EPIDEMIOLOGY

"RESUME OF NATURAL HISTORY OF DISEASE"

Arranged by :

Name :Septiya Agestin Cahyaningrum

SIN : 6411421006

class : 2 – IUP

Supporting lecturers:

dr. Arulita Ika Fibriani, M. Kes.

PUBLIC HEALTH STUDY

DEPARTMENT OF PUBLIC HEALTH SCIENCE

FACULTY OF SPORT SCIENCE

SEMARANG STATE UNIVERSITY

YEAR 2022
A. Understanding the Natural History of Disease
In general, the scientific history of disease is the process of the disease course starting
from exposure to the end of the disease (healing, disability, or death) without any
medical intervention, so that a disease takes place naturally. In addition to the general
understanding, there are several ideas that convey the definition of the scientific
history of disease, including the following:
1. Scientific history of disease is the development of disease without intervention or
other forms of intervention so that the disease progresses naturally (without any
treatment). ( Nugrahaeni, 2014 )
2. The scientific history of disease is the natural development of a disease (without
medical intervention) so that a disease occurs naturally. (Last, 2001)
3. The scientific history of disease aims to measure the health conditions that will be
obtained in sick people if they do not get treatment that is significant for their
health. (Rohtmann, 2008)
4. Scientific history of disease is one of the goals of descriptive epidemiological
studies. Other terms that are often used in terms of natural history of disease
include: Natural History of Disease, Natural Course of Disease, or Natural History
of Illness. (Van de Broeck, 2013)
5. The scientific history of disease is the process of developing a disease without any
intentional and planned human intervention. (Hikmawati, 2011)
B. The Purpose of Understanding the Natural History of Disease
The purpose of understanding the history of the disease is to recognize or detect a
disease or health problem by recognizing the symptoms, signs, and results of related
examinations or recognizing general health problems through indicators of the problem.
C. Benefits of Understanding the Natural History of Disease
1. Can perform various kinds of therapy against the disease, especially in the early
phase of the disease. Because in the early stages of the disease is the right time to
administer therapy, the earlier the therapy the better the results to be expected.
2. The natural history of the disease can determine the diagnosis of a disease, namely
by knowing the incubation period. Because the incubation period of a disease can
be used as a guide in determining the type of disease, especially when an
extraordinary event occurs.
 3. It can be used as a prevention effort, because knowing the chain of disease
transmission can easily find important cutting points to intervene in disease
prevention efforts.

By knowing the natural history of the disease, we can obtain important information
which includes (Bustan, 2012):

1. The biological nature of pathogenic germs can be used as information material

to carry out disease prevention efforts, in terms of eradicating disease germs.
2. The duration and severity of complaints experienced by patients
3. The incubation period or latency period, the period or time it takes during the
course of a disease to cause someone to fall ill
4. As a basis for completeness of complaints that become information material
for making a diagnosis
5. As a basis for determining the process of disease occurrence according to
season, when the disease occurs more often.
6. As a basis for determining the geographic location of disease attacks so that it
can be easily detected where the disease occurs
D. Stages of Natural History of Disease
1. Pre Pathogenesis Stage (Stage Of Susceptibility)
The prepathogenesis period is the initial interaction between host,
agent and environmental factors. At this stage the disease has not yet
developed but the conditions that underlie the occurrence of the disease
already exist. The susceptible phase is included in the prepathogenesis stage.
Susceptibility phase, The susceptible phase is the stage in which the etiologic
process takes place, in which the first causative factor encounters the host for
the first time. Here the first causative factor has not yet caused the disease, but
has begun to lay the foundations for the development of the disease. For
example, high LDL (low density lipoprotein) cholesterol increases the
likelihood of coronary heart disease, smoking increases the probability of
pulmonary Ca incidence, and so on.

2. Pathogenesis Stage (Stage Of Clinical Disease)

This stage starts from the occurrence of pathological changes due to
exposure to disease agents until the disease becomes cured, disabled, or dies.
Last (2001) divided this stage into three, namely the pathological onset stage,
presymptomatic stage, and clinical stage. CDC (2012) divides the
prepathogenesis period as follows: stage of subclincal disease, stage of clinical
disease, and stage of recovery, disability or death. Other literature divides this
period into four stages, namely the incubation period, early disease, late
disease, and late disease.

a. Stage of Subclinical Disease

Incubation stageis the stage of entry of germs until just before the
onset of symptoms. At this stage what happens include; the immune system is
not strong, the disease continues, there is a disturbance in the form of body
functions and the disease is getting worse and symptoms appear. This phase is
also called the asymptomatic stage; or presymptomatic stage; or preclinical
phase; or the incubation/latency period or the process of induction and
promotion (empirical induction period). This stage begins with the onset of
the first signs/symptoms of the disease. After the disease process is triggered
by exposure, there will be pathological changes in individuals who are not
concerned about their health.
In infectious diseases, this phase is also called the incubation
period, while in chronic/non-communicable diseases it is called the latency
period. During this period, the symptoms of the disease do not appear
(inapparent). This period can last from a few seconds quickly (in poisoning
and allergic/hypersensitivity conditions), to last a long time (in chronic
disease). There is even variation in the length of the incubation period for
only one disease. For example in Hepatitis A about 7 weeks. In leukemia
in Hiroshima atomic bomb survivors, the latency varies between 2-12
years, with a peak period of 6-7 years.
Although disease is not visible during the incubation period, some
pathological changes can be detected by laboratory tests, radiography, or
other screening methods. The screening program should indeed be run during
the incubation period, because it will be more effective if the disease
progresses and shows symptoms. The period during which an individual is
capable of transmitting a disease starting from infection until the infection is
detected by laboratory examination is called the windows period.
 Meanwhile, the time since the disease is detected by screening tests (eg
laboratory) until clinical manifestations appear is called the sojourn time or
detectable preclinic period. The period of time a person with a disease can
transmit the disease is called the infection period.
Boslaugh (2008) refers to this stage as the preclinical phase,
namely the phase where the disease has not yet shown symptoms, but is
biologically present. This phase begins with the onset of the biological
features of the disease and ends when the individual experiences the first
symptoms. So that at this stage there is actually a disease in the individual,
but no symptoms appear. Gerstmann (2013) divides the subclinical phase
into the induction period and the latency period. The induction period
occurs at the time interval between the time of the agent's natural history of
disease. Disease acts, until the host inevitably gets sick.
While the latency period occurs after the host is exposed to the disease
but has not shown clinical signs. During this period of latency various causes
may increase or decrease during the course of the disease. The combination of
the induction period and the latency period is called the empirical induction
period or in non-communicable diseases it is called the multi causal
incubation period. In this phase there is also a process called the promotion
process. The promotion process is the process of increasing an irreversible
and asymptomatic pathological state, becoming a state that causes clinical
manifestations. In this process, the disease agent will increase its activity,
enter the body, thereby causing cell transformation or cell dysfunction, finally
showing symptoms or clinical signs.
b. Stage of Clinical Disease
At this stage, symptoms of the disease have appeared, already feeling
sick, but still mild, the patient can still carry out daily activities. Treatment
is enough with street drugs and avoid transmission to other people. This
stage is also called the duration period; or disease expression processes; or
early stage of the disease. The changes that occur in the body's tissues are
sufficient to produce symptoms and signs of disease. The host is feeling
mild pain, but is still able to carry out light activities. This phase can be
acute (generally in poisoning and infectious diseases) or chronic (generally
in non-communicable diseases). This period is also called the duration or
 expression period, which is the time required by an exposure to reach a
dose sufficient to cause a disease reaction.
c. Stage of Recovery, Disability, or Death
At this stage the disease is getting worse, the patient cannot do work
and if treatment requires treatment. At this stage the course of the disease
will stop with several conditions, namely complete recovery, the patient is
said to be perfect if his condition returns to the way it was before the
illness, recovers with a disability, The patient recovers but is not perfect
because he leaves physical, social and functional disabilities, Career i.e.
the patient seems to have a disability. has recovered and the symptoms are
gone / not visible but in the patient's body there are germs.

Other literature divides this period into four stages, namely the incubation
period, early disease, late disease, and late disease.

a. Prepathogenesis Stage
This interaction still occurs outside the body, in the sense that
the germs are still outside the host's body. In the prepathogenesis
process, malaria can occur in people who live in malaria areas or
people who travel to malaria areas.
The life cycle of malaria species consists of a sexual phase
(sporogony) in the body of the Anopheles mosquito and an asexual
phase (schizogony) in the body of a vertebral host, including
humans. The prepathogenesis stage of malaria begins in the sexual
phase (sporogony). The sexual phase begins with the union of male
and female gametes to form ookinetes in the mosquito's stomach.
Ookinet will penetrate the stomach wall to form cysts on the outer
membrane of the mosquito stomach. (Arif et. Al., 2001). The time
required for this process is 8-35 days, depending on the
environmental situation and the type of parasite. In this place, the
cyst will form thousands of sporozoites which are released and then
spread to all mosquito organs, including the mosquito's salivary
glands. It is in this gland that the sporozoites mature and are ready to
be transmitted when a mosquito bites a human (Widoyono, 2008).
b. Incubation Stage
The incubation period for malaria is a few days to several
months after which the signs and symptoms that sufferers complain
of such as fever, chills, rheumatic or joint pain, sometimes vomiting,
etc. appear. The incubation period for natural transmission for each
parasite species is as follows, Plasmodium falciparum 12 days.
Plasmodium vivax and Plasmodium ovale 13 -17 days. Plasmodium
malariae 28 - 30 days (Arif et. Al., 2001).
Humans who are bitten by infective mosquitoes will experience
symptoms according to the number of sporozoites, plasmodium
quality, and body resistance. Sporozoites will start the
exoerythrocytic stage by entering the liver cells. In the liver, the
sporozoites mature into schizonts, which rupture and release tissue
merozoites. Merozoites will enter the bloodstream and infect
erythrocytes to start the erythrocyte cycle.
Merozoites in erythrocytes will undergo morphological changes,
namely: merozoites -> ring shape -> trophozoites -> merozoites. This
change process takes 2-3 days. Some of these merozoites will develop
to form gametocytes to re-start the sexual cycle into microgametes
(males) and macrogametes (females). This cycle is called the intrinsic
budding period. Infected erythrocytes usually rupture which manifests
in clinical symptoms. If a mosquito bites an infected human, the
gametocytes present in the human blood will be sucked in by the
mosquito. Thus, the sexual cycle in mosquitoes begins, and so on the
transmission of malaria (Widoyono, 2008).
The period between the onset of infection and the discovery of
parasites in the peripheral blood is the prepatent period, while the
incubation period starts from the entry of sporozoites in the host
body until the onset of clinical symptoms. The prepatent period of
each plasmodium is different. Prepatent period of P. falcifarum is 6-
25 days, P. Vivax 8-27 days, P. ovale 12-20 days, and P. Malariae
18-59 days.
c. Early/Clinical Stage
Several clinical conditions are known in the course of malaria
infection, namely:
Primary attack (Clinical Period)
That is the state starting from the end of the incubation period and
starting to occur paroxysmal attacks consisting of chills/chills; hot and
sweaty. This paroxysmal attack can be short or long depending on the
multiplication of the parasite and the state of the patient's immunity. The
usual symptom is the occurrence of the "Trias of Malaria"
(Malaria proxysm) sequentially:
1) cold period
Starting to shiver, the skin is cold and dry, the patient often wraps
himself in a blanket or sarong and when he shivers, the whole
body often vibrates and the teeth are knocked against each other,
pale to cyanosis like a cold person. This period lasts 15 minutes
to 1 hour followed by an increase in temperature.
2) hot period
Patients with red face, hot and dry skin, rapid pulse, and high
body temperature up to 40oC or more, sufferers. This period is
longer than the cold phase, can be up to 2 hours or more,
followed by a state of sweating.
3) Sweating period
The patient sweats starting from the temporal, followed by the
whole body, until wet, the temperature drops, the patient feels
tired and often falls asleep. When the patient wakes up, he feels
healthy and can do his usual work (Rampongan, 2007).
4) Latent period
That is the period without symptoms and without parasitemia
during the occurrence of malaria infection. Usually occurs
between two paroxysmal states.
 5) Recrudescense
Namely the recurrence of clinical symptoms and parasitemia
within 8 weeks after the end of the primary attack.
6) recurrence
Namely the recurrence of clinical symptoms or parasitemia after
24 weeks of the end of the primary attack.
7) Relapse or “Rechute”
Is the recurrence of clinical symptoms or parasitemia that is
longer than the time between periodic attacks of primary
infection. (Rampongan, 2007)
d. Advanced Stage
It is the stage in which the disease becomes more pronounced and
may get worse with all the pathological abnormalities and symptoms.
At this stage the disease is already showing symptoms and clear
clinical abnormalities, so the diagnosis is relatively easy to establish.
And also need treatment. In the advanced stages of malaria,
depending on the type or type of malaria disease (Widoyono, 2008).
e. Final Stage
In the final stages of malaria, the disease can be completely cured,
carriers or carriers are cured, and there are also those who died due to
the attacking plasmodium, namely Plasmodium falciparum. This
type of plasmodium can cause death and is the most common cause
of infection. P. falciparum can attack organs and cause damage to the
brain, kidneys, lungs, liver and heart (Arif et. al., 2001).
E. Disease Prevention Efforts
Based on the natural history of the disease, preventive measures against disease
can be broadly categorized into:
1. Primary preventive efforts (primary prevention)
Conducted in the period of prepathogenesis – stage of susceptibility
The aim is to intervene before the occurrence of pathological changes in the
host, for example keeping humans from contact with the agent. Efforts are
made to promote health, provide specific protection. Examples of preventive
efforts include:
1) counseling, health education
 2) nutrition according to standards for a person's growth and
development
3) mental health
4) provision of healthy housing
5) Sufficient recreation
6) suitable job
7) marriage counseling and sex education
8) periodic health checks. Special protections include:
a. immunization
b. personal hygiene
c. use of environmental sanitation
d. protection against occupational hazards
e. accident protection
f. use of certain nutrients
g. protection against carcinogens
h. avoid allergens
2. Secondary preventive business
The aim is to cure or stop the disease process, prevent the spread of infectious
diseases, prevent complications and sequelae and shorten the period of disability.
Efforts made are:
a. Early diagnosis and prompt treatment
b. Disability limitation (limitation of disability) Efforts for early diagnosis and
prompt treatment include:
1) case finding, individual or group
2) screening survey
3) treatment and prevent disease
4) prevent the spread of infectious diseases
5) prevent complications and sequelae
6) shorten the period of incapacity Efforts to limit disability include:
a. adequate treatment to stop the disease process and prevent further
complications and consequences.
b. Provision of facilities to limit disability and to prevent death.
3. Tertiary preventive business (tertiary prevention)

If there has been a structural defect/damage or disability, then to prevent the

condition from getting worse or the disability to persist, tertiary preventive
measures with rehabilitation are carried out. The goal is to restore the individual
so that he can live usefully in a society with limited circumstances. Rehabilitation:

a. It is necessary to provide facilities for training and education in hospitals and

in public places.
b. Utilize and maintain as well as possible the remaining capacity of a person.
c. Conduct education and counseling for the general public and the industrial
community to use workers who have been rehabilitated as permanent
employees and are placed in places appropriate to their disabilities.
d. Occupational therapy in the hospital
e. Provide a special shelter.
 BIBLIOGRAPHY

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