INFECTIOUS DISEASE EPIDEMIOLOGY

I. Definition of Terms
A. Endemic, epidemic, pandemic
B. Outbreak VS. cluster
C. Disease surveillance
II. Epidemics
A. Essential ingredients of an epidemic
1. Pathogen
a. Recent increase in dosage
b. Change in virulence
c. Recent introduction to a setting where it has never been before
d. Enhanced method of transmission
2. Host
a. Change in susceptibility of host
b. Change in host response to pathogenic agent
3. Environment
a. Introduction into new portals of entry
b. Cultural behavioural factors increasing host exposure
B. Determinants of an increase in baseline (epidemics)
1. Current disease level exceeds 95th percentile for 2 weeks
2. More than 2x the incidence rate over the specified time period
3. Comparison of the indices of the disease with the incidence for the last 5 years using
median
C. Epidemic curves (epi curve)
1. Information gathered
a. Time trend
b. Outliers (index care, sentinel case)
c. Pattern of spread
d. Time of exposure
2. Patterns
a. Common-source
i. Point*
ii. Continuous*
iii. Intermittent
b. Propagated*
c. Mixed
*considered as the 3 main types of epidemics
III. Disease Surveillance
A. Objectives
1. Epidemic (outbreak) detection
2. Monitoring trends of endemic diseases
3. Evaluation of an intervention
4. Monitoring progress toward a control objective
5. Monitoring program performance
6. Estimation of future disease impact
B. Philippine Integrated Disease Surveillance and Response (PIDSR)
1. Flow of reporting of notifiable diseases
2. Notifiable disease
a. Diseases targeted for eradication or elimination
b. Epidemic-prone diseases
c. Other diseases of public health importance

3. Alert level for certain diseases

IV. Outbreak Investigation
A. Criteria for initiating an outbreak investigation
B. Steps
C. Attack Rate (AR)
1. Type of IR
2. In outbreak setting, AR is used as a synonym for risk
3. Number of persons with the disease/number of people exposed x 100
4. Other attack rates
1. Secondary AR – compare community transmission and household (contact)
transmission

2. Over-all AR – new cases in total population