Measures of Dynamics of Infectiousness

Session Two
Communicable/Infectious Disease
Epidemiology
BY:
Sisay S. (BSc, MPH in Epidemiology)

July, 2022
7/7/2022 Sisay S (Bsc., MPH in Epidemiology) 1

• Learning objectives
• By the end of this session, students will be able to:

• List the major components of the infectious disease cycle
• Describe natural history and time course of an infectious

disease
• Describe the type of carriers and roles in the infectious

disease transmission
• Models of infectious diseases
7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 2

• Communicable disease (infectious disease)
• Is an illness due to a specific infectious agent or its
toxic products that arises through transmission of that
agent or its products from an infected person, animal,
or reservoir to a susceptible host, either directly or
indirectly through an intermediate plant or animal
host, vector, or the inanimate environment.

• Infectious disease epidemiology
• The study of circumstances under which both
infection and disease occur in a population and the
factors which influence their frequency, spread and
distribution of infectious diseases.
• Each disease has different progress on the individual

Natural History of Diseases
• It refers to the progression of a disease process in an
individual over time, in the absence of intervention.
• There are four stages in the natural history of a
disease.
7/7/2022
5 Sisay S. (Bsc., MPH in Epidemiology)
• Natural…
• Begins by exposure to a causative agent capable of causing

disease.
• Without intervention, the process ends with recovery,

disability or death.
• The course can be halted at any time in the progression by

intervention, host factors and other influences.
7/7/2022
• Stage of susceptibility
• Disease has not yet developed, but the

groundwork has been laid by the presence of
factors that favor its occurrence.
–Example: unvaccinated child is susceptible to
measles.
7/7/2022 7
Sisay S. (Bsc., MPH in Epidemiology)
• Stage of Pre-symptomatic (sub-clinical) disease;
• No manifestations of the disease but pathologic
changes (damages) have started to occur in the body.
• The disease can only be detected through special

tests since the signs and symptoms of the disease
are not present.
– Examples: Detection of antibodies against HIV in

an apparently healthy person.

• The Clinical stage
• The person has developed signs and symptoms of the
disease.
• The clinical stage of different diseases differs in duration,

severity and outcome.
• The outcomes of this stage may be recovery, disability or

death.
• Examples: Common cold has a short and mild clinical

stage and almost everyone recovers quickly.
7/7/2022 9
• Stage of disability or death
• Some diseases run their course and then resolve
completely either spontaneously or by treatment.
• In others the disease may result in a residual defect,

leaving the person disabled for a short or longer
duration.
• Still, other diseases will end in death.

• Eventually the host becomes non-infectious by,
• Clearing the infection, possibly by developing
immunity
• Therapeutic intervention, or
• Death.
• The host may become non-infectious while still

harboring the microbe (also called carrier).
7/7/2022
Time Course of a Disease in Relation to Its Clinical
Expression and Communicability
7/7/2022
12 Generation period Sisay S. (Bsc., MPH in Epidemiology)
• The natural history of infectiousness includes:
Pre patent period: the time interval from infection to
becoming infectious (shedding of the agent).
Infectious period: the time during which an infected

host could infect another host or vector.
Incubation period: the time interval from infection to

symptomatic disease.
7/7/2022
13
• Reading assignment
• What is carriers?
• What are asymptomatic, Incubatory, Convalescent,

Chronic carriers
• Why carriers are more disease transmitters than

symptomatic cases?
• What is ice burg effect?

• Theories of disease Causation
• Cause of disease: is an event, condition,
characteristic or a combination of these factors
which plays an important role in producing the
disease.
• Not all associations between exposure and disease

are causal.

Necessary/primary and sufficient cause model
• Necessary cause/primary cause: A causal factor
whose presence is required for the occurrence of the
disease.
• Sufficient cause: A causal factor or collection of

factors whose presence is always followed by the
occurrence of the disease.
– Example: Tubercle bacillus is a necessary factor for
tuberculosis.
7/7/2022
16
– Rabies virus is sufficient for developing clinical rabies.
2. The epidemiologic triad or triangle
• Is the traditional model of infectious disease causation.
• Infectious diseases result from the interaction between
the infectious agent, host/reservoir and environment.
Host
Environment
Agent
Fig 2. Epidemiological triangle model of disease causation
7/7/2022
• Epidemiologic triad or triangle…
• The epidemiologic triangle, depicts the relationship
among three key factors in the occurrence of disease
or injury: agent, environment, and host.
• From the perspective of epidemiologic triangle, the

host, agent, and environment can coexist
harmoniously.
• Disease and injury occur only when there is altered

equilibrium between them.
3. The web model
• It is response to the idea of

non-infectious diseases
having no unique agent
• There is no single cause
• Causes of disease are

interacting
20
7/7/2022 21
Components of Infectious Disease Process
Components of Chain of Infection

1. Causative Agent
2. Reservoir host
3. Portal of exit
4. Mode of transmission
5. Portal of entry
22
7/7/2022
6. Susceptible host
Sisay S. BSc, MPH in epidemiology
• The Agents
• The agents in the infectious process range from
viral particles to complex multi cellular organisms.
7/7/2022 23
• Reservoirs
• Habitat, in which an infectious agent normally lives, transforms,
develops and/or multiplies.
• Reservoirs for infectious agents may be humans, animals, plants or
other inanimate objects.
• All infected humans, whether showing signs and symptoms of the
disease or not, are potential sources of infection to others.
• A person who does not have apparent clinical disease, but is a
potential source of infection to other people is called a Carrier.
• An example of carrier is a person infected with HIV.
• Some diseases are transmitted to human beings from animals. These
diseases are called zoonoses.
• E.g. Rabies, anthrax, etc.
• Portal of Exit
• Portal of exit is the way the infectious agent leaves
the reservoir
• Possible portals of exit include all body secretions

and discharges: Mucus, saliva, tears, breast milk,
vaginal and cervical discharges, excretions (feces and
urine), blood, and tissues.
• For example feces is the portal of exit for the eggs

of hook worm.
• Modes of Transmission
• The transfer of an infectious agent from an infected host
(reservoir) to a susceptible host.
• Direct transmission: Immediate direct transfer of the

agent from a reservoir to a susceptible host.
• Indirect transmission: Transmission of an infectious

agent to a susceptible host is through the aid of a vehicle,
a vector or suspended air particles.
7/7/2022
• Direct transmission • Indirect transmission
 Direct contact
 Airborne
Touching
Vehicle-borne
 Kissing
 Biting Vector-borne
Sexual intercourse Non-vector
Blood transfusion
intermediate host
Direct projection
Coughing,
Sneezing,
Singing
Trans-placental
7/7/2022 Sisay S. (Bsc., MPH
27in Epidemiology)
• Secondary Attack Rate
• A secondary attack rate is a measure of frequency of
new cases of a disease among the contacts of known
cases.

• Binomial Model of Transmission Probability
• The numerator is the same as for secondary attack
rate (SAR).
• Denominator include the total number of potentially

infectious contacts that susceptible individuals make

• Portal of entry
• Is the site where an infectious agent enters a
susceptible host.
• Examples:
– Nasal mucosa is portal of entry for common cold
– Conjunctiva is the portal of entry for trachoma
– Injury site is portal of entry for tetanus
7/7/2022 32
• Susceptible human host:
• The susceptible human host is the final link in the infectious
process.
• Host susceptibility or resistance can be seen at the individual and at
the community level.
• Host resistance at the community (population) level is called herd
immunity.
• It the resistance of a population to the introduction and spread of
an infectious agent, based on the immunity of a high proportion of
individual members of the population, thereby lessening the
likelihood of a person with a disease coming into contact with
susceptible.
7/7/2022 33
• Example –
• If 90% of the children are vaccinated for measles,
the remaining 10 % of the children who are not
vaccinated might not become infected with measles
because most of the children (90 %) are vaccinated.
• That means transmission from infected person to

other susceptible children will not be easier.

Infection and Disease Outcome
• Exposure to an infectious agent does not necessarily lead

to infection, and
• An infection does not necessarily lead to disease
• Infection may remain asymptomatic or sub-clinical, or

may lead to overt clinical disease
Disease
Exposure Infection Disease outcome
Infectiousness Pathogenicity Virulence
Outcomes at each stage of infection

7/7/2022
36
• The progress of an infectious agent and disease
outcome can be quantified as follows:
1. From exposure to infection
 Infectiousness: the proportion of an exposed

susceptible host who become infected (measured by
infection rate), as:
No. infected X 100

No. susceptible and exposed
7/7/2022
2. From infection to disease
 Pathogenicity: the proportion of infected people who develop

clinical disease, and measured by the clinical-to sub-clinical
ratio, as:
No. of clinical cases X 100

No. of sub-clinical cases
7/7/2022
Cont….
3. From disease to disease outcome
 Virulence: the proportion of persons with clinical

disease who become severely ill or die, and it is measured
by Case-fatality-rate or hospitalization rate
No of death of a specific disease X 100
Case-fatality-rate = Total No of cases of that specific disease
Hospitalization rate = No of hospitalized persons of a specific X 100

disease
Total No of cases of that specific disease
7/7/2022 Sisay S. (Bsc., MPH in Epidemiology)

39
• Case study
• One hundred people attend a wedding feast, and eighty
of them ate a piece of the wedding cake. Ten of the
participant were later hospitalized with sever
gastroenteritis but fortunately none of them died. When
the incident was later investigated the infections agent
(IgM antibodies) were found in 60 of the 80 participants
who had eaten cake, including the ten hospitalized ones.
Another 20 of the 60 participants with antibodies had
reported having experience diarrhea but not serious
enough to report to health services.
• Question
• How many peoples are susceptible to infected cake
• How many peoples are exposed to infected cake
• How many peoples are infected by infective agent
• How many peoples develop disease?
• Infectiousness of the disease
• Pathogenecity of the disease
• Virulence of the disease

Levels of Disease Prevention

• Levels of Disease Prevention
• It is important for implementing interventions
• It involves the interruption or slowing of disease

progression through appropriate intervention.
• Epidemiology plays a central role in disease

prevention by identifying modifiable causes of
disease and their risk factors
7/7/2022
• There are several stages during the course of a disease at
which we can intervene in order to control the disease.
• Three levels, (Primary, Secondary and Tertiary)
I. Primary prevention
• The objectives here are to promote health,
prevent exposure, and prevent occurrence of
disease.
7/7/2022
A. Health promotion (Primordial):
• This consists of general non-specific

interventions that enhance health and the body’s
ability to resist disease
• The improvement of socioeconomic status

through the provision of adequately.
– Education,
– Affordable and adequate housing and clothing,

etc.
7/7/2022
B. Prevention of exposure:
 There are many examples of interventions aimed at this
stage,
 Relatively they are specific to individual diseases
compared to primordial prevention
Example
– Provision of safe and adequate water, proper excreta
disposal
– Provision of vector control;
– Provision of a safe environment at home
– Use of bed nets
– Consistent use of condom
7/7/2022
C. Prevention of disease:
• This is when the intervention aims to prevent
initiation of disease, in persons who may already
be exposed to agent
• An example of intervention, which acts at this

stage is immunization.
• Some times it may be difficult to differentiate

interventions in what form of prevention they
involved
7/7/2022
II. Secondary prevention
• Interventions that act after the biological onset of
a disease, but before permanent damage sets in.
• The objective here is to stop or slow the

progression of disease and to prevent or limit
permanent damage.
• Strategy at this stage is through early detection and

treatment of disease.
7/7/2022
III. Tertiary prevention
• Intervention that acts after permanent damage has
set in,
• The objective of tertiary prevention is to limit the

impact of that damage.
• The impact can be physical, psychological, social

(social stigma or avoidance by others), and
financial.
• Strategy at this stage in general is rehabilitative.

7/7/2022

Measures of Dynamics of Infectiousness

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Measures of Dynamics of Infectiousness

Uploaded by

Copyright:

Available Formats

Session Two

Sisay S. (BSc, MPH in Epidemiology)

7/7/2022 Sisay S (Bsc., MPH in Epidemiology) 1

• By the end of this session, students will be able to:

• Describe natural history and time course of an infectious

• Describe the type of carriers and roles in the infectious

• Models of infectious diseases

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 2

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 3

• Each disease has different progress on the individual

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 4

• Begins by exposure to a causative agent capable of causing

• Without intervention, the process ends with recovery,

• The course can be halted at any time in the progression by

• Disease has not yet developed, but the

• The disease can only be detected through special

– Examples: Detection of antibodies against HIV in

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 8

• The clinical stage of different diseases differs in duration,

• The outcomes of this stage may be recovery, disability or

• Examples: Common cold has a short and mild clinical

• In others the disease may result in a residual defect,

• Still, other diseases will end in death.

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 10

• The host may become non-infectious while still

Infectious period: the time during which an infected

Incubation period: the time interval from infection to

• What are asymptomatic, Incubatory, Convalescent,

• Why carriers are more disease transmitters than

• What is ice burg effect?

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 14

• Not all associations between exposure and disease

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 15

• Sufficient cause: A causal factor or collection of

Fig 2. Epidemiological triangle model of disease causation

• From the perspective of epidemiologic triangle, the

• Disease and injury occur only when there is altered

• It is response to the idea of

• There is no single cause

• Causes of disease are

Components of Chain of Infection

• Possible portals of exit include all body secretions

• For example feces is the portal of exit for the eggs

• Direct transmission: Immediate direct transfer of the

• Indirect transmission: Transmission of an infectious

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 30

• Denominator include the total number of potentially

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 31

– Conjunctiva is the portal of entry for trachoma

– Injury site is portal of entry for tetanus

• That means transmission from infected person to

7/7/2022 Sisay S. (Bsc., MPH in Epidemiology) 34

• Exposure to an infectious agent does not necessarily lead

• An infection does not necessarily lead to disease

• Infection may remain asymptomatic or sub-clinical, or

Infectiousness Pathogenicity Virulence

Outcomes at each stage of infection

1. From exposure to infection

 Infectiousness: the proportion of an exposed

No. infected X 100

 Pathogenicity: the proportion of infected people who develop

No. of clinical cases X 100

 Virulence: the proportion of persons with clinical