medium (i.e.
contact – with infected animal or with domestic water, food, air, etc) Waterborne Transmission
pet waste Inhalation – from contaminated hides, water contamination i.e. cholera, Shigella
fur, feathers Ingestion – contaminated food and Foodborne Transmission raw of poorly
water; consumption of infected animal products preserved or prepared food Airborne
Injection of the pathogen – insect vector Animal Transmission spread of agents of infection by
reservoir droplet nuclei in dust that travel > 1 meter from
In a nim a t e ( n o n -livin g ) r e s e r v oir the reservoir to host
• V e hicle T r a n s mis sio n
• V e c t o r T r a n s mis sio n
animals that carry pathogens from one host to
another
Control of Epidemic Disease
• 13%
••
•••
Report cases of communicable diseases to
proper agencies Public education Identification
and elimination of reservoirs of infection
Isolated disease person Participate in
immunization program Help to treat sick person
P A T H O G E N E SIS O F IN F E C TIO N
P a t h o g e n e sis
•••
A.
Pathos – Disease Genesis – Means origin It is
the source or cause of an illness or abnormal
condition
INFECTION It involves the growth and
multiplication of microorganism that result in
damage to the host. It is the invasion of the body
by pathogenic microorganisms that reproduce
and multiply, causing disease by local cellular
injury, secretion of a toxin, or antigen-antibody
reaction in the host.
T y p e s o f in f e c tio n a s t o c a u s e
• (Generalized Infection) Microbes are spread
• throughout the body by blood or lymph
• Bacteremia Is the presence of bacteria in the
Autogenous infection Is caused by a
microorganism from the microbiota of the
individual. Iatrogenic infection Is an infection
that occurs as the result of medical treatment or
medical procedures. Opportunistic infection Is
an infection in immunocompromised hosts that
do not cause disease in individuals with a
normal immune system It may due to overuse of
antibiotics, immunosuppressive drugs and
chemotherapeutic agents.
• invade the bloodstream and localized at different
Nosocomial infection Is a type of infection
acquired at a health care facility Each
nosocomial infection adds 5-10 days to the
affected patients hospital stay Hand washing is
still the cornerstone of modern infection control
programs
Common Nosocomial infection Urinary tract
infection – 33% Lung infection – 15% Surgical
site infection – 15% Blood stream infection –
Predisposing Factors to Nosocomial Infection
Wide variety of microbes in hospital
environment Weakened or
immunocompromised patients Chain of
transmission ( direct or indirect) from health
workers to patient from patient to patient
fomites- catheters, needles, dressings, beds,
wheelchairs airborne transmission vector-borne
transmission
1.
A.
Types of infections according to distribution in
the host: Local Infection It means signs and
symptoms are confined to one area Example:
infected wound, boils, abscess, acne 2. Focal
infection It starts as a local infection and spread
to other parts of the body. example: tooth
infection, tonsilitis, appendicitis, wound
infection caused by C. tetani 3. Systemic
blood (1-10 bacteria/ml of blood) The organisms
invade the bloodstream without active
multiplication The highest concentration of
bacteria in the blood.
B. Septicemia Active multiplication of bacteria
in the blood (active multiplication of the
invasive organsm) C. Pyemia It is a condition
wherein pus-producing organisms repeatedly
parts of the body D. Toxemia Is the presence of
toxins in the blood When bacteria are localized
in one area but produced a toxin, which spreads
and absorbed by the body cells.
E x t e n t o f in f e c tio n
1.
Primary infection Is an initial infection causing
the illness Example: common cold 2.
Secondary infection It is caused by opportunistic
pathogen after primary infection has weakened
host immune system. example: pneumonia or
bronchitis may develop after the common cold
3. Latent infection( silent phase) Is clinically
silent inside the body without any noticeable
illness in the host before suddenly causing
severe and acute infection Example: over 90%
of polio infection are asymptomatic
4. Mixed infection It is caused by two or more
organisms. Example: wound infection
5. Acute infection Is a type of infection that
develops and progress slowly example:
whooping cough
6. Chronic infection Is an infection which
develops slowly with milder but longer-lasting
symptoms example: tuberculosis
R o u t e s o f in f e c tio n
1. a.
b.
c. d.
a. b. c.
Direct transmission Congenital contact – S.
agalactiae, N. gonorrheae, T. pallidum Sexual
contact – N. gonorrheae, T. pallidum, C.
trachomatis Hand to hand transmission –
rhinovirus Infectious respiratory secretions or
droplets – S. pyogenes, N. meningitidis 2.
Indirect transmission Fomites – spoon, fork,
glass, mug Water – salmonella, shigella, vibrio
Arthropod vectors – borrelia, francisella,
yersinia
Dis e a s e
1.
Is a specific illness or disorder characterized by
a recognizable set of signs and symptoms
attributed to hereditary, infection, diet or
environment It results when the infection
produces notable changes in human physiology
that are often associated with damages to one or
more of the body’s organ system.
Classification of infectious diseases:
Communicable disease It is spread from one
host to another, directly or indirectly Example:
tuberculosis, herpes, flu, AIDS, chicken pox,
mumps 2. Contagious disease It is spread easily
from one person to another Example : chicken
pox and measles
1. 2.
3.
4.
3. Non-communicable disease It is not spread
from host to another It is caused by microbes
that live outside the body or by opportunistic
pathogens that live inside the body example:
tetanus and botulism Classification of Disease as
to Occurrence: Sporadic disease- it occurs
occasionally Endemic disease – constantly
present in a particular location or population
Epidemic disease – many people acquire the
disease in a particular location or population
Pandemic disease – an epidemic that spans the
world (world wide epidemics)
E f f e c t s o f in f e c tio u s dis e a s e
1.
Signs These are objective changes that can be
measured example: fever, redness, swelling,
paralysis 2. Symptoms These are subjective
feelings not obvious to a person (pain, malaise)
3. Syndrome Is a group of signs and symptoms
that are associated with a disease. example:
AIDS
1.
Phases of infectious diseases: Incubation period
Is the time between the exposure to a pathogenic
organism and the onset of symptoms. 2.
Prodromal period Is the appearance of the signs
and sypmtoms 3. Clinical/illness period Is the
peak of characteristic signs and symptoms of an
infection or a disease 4. Decline period Is the
period wherein the signs and symptoms begin to
subside as the host condition improves The
condition of host deteriorates possibly leading to
death 5. Convalescent period/ period of recovery
- Is the full recovery of the surviving host
P r e dis p o sin g f a c t o r s
1. 2. 3. 4. 5. 6. 7. 8. 9.
Gender Genetic factors Climate and weather
Nutrition Fatigue/stress Environment Lifestyle
Age Occupation
1.
Pathogens - Are microorganisms that cause
infection and/or illness Pathogenicity - pertains
to the ability of a pathogenic agent to produce a
disease in a susceptable individual Two (2)
General classes of pathogenic microorganisms:
True pathogens They are able to invade the
tissues of healthy individuals through some
inherent ability (power) of their own 2.
Opportunistic pathogens These are organisms
that normally do not cause disease in their
natural habitat in a healthy person – they may
cause disease if the host is weakend These are
organisms that only cause infections when one
or more of the host’s defense mechanisms are
disrupted, damaged, changed or malfunctioning.
H o s t Mic r o b e R ela tio n s hip
1.
Symbiosis -is the association of two organism
living together 2. Mutualism Is a symbiotic
relationship where both the host and organism
benefit from one another 3. Commensalism Is a
relationship where the organism benefits, but
there is no beneficial or harmful effect to the
host 4. Parasitism -is a relationship where the
organism benefits at the expense of the host
Virulence Is the power of the microorganisms to
produce disease Is the degree of pathogenicity It
is measured by the number of microorganism
necessary to cause infection in the host
Virulent -it pertains to a very pathogenic
microorganism or rapidly progressive condition
Those organisms that can establish infection
with a relatively low infective dose are
considered more virulent than those that require
high numbers for infection
1.
Factors influencing microbial virulence Toxic
factors T o xin s are poisonous substance
produced by pathogenic microorganisms T o xig
e nicit y is the ability to produce toxic
substances. example: diphtheria toxin,
tetanospasmin, botulism toxin, enterotoxin 2.
Enzymatic factors These are produced by
bacteria example: hyaluronidase, coagulase,
leucocidin 3. Cellular structure -capsule resists
phagocytosis
H o s t r e sis t a n t f a c t o r s
1.
Physical barriers The skin serves as the physical
and chemical barrier to microorganism The
acellular, outermost layer of the skin and tightly
packed cellular layers underneath provide an
impenetrable physical barrier to all
microorganisms unless damaged 2. Cleansing
mechanism The nasal hairs keep out airborne
particles that may contain microorganisms
Cough-sneeze reflex contributes to the removal
of potentially infective agents. The cells lining
the trachea contain cilia
3. Antimicrobial substances Example: lysozyme
and bile salts -lysozymes destroy bacterial cell
walls; bile salts disrupt bacterial membranes. 4.
indigenous/normal microbial flora These are
microorganisms that are commonly found on or
in body sites of healthy persons. a. resident
flora- inhabit and multiply; colonize an area for
months or years b. transient flora- inhabit but do
not multiply; colonize an area temporarily; they
are eliminated by either the host inherent
immune defense or by competition with resident
flora Note: Microorganisms usually do not
multiply in the esophagus and stomach, but are
present in ingested food and as transient flora.
5. Phagocytosis Is the process by which certain
cells engulf and dispose off microorganisms and
cell debris. Phagocytes (polymorphonuclear
leukocytes and macrophages) - these are cells
that ingest and destroy bacteria and other foreign
particles - these cells ingest bacteria by a
process known as endocytosis 6. Inflammation It
plays an important role as a reinforcement
mechanism against microbial survival and
proliferation in tissues and organs Signs:
swelling, redness, heat,pain and loss of function
7. Immune response -it provides the human host
with the ability to mount a specific protective
response to the presence of a microorganism
-immune system has a ‘’memory’’ so that if a
organism is encountered second time.
2 a r m s o f s p e cific im m u nit y
A.
Humoral (antibody-mediated) immunity It is
based on the action of soluble proteins called
antibodies that occur in the body fluid and on
the plasma membrane of B lymphocytes B.
Cellular (cell-mediated) immunity -is based on
the action of specific kinds of Tlymphocytes that
directly attack cells infected with viruses or
parasites
In f e c tio u s a g e n t f a c t o r s
1.
Adherence In order for a microorganism to
cause disease, It must penetrate the mucous
layer and attach to the epithelium 2.
Proliferation In order to establish itself and
cause disease, a pathogen must be able to
replicate following attachment to host cells 3.
Tissue damage A disease or an infection is
noticeable only if tissue damage occurs
4. Production of toxins a. exotoxins- these are
the most lethal substances known; specific and
more limited; present in grampositive bacteria
b. endotoxins- it is released when bacteria die
and their cell walls undergo lysis, thus liberating
the endotoxin, it also liberates fever in the
hypothalamus 5. Invasion The process of
penetrating and growing in tissues With some
organisms, invasion involves only a few layers
of cell, with others it involves deep tisssues 6.
Dissemination - The spread of organisms to
distant sites
R o u t e s o f t r a n s mis sio n
1.
Airborne transmission Respiratory spread of
infectious disease is common Secretions are
aerolized by coughing, sneezing and talking
Infectious diseases such as tubercolusis,
brucellosis, tularemia, legionellosis and plague
may be acquired through inhalation of infectious
particles or droplet 2. Transmission by food and
water Infection occur via the faecal-oral route
Gastric enzymes and juices in the stomach act to
prevent survival of most organisms 3. Close
contact - It refers to passage of organism by
salivary, skin, and genital contact
4. Cuts and bites Bites are infection by the
normal flora of the mouth
5. Arthropods -the infectious agents multiply in
the arthropod which then feeds off a human host
and transmit the microorganism
6. Zoonosis It depends on the contact with
animals or animal by-product - Diseases may be
passed by arthropod vector, contact with
secretions, and contact with animal carcasses
and products
T e r min olo gi e s 1.
Active immunization Is the protection of
susceptible humans and domestic animals from
communicable diseases by the administration of
vaccines For this type of immunizations, vaccine
may be prepared from killed microorganisms,
living, weakened (attenuated), inactivated
bacterial toxins. Etc. 2. Passive immunization It
is administered to individuals exposed to certain
pathogens that cause diseases 3. Natural (innate)
immunity - Is a non specific response which
activates chemotaxis, the process by which
phagocytes are directed to the site of
proliferation and engulf invading organism
4. Acquired active immunity Is the specific
response of the host to an invading organism 5.
Opsonizing antibodies These are antibodies
attached to the surface of microorganisms and
render pathogens susceptible to phagocytosis 6.
Neutralizing antibodies These are antibodies
attached to surface of microorganisms and block
surface receptors 7. Complement-fixing
antibodies These are antibodies attached to the
surface of pathogens and destroy antibodies by
lysis 8. Antigenic shift - Is a major genetically
determined change in the antigenic character of
a pathogen which may result to not being
recognized by immune system
9. Antigenic drift Is a minor antigenic change as
a result of mutation in pathogen strains, and
facilitates the pathogen avoids host immune 10.
Anamnestic response Is the ability of the B
lymphocytes to recall pathogens during primary
exposure, thus second exposure elicits higher
antibody response
B A SIC T E R MIN O L O GIE S IN E PID E
MIO L O G Y
• infection, may be a person, animal or something
1.
Is the study of occurrence, distribution and
causes of disease and injury Carrier -is a person
or animal who harbours and spreads a
microorganism that causes disease but who does
not become ill Capable of transmitting the
infection or disease a. casual/acute/transient
carrier- it harbours the microorganism
temporarily for a few days or weeks. b. chronic
carrier- it remains infected for a relatively long
time, sometimes throughout life c.
convalescence carrier- is an individual who has
recovered from infection but continues to harbor
large number of the pathogen d. active carrier- is
an individual who has an overt clinical case of
the disease
2. Endemic When an organism or disease is
constantly present in a population It is
indigenous to a geographic area or population 3.
Sporadic Occurs occasionally 4. Epidemic When
a disease affects significantly large number of
people at the same time in a geographic area
Influenza is a classic example of an epidemic 5.
Pandemic Is an epidemic over a large area
affecting tens of millions of people 6. Incidence
rate -is the number of times a new event occurs
in a given period of time
7. Incubation period Is the time between
exposure to a pathogen and the onset of
symptoms It is difficult to determine bacause
individuals often have difficulty pinpointing the
date or time of exposure 8. Morbidity rate Is the
rate at which an illness occurs; a measure of the
infectiousness of an organism. Is the number of
cases of a disease in a specified population
during a defined time interval 9. Mortality rate
Is the number of deaths due to a disease in a
population 10. Reservoir - Is the source of an
in the environment.
11. Contact isolation – a type of isolation to
prevent transmission of diseases spread by close
or direct contact. 12. Fomites – inanimate
objects that may be contaminated with infectious
organisms and may serve as a means of their
transmission. 13. Infection – a pathological
condition caused by growth of microorganisms
in the host 14. Isolation – the practice of limiting
the movement and social contact of a patient
who is potentially infectious or who must be
protected from exposure to infectious agents.
16. Nonpathogenic- not normally causing
disease in a healthy individual 17. Nosocomial
infection- infection acquired in a hospital or
health care facility 18. Pathogen- an organism or
agent capable of causing disease in a host 19.
Respiratory isolation- a type of isolation to
prevent transmission of organisms spread
through the air over short distances 20.
Reverse/Protective isolation- a type of isolation
designed to protect highly susceptible patients
from exposure to infectious agents; protective
isolation 21. Strict isolation- a type of isolation
to prevent transmission of highly contagious or
virulent infections
23. Malfunction of an organ- e.g.
hyperthyroidism 24. Vitamin deficiency - e.g.
scurvy
I s ola tio n t e c h niq u e s u s e d in h o s pit als
t o p r e v e n t s p r e a d o f in f e c tio n in h o s
pit als Isolatio n Route of transmissi on Isolation
technique/s Diseases Strict All Private rooms,
gowns, gloves, masks, sterilize all Congenital
rubella, chicken pox, plague (pneumonic),
generalized staphylococcal infections
I s ola tio n t e c h niq u e s u s e d in h o s pit als
t o p r e v e n t s p r e a d o f in f e c tio n in h o s
pit als Isolation Route of transmissio n Isolation
technique/s Diseases Respirato ry Respiratory
Private rooms, masks, contaminat ed articles
Measles, pertussis, tuberculosis
I s ola tio n t e c h niq u e s u s e d in h o s pit als
t o p r e v e n t s p r e a d o f in f e c tio n in h o s
pit als
Isolation Route of transmissio n
Isolation technique/s
Diseases
Enteric Enteric, from feces   Route of exit Route of Transmission or entry
Private rooms, gowns, gloves, contaminat ed
articles
Salmonella, Shigella, hepatitis
I s ola tio n t e c h niq u e s u s e d in h o s pit als
t o p r e v e n t s p r e a d o f in f e c tio n in h o s
pit als Isolation Route of transmissio n Isolation
technique/s Diseases Contact Contact with
lesions, infected wounds   Private rooms, gowns,
gloves, masks Infected burns, draining wounds
I s ola tio n t e c h niq u e s u s e d in h o s pit als
t o p r e v e n t s p r e a d o f in f e c tio n in h o s
pit als Isolation Route of transmissio n Isolation
technique/s Diseases Blood and body fluid
Contact with blood or body fluids   Private room
Hepatitis or HIV
I s ola tio n t e c h niq u e s u s e d in h o s pit als
t o p r e v e n t s p r e a d o f in f e c tio n in h o s
pit als Isolation Route of transmissio n Isolation
technique/s Diseases Protectiv e  Staff to patient
Universal precautions, private rooms, masks
Extensive burns
C o m m o n R o u t e s o f T r a n s mis sio n
Route of exit Route of Transmission or entry
Disease Skin Skin dischargeair-respiratory tract
Chicken pox, colds, influenza, measles, staph
and strep infections
C o m m o n R o u t e s o f T r a n s mis sio n
Route of exit
Route of Transmission or entry
Disease
Respiratory Aerosol droplet inhalation, nose or
mouth- hand or object-nose
Colds, influenza, pneumonia, mumps, measles,
chicken pox, tuberculosis
C o m m o n R o u t e s o f T r a n s mis sio n
Route of exit Route of Transmission or entry
Disease
Gastrointesti nal
Feces-handmouth / Stoolsoil-food-mouth
Gastroenteritis, hepatitis, salmonellosis,
shigellosis, typhoid fever, cholera, giardiasis,
ameobiasis
C o m m o n R o u t e s o f T r a n s mis sio n
Route of exit Route of Transmission or entry
Disease
Salivary Direct salivary transfer
Herpes cold sores, infectious mononucleosis,
tuberculosis, strep throat
C o m m o n R o u t e s o f T r a n s mis sio n
Disease
Genital secretions
Urethral or cervical secretion and Semen
Gonorrhea, herpes, Chlamydia infection
C o m m o n R o u t e s o f T r a n s mis sio n
Route of exit Route of Transmission or entry
Disease
Blood Transfusion or needle prick
Cytomegaloviru s infection, malaria, AIDS,
syphilis, warts HepatitisB; cytomegaloviru s
infection, malaria, AIDS
C o m m o n R o u t e s o f T r a n s mis sio n
Route of exit
Route of Transmission or entry
Disease
Zoonotic Insect bite Animal bite Contact with
carcasses Arthropod
Malaria, relapsing fever Rabies, anthrax, Rocky
mountain Spotted fever, Lyme disease, typhus,
encephalitis, yellow fever, malaria