Patterns of Disease Occurrence:

Sporadic refers to a disease that occurs infrequently and irregularly. Occasional

occurrences affect a small number of people.

Example 1: Single case of rabies was diagnosed in a community.

Example 2: Fewer than 10 cases of rabies per year; last week, 1 case

Endemic refers to the constant presence and/or usual prevalence of a disease or

infectious agent in a population within a geographic area. Cases are present all year
round within a geographic area.
Example: About 60 cases of measles are usually reported in this region per
week, slightly less than the national average

Hyperendemic refers to persistent, high levels of disease occurrence.

Example: Average annual incidence was 364 cases of pulmonary tuberculosis per
100,000 population in one area, compared with national average of 134
cases per 100,000 population

Epidemic refers to an increase, often sudden, in the number of cases of a disease

above what is normally expected in that population in that area. An epidemic occurs
when an infectious disease spreads rapidly to many people.
Example: 30 cases of cholera occurred within 3 weeks among residents of a
particular neighborhood (usually 0 or 1 per year)

Outbreak carries the same definition of epidemic, but is often used for a more limited
geographic area. An outbreak may occur in a community or geographical area, or may
affect several countries. It may last for a few days or weeks, or even for several years.
Some outbreaks are expected each year, such as influenza. Sometimes a single case
of an infectious disease may be considered an outbreak. This may be true if the
disease is rare (e.g., foodborne botulism) or has serious public health implications (e.g.,
bioterrorism agents such as anthrax).
Cluster refers to an aggregation of cases grouped in place and time that are suspected
to be greater than the number expected, even though the expected number may not be
known.
Example: If one man from a family has travelled abroad and he transmits the
Corona virus infection to other family members or his extended family.

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Pandemic refers to an epidemic that has spread over several countries or continents,
usually affecting a large number of people.
Example: Over 20 million people worldwide died from influenza in 1918–1919

Epidemics occur when an agent and susceptible hosts are present in adequate
numbers, and the agent can be effectively conveyed from a source to the susceptible
hosts. More specifically, an epidemic may result from:
1. A recent increase in amount or virulence of the agent,
2. The recent introduction of the agent into a setting where it has not been before,
3. An enhanced mode of transmission so that more susceptible persons are
exposed,
4. A change in the susceptibility of the host response to the agent, and/or
5. Factors that increase host exposure or involve introduction through new
portals of entry

Epidemic Patterns
Epidemics can be classified according to their manner of spread through a population:

1. Common-source: A common-source outbreak is one in which a group of

persons are all exposed to an infectious agent or a toxin from the same
source.
1.1. Point Source: If the group is exposed over a relatively brief period, so
that everyone who becomes ill does so within one incubation period. If the
number of cases during an epidemic were plotted over time, the resulting
graph, called an epidemic curve, would typically have a steep upslope and
a more gradual downslope (a so-called “log-normal distribution”).

1.2. Continuous: Case-patients may have been exposed over a period of

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 days, weeks, or longer. In a continuous common-source outbreak, the
range of exposures and range of incubation periods tend to flatten and
widen the peaks of the epidemic curve.
1.3. Intermittent: The epidemic curve of an intermittent common-source
outbreak often has a pattern reflecting the intermittent nature of the
exposure.

2. Propagated: A propagated outbreak results from transmission from one

person to another. Usually, transmission is by direct person-to-person contact.
In propagated outbreaks, cases occur over more than one incubation period.

3. Mixed: Some epidemics have features of both common-source epidemics and

propagated epidemics. The pattern of a common-source outbreak followed by
secondary person-to-person spread is not uncommon.

Epidemic Pattern: Point-Source (With steep slope and more gradual slope epidemic
curve)

Epidemic Pattern: Continuous Common-Source Outbreak (exposure and incubation

period ranges tend to flatten and widen the peaks of the epidemic curve)

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 Intermittent Common-Source Outbreak:

Epidemic Pattern: Propagated Outbreak (In propagated outbreaks, cases occur over
more than one incubation period)

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The epidemic usually wanes after a few generations, either because the number of
susceptible persons falls below some critical level required to sustain transmission.

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