Epidemiology

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Introduction
• Summarize the historical evolution of epidemiology
• Name some of the key uses of epidemiology
• Identify the core epidemiology functions
• Describe primary applications of epidemiology in public health practice
• Specify the elements of a case definition and state the effect of changing the
value of any of the elements
• List the key features and uses of descriptive epidemiology
• List the key features and uses of analytic epidemiology
• List the three components of the epidemiologic triad
• Describe the different modes of transmission of communicable disease in a
population

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Epidemiology*

• By definition, epidemiology is the study

(scientific, systematic, and data-driven)
• of the distribution (frequency, pattern) and
determinants (causes, risk factors)
• of health-related states and events (not just
diseases)
• in specified populations (neighborhood,
school, city, state, country, global).
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Epidemiology*

• is the method used to find the causes of

health outcomes and diseases in populations
• the patient is the community and individuals
are viewed collectively

*Source: Principles of Epidemiology, 3rd Edition

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Objectives of Epidemiology

• identify the etiology or cause of a disease and the

relevant risk factors
• study the natural history and prognosis of disease.
• evaluate both existing and newly developed
preventive and therapeutic measures and modes of
health care delivery.
• to provide the foundation for developing public
policy
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Epidemiology’s roots are
nearly 2500 years old.
Circa 400 B.C. “On airs, waters, and places,” - hippocrates

1662 "Natural and political observations . . . made upon the bills of mortality" - john graunt
Father of modern vital statistics and surveillance having developed a nosology (disease
1800
classification) William Farr- international classification of diseases (ICD),
1854 Father of field epidemiology - john snow

1930s and 1940s Epidemiologists extended their methods to noninfectious diseases

1960s and early 1970s Eradicate naturally occurring smallpox worldwide

1980s Studies of injuries and violence

Expansion of epidemiology to look at specific pathways, molecules and genes that
1990s
influence risk of developing disease
late 90's onwards Biologic warfare and bioterrorism

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*https://en.wikipedia.org/wiki/List_of_epidemics JDJSORIANO
Public Health Problems or Events Investigated*

• Infectious Diseases
• Injuries
• Environmental Exposures
• Non-infectious diseases
• Natural Disasters
• Terrorism

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 Changing patterns of community health
problems

*Source: Gordis Epidemiology, 5th Edition JDJSORIANO

Prevention is better than Cure

Primary Prevention
- Preventing the initial development of a disease
Secondary Prevention
- Early detection of existing disease to reduce
severity and complications
Tertiary Prevention
-Reducing the impact of the disease
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Epidemiology and its uses

• Searching for causes

• Assessing the community’s health
• Making individual decisions
• Completing the clinical picture

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Epidemiologic Triad

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Chain of Infection

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Chain of Infection

1. Reservoir
– Human reservoirs
– Animal reservoirs
– Environmental reservoirs
2. Portal of exit
3. Portal of entry
4. Host
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Modes Of Transmission

• Direct
• Direct contact
• Droplet spread
• Indirect
• Airborne
• Vehicleborne
• Vectorborne (mechanical or biologic)

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Core Epidemiologic Functions

• Public health surveillance

• Field investigation
• Analytic studies
• Evaluation
• Linkages

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 The Roots Of Epidemiological
Ethics*

• Bioethics
• Philosophical ethics
• Advocacy, conflicts of interest, and scientific
misconduct

*Source: https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-epidemiology/ethics-etiquette-epidemiology-research
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Declaration of Helsinki

- ethical principles to provide guidance to physicians

and other participants in medical research involving
human subjects
▪ Safeguarding research subjects
▪ Informed consent
▪ Minimizing risk
▪ Adhering to an approved research plan/protocol.

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• Informed consent
– Information
– Understanding
– Voluntariness
• Conflicts of interest
• Publications
• Scientific misconduct
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Analytic Epidemiology
the search for causes and effects, or the why and the how

Comparison group
• Demographic factor such as age, race, or sex;
• Constitutional factor such as blood group or
immune status;
• Behavior or act such as smoking or having
eaten salsa; or
• Circumstance such as living near a toxic waste
site.
• Experimental studies
• Observational studies
❖Cohort study
❖retrospective
❖Case-control study.
❖Cross-sectional study.
•

Descriptive epidemiology

Describe the distributions of diseases and determinants

❖secular trends – long-term variations
❖cyclic changes – periodic fluctuations on an annual
or other basis
❖epidemic disease outbreaks – short-term
fluctuations.