C.

EPIDEMIOLOGY and the NURSE:

Epidemiology – the study of patterns of occurrence and distribution of disease in the community
as well as the factors that affect disease patterns.
- the study of the spread of disease in a group of individuals as in public health.
It concerns the factors of causation.

It is the backbone of the prevention of disease.

 Two things to be known in-order to control a disease effectively:

- The conditions surrounding its occurrence
- The factors favoring the development
 Uses of Epidemiology: According to Morris,
- To study the history of the health populations and the rise and fall of disease and
changes in their character.
- To diagnose the health of the community and the condition of the people
a. measure the distribution and dimension of illness in terms of incidence,
prevalence, disability and mortality
b. to set health problems in perspective and to define their relative
importance
c. to identify groups needing special attention.
a. To study the work of health sOne of the advantages of Public Health Nursing
iservices and to improve them. The success with which the services achieve their stated
goals and the effects on community health have to be appraised in relation to
resources. Action research can lead to future plans for better services.
b. To estimate the risks of disease, accidents, defects and the chances of avoiding them.
c. To identify syndromes by describing the distribution and association of clinical
phenomena in the population.
d. To complete the clinical picture of chronic disease and describe their natural history.
e. To search for causes of health and disease by comparing the experience of groups that
are clearly defined by their composition, inheritance, behavio0r and environments.

b. Natural history of disease – refers to the progress of a disease process in an individual overtime,
in the absence of intervention.
The process begins with exposure to or accumulation of factors capable of causing disease.
without medical intervention, the process ends with
1. Recover
2. Disability
3. Death

Four stages of natural history of disease:

1. Exposure – start of exposure
The susceptible host has come in close contact with the infectious agent, but
It has not yet entered the host’s body cells.
Examples of exposed host:
a. A person who shakes hands with someone suffering from a common cold
 b. A child living in the same room or house as an adult with tuberculosis
c. A person eating contaminated food or drinking contaminated water
2. Infection – the infectious agent has entered the host’s body and has begun multiplying.
Also, this is the entry and multiplication of infectious agent.
Example: a person who has eaten food contaminated with Salmonella typhii, the
bacteria that cause typhoid fever, if exposed, and if the bacteria enter the cells lining
the intestines and start multiplying, the person is said to be infected.
At this stage, there are no clinical manifestations of the disease, which are the typical
signs and symptoms of the illness.
Signs – the features that can only be detected by a trained health worker.
Ex: high temperature, fast pulse rate, enlargement of organs in the abdomen
Symptoms – the complaints the patient can tell you about.
Ex: headache vomiting, dizziness
3. Infectious Disease – the clinical manifestations of the disease are present in the infected
host.
Ex: a person infected with Hepatitis A has jaundice accompanied by pruritus and
Urticaria, fever, anorexia and abdominal discomfort is in this stage – in this case
Hepa A.
Infectious disease host factors:
a. Overall health
b. Immune status
c. Comorbidities and underlying health conditions
d. Nutrition
e. Genetics
Incubation period – the time interval between the onset or start of infection and the first
appearance of clinical manifestations of a disease. In this case, Hepa A, incubation period
is approximately 28 days.
Active cases – infected hosts or persons who have clinical manifestations of the disease.
Carriers – infected hosts or persons who do not have clinical manifestations.
Both can transmit the infection to others.
Not all infected hosts may develop the disease. This depends on the level of immunity of
the hosts and the type of infectious agent.
Two classifications of a disease depending on the time course:
1. Acute – characterized by sudden onset and short duration of illness.
Ex: diarrhea that starts suddenly and lasts less than 14 days
2. Chronic – characterized by prolonged duration of illness
Ex: diarrhea that lasts more than 14 days
4. Outcome - the disease may result in recovery, disability or death of the patient.
Ex: a child who recovers fully from diarrheal disease, or is paralyzed from
Poliomyelitis, or dies from pneumonia
c. Epidemiologic Triangle:
It is a tool to help understand infectious diseases.
It is a model for explaining the organism causing the disease and the conditions that
 allow it to reproduce and spread.
Epidemic or outbreak – the occurrence of more cases of disease, injury, or other health
condition than expected in a given area or among a specific group of persons during a
specific period.
Endemic - the habitual presence or usual occurrence of a disease within a given geographic
area.
Ex: parasitism is endemic to mountainous areas.
Pandemic – a worldwide epidemic affecting an exceptionally high proportion of the global
population.
Components of the epidemiologic triangle:
1. Agent - the microorganism that actually carries the disease. It could be a form of
bacteria, virus, fungus, protozoans or parasite.
2. Host – the organism that carries the disease.
A host does not necessarily get sick.
Hosts can act as carriers for an agent without displaying any outward symptoms
of the disease.
Hosts get sick or carry an agent because some part of their physiology is hospitable
or attractive to the agent.
3. Environment – outside factors that affect the spread of the disease but are not
directly a part of the agent or the host.
Environment can refer to:
f. Physical
g. Climactic conditions
h. Ecology
i. Geography
j. Social environment ( poverty, demographics, urban crowding )
k. Agent environment ( changes in microflora can cause once harmless organisms to
flourish and cause disease )
The Triangle in Action: COVID – 1
Agent (pathogen) :
COVID-- - 19 or SARS-CoV-2 is a coronavirus
Host:
Infects humans and some animals (bats, cats, others)
Spreads person to person, mainly through respiratory droplets
Higher risk – older persons, immunocompromised, people with preexisting
health conditions
Environment:
Worldwide distribution
 Demographic, political and social factors
Duration of infectiousness – the amount of time that an infected host is infectious.

Infectious Disease Terms:

1. Reservoir – a human, animal or environment that is a habitat for an agent.
Ex: when an agent exists inside a primary host species without causing health problems in that
species.
2. Vector – an organism that spreads infection
Ex: a flea, tick or mosquito
3. Fomite – an inanimate object that can be the vehicle
4. Zoonosis – a disease initially transmitted from animals to humans
Ex: COVID –
Epidemiologic process:
Purpose – to identify a problem, collect data, formulate and test hypotheses.
It involves the collection and analysis of more facts or data to determine the cause
of illness.
To implement control measures to prevent additional illness.
Steps of an investigation: Outline Plan for Epidemiological investigation
1. Confirmation of outbreak
a. Is there an increase in the number of cases expected in the population/time/place?
b. Confirm numbers, interview cases, review laboratory findings
c. Is further investigation needed? The extent and urgency of the investigation should be
considered.
2. Verify Diagnosis
a. Obtain medical records and laboratory reports
b. Repeat tests if necessary
c. Further clinical testing if needed
3. Case Definition – components
l. Person – Type of Illness ( e.g. a person with an acute illness )
m. Place - Location of suspected exposure
n. Time - Based on Incubation ( if known )
o. Clinical symptoms/Lab results
p. Define population at risk
4. Case Finding
a. Interview known cases
b. Locate others exposed to probable risk factor
c. Review routine surveillance data, notifications and laboratory results
d. Contact other members of the Health Team
5. Descriptive Epidemiology
a. Epidemic curve
Graph of occurrences of cases overtime, this can help determine the nature of the
outbreak
 q. Point ( common source )
r. Propagated ( continuing source )
s. Point source and person to person spread
Line List
A table summarizing the information about persons associated with the outbreak.
Each row represents a single individual and each column represents a specific characteristic:
t. Identifying information
u. Demographics
v. Dates of illness/results
w. Pertinent risk factors
x. Exposures
y. Clinical details/lab results
6. Generate Hypotheses
Causes may have already been suspected, however, a formal hypothesis is helpful to
Establish after reflecting on the data interpreted in the descriptive epidemiology.
It is useful in determining the most likely exposure that has caused the outbreak
7. Analytical Epidemiology
Useful to conduct analytical studies to test the hypothesis.
z. Assess exposures consistently between cases and controls ( ill and non-ill )
8. Evaluate Control Measures
aa. Monitor incidence of cases once control measures enforced
bb. Laboratory results useful for continued definitive identification of infectious agent in
cases and if appropriate monitoring response to treatment/control measures.
9. Surveillance
cc. Documenting the effectiveness of control measures
dd. Enhanced surveillance through laboratories and healthcare providers
Outline on the Operational Procedure During a Disease Outbreak:
a. Organization of Team
ee. Coordination of personnel
a. National
b. Regional
c. Provincial / city
d. Municipal
e. Other agencies
ff. Orientation / demonstration on the methodology to be employed
gg. Area of Assignment of Teams
hh. Check list on the Team’s paraphernalia
b. Epidemiological Investigation
ii. Active case finding
jj. Carriers and contact control
kk. Surveillance
c. Collection of Laboratory Specimens
 ll. Rectal Swabbing
a. Transport Media
b. Empty sterile bottles and / or container
c. Other article and / or applicator for swabbing
- Food Sampling
a. Food leftovers and suspicious foodstuffs
- Others that are relevant to the disease
a. Vomitus
b. Feces
c. Blood
d. Other secretions, excretion and discharges
4. Treatment of Patients and Contacts
- Analgesics/antipyretics
- Antibiotics
- Parenteral fluids
- Supportive drugs
- Emergency drugs
- Isolation of patients
- Boiling and disinfection of fomites
- Conduction of patients to hospital
5. Immunization Campaign
- Type of Vaccine
- Dosage, schedule technique
- Areas to be covered
- Target population
- Consolidation and evaluation of data
6. Environmental Sanitation (during the Survey)
- Water
a. Boiling
b. Chlorination of drinking jars and other containers for domestic use
c. Treatment of improved dug wells, pump, water system, etc.

- Toilets and Surroundings

a. Location of toilet
 b. Construction of temporary lathes use lime and soil
c. Backfilling with soil
d. Drainage Construction ( self-help )
e. Creoline, Lysol

mm. Garbage Disposal

a. Burning
b. Burying
c. Other methods
nn. Insect and Vermin Control
a. Elimination of harborage and proper storage of foodstuffs
b. Fogging
c. Insecticide spraying
d. Baits, rodenticide
oo. Food Sanitation
a. Proper cooking
b. Protection from flies, cockroaches, rats, etc.
c. Proper handling of cooked foods and utensils
7. Health Education
- Individual approach
- Community approach and meetings
- Schools PTA, church and other congregations
8. Involvement of Other Agencies
- Public
- Private
- Civic
- Religious
- Other voluntary organizations
9. Reporting
- Telegraphic Report
- Written
a. Preliminary
b. Progressive and analytical
c. Final Report
d. Evaluation
e. Recommendation
Control Measures
 May be indicated from the start of the outbreak

Control Source
Consider closing outlet Animal / Human / Environmental
 Isolate and/or treat cases
 Destroy/treat food
Protect Persons at Risk
 Consider prophylaxis ( e.g. antibiotics )
 Improve hygiene/ personal protective equipment if applicable
Interrupting Transmission
 Depends on the mode of spread ( e.g. bottled water if contaminated )

Communication:
During outbreak
 Agree media strategy at initial meeting and review at every meeting
 Information to the public and health professionals
After outbreak
 Outbreak report published and disseminated
 Recommendations made
Functions of the Nurse in Epidemiology:
 Maintains surveillance of the occurrence of notifiable diseases.
 Coordinates with other members of the health team during a disease outbreak.
 Participates in case finding and collection of laboratory specimens.
 Isolates cases of communicable diseases.
 Renders nursing care, teaches and supervises giving care.
 Performs and teaches household members methods concurrent and terminal disinfection.
 Gives health teachings to prevent spread of disease to individuals and families.
 Follow up cases and contacts.
 Organizes, coordinates and conducts community health education campaign, meetings.
 Refers cases when necessary.
 Coordinates with other community agencies.
 Accomplishes and keeps records and reports, and submits to proper office/agencies.

 Purpose of epidemiologic investigation - to identify the source of an epidemic, like, what

brought about the epidemic.