BE-100 - LEC

M8.2 INTRODUCTION TO EPIDEMIOLOGY

Cristela Mae C. Candelario| March 03, 2022

I. EPIDEMIOLOGY III. 4 LEVELS OF SCIENTIFIC STUDY OF DISEASE

® Study of factors that determine the occurrence 1. SUBMOLECULAR OR MOLECULAR LEVEL

and distribution of the disease in a population. ® Cell Biology
Ø Derived from the Greek roots ® Genetics
§ “epi”, meaning “Upon,” ® Biochemistry
§ “demos” meaning “people” or ® Immunology
“population,”
§ “logos” meaning” study”. II. TISSUE OR ORGAN LEVEL
® Anatomic Pathology
EPIDEMIOLOGISTS
® Public health professionals who investigate III. LEVEL OF INDIVIDUAL PATIENTS
patterns, cause of disease, and injury in ® Clinical Medicine
humans
® They gather data from entire populations IV. LEVEL OF POPULATIONS
® Epidemiology
II. BRANCHES OF EPIDEMIOLOGY

IV. STAGES OF DISEASE

1. CLASSICAL EPIDEMIOLOGY
® Population-oriented
® Branch of Epidemiology
® Studies the community origins of STAGE OF LEVEL OF
health problems TYPE OF RESPONSE
DISEASE PREVENTION
® It is concerned with discovering risk
factors ® HEALTH
® Focuses more on health problems in PRIMARY PROMOTION
the community (e.g., infectious agents, PRE-DISEASE
PREVENTION ® SPECIFIC
human behavior, social factors, and PROTECTION
economic factors).
® PRE-
2. CLINICAL EPIDEMIOLOGY LATENT SECONDARY SYMPTOMATIC
® Studies patients in health care settings DISEASE PREVENTION ® DIAGNOSIS AND
® Improve prevention, early detection, TREATMENT
diagnosis, treatment, prognosis, and care
of illnesses in individuals
® Patient-Oriented branch of Epidemiology ® DISABILITY
LIMITATION FOR
3. SYNDROMIC EPIDEMIOLOGY EARLY
® Looks for patterns of signs and SYMPTOMATIC
symptoms that indicate an origin in SYMPTOMATIC TERTIARY DISEASE
bioterrorism DISEASE PREVENTION
® Shoulders health-related issues that ® REHABILITATION
threaten national security. FOR LATE
SYMPTOMATIC
4. INFECTIOUS DISEASE EPIDEMIOLOGY DISEASE
® Study of the Complex Relationships
among hosts and infectious agents.
® Investigates the occurrence of
epidemics of communicable diseases.
® Heavily dependent on laboratory
support (microbiology, serology).

5. CHRONIC DISEASE EPIDEMIOLOGY

® Addresses chronic health disorders'
etiology, prevention, distribution, natural
history, and treatment
® Dependent on sampling and statistical
methods.

IMPORTANT HIGHLIGHT:
ü The difference between Infectious disease
epidemiology and chronic disease
epidemiology is becoming less significant and
prevalent due to the introduction of
molecular diagnostics and improvement of
statistical methods to study diseases.

Transer: Vigilla, R.E. 1

Editor: Sacedon, A. & Ismael, Y.
 BE-100 - LEC
M8.2 INTRODUCTION TO EPIDEMIOLOGY
Cristela Mae C. Candelario| March 03, 2022

V. MECHANISMS AND CAUSE OF DISEASE 3. ENVIRONMENT

® Influences the probability and
circumstances of contact between host and
the agent

4. VECTORS
® Must have a specific relationship to the agent,
the environment, and the host

Examples:
Ø Insects, arachnids, mammals
Ø Human groups (e.g., butchers)
Ø Inanimate objects
Ø Part of the Environment

5. RISK FACTORS AND PREVENTABLE CAUSES

® Intrinsic Factors
Ø Genetics, nutritional status,
reproductive activities, personal
behavior
EPIDEMIOLOGIC TRIANGLE
® A model that scientists have developed for
® Extrinsic Factors
studying health problems. It can help
Ø Man-made or naturally-occurring
understand infectious diseases and how they carcinogens, viral infections
spread (CDC, n.d.).
Ø It is estimated that the majority of
® 3 PARTS: cancer cases are preventable (WHO,
Ø Pathogen n.d.).
Ø Host
Ø Environment VI. BEINGS MODEL

ü NOTE: Vectors are sometimes considered the ® postulates that human diseases and its
4th part of the triangle; however, it is not consequences are caused by a complex
applicable to all types of diseases. interplay of nine different factors.

6. HOST FACTORS
® Responsible for the degree to which the
individual is able to adapt to the stressors “B” – BIOLOGIC AND BEHAVIORAL FACTORS
produced by the agent. ® Influenced by gender, age, weight, bone
density, etc.
® Factors affecting Host resistance
Ø Genotype Risk Factors:
Ø Nutritional status ® Cigarette smoking
Ø Body-Mass Index ® Overweight/Obesity
Ø Immune System ® Unprotected Sexual Intercourse
Ø Social Behavior ® Excessive Alcohol Intake
® Abuse of Legal and Illegal Drugs
® Driving under influence of alcohol
® Homicide/suicide attempts
7. AGENTS OF DISEASE OR ILLNESS
CATEGORIES
EX:
® BIOLOGIC AGENTS
® Osteomalacia refers to a marked softening of
Ø Allergens, infectious organisms,
your bones, most often caused by severe
biological toxins, food
vitamin D deficiency. Some Muslim women in
other nations lack vitamin D due to cultural
® CHEMICAL AGENTS norms, resulting to Osteomalacia.
Ø Chemical toxins, and dust
® Excessive fat intake and obesity are also
caused by biological and behavioral factors.
® PHYSICAL AGENTS
® Change in Behavior could change the
Ø Kinetic Energy, Radiation, heat, cold,
outcomes
noise
“E” – ENVIRONMENTAL FACTORS
® SOCIAL AND PSYCHOLOGICAL
® Epidemiologists describe the patterns of
STRESSORS
the disease, develop, and test hypothesis
Ø Anxiety & Depression
about casual factors, and introduce
methods to prevent further cases of the
disease.

Transer: Vigilla, R.E. 2

Editor: Sacedon, A. & Ismael, Y.
 BE-100 - LEC
M8.2 INTRODUCTION TO EPIDEMIOLOGY
Cristela Mae C. Candelario| March 03, 2022

“I” – IMMUNOLOGIC FACTORS

® SMALLPOX
Ø First Infectious disease known to have
been eradicated from the globe.

® HERD IMMUNITY
Ø When a vaccine diminishes an
immunized person’s ability to spread
the disease, leading to reduced
disease transmission.

® IMMUNODEFICIENCY
Ø Could be caused by:
• Genetic abnormalities ® Herd immunity in a nutshell:
• Infections
• Certain conditions
• HIV

“N” – NUTRITIONAL FACTORS

® Dietary variations play an important role in
producing differences in disease rates among
populations.

EX: Japanese Americans living in Hawaii had a much

higher rate of myocardial infarction than Japanese
people living in mainland Japan. Diet plays a role in this
trend.
® Dennis Burkitt stated the importance of dietary
fibers in maintaining good health. He observed
that many African Americans suffer common
diseases such as coronary heart diseases but
dietary fibers allow the indigenous populations
in tropical Africa to yield lower cases of
diseases such as appendicitis, diabetes
mellitus and of course, coronary heart
diseases.
“G” – GENETIC FACTORS
® Addresses the distribution of normal and
abnormal genes in a given population
HERITABLITY
® Contribution of genes relative to
determinants of the disease
GENETIC SCREENING
® Important in identifying problems in newborns
and in determining susceptibility genes
“S” – SERVICES, SOCIAL FACTORS,
SPIRITUAL FACTORS
® MEDICAL CARE SERVICES
® LATROGENIC DISEASE
CASE 1: DIPHTHERIA
® Caused by Corynebacterium diphtheriae
® In 1990, a major epidemic appeared in Russia
despite the vaccination among individuals.
What went Wrong?
® Low rate of booster shots was administered in the
population leading to decreased immunity over time.
Recommendation:
® Additional single vaccinations for adults to provide
natural booster effect.
CASE 2: SMALLPOX
® First infectious disease is known to have been
all eradicated from the globe
® Caused by Variola Virus
® Variola minor
Ø A dominant but less fatal viral strain.
® Variola major
Ø The less dominant, but the more fatal viral
strain.
® Before smallpox vaccination, Variolation is
AND implemented to create artificial immunity.
Ø An obsolete method of immunizing patients
against smallpox by infecting them with
substances from the pustules of patients
with a mild form of the disease

® SOCIAL AND SPRITUAL FACTORS

® Personal beliefs, religious faith
® Family support, social networks
VII. VACCINATION AND PATTERNS OF IMMUNITY
® Degree of immunity necessary to eliminate
disease from a population varies on the type
of infectious organism, time of the year, and
the density and social patterns of the
population.

Transer: Vigilla, R.E. 3

Editor: Sacedon, A. & Ismael, Y.

CASE 3: POLIOMYELITIS
® Caused by the Poliovirus
® Transmitted by person-to-person through fecal-
to-fecal route or by vehicle (food).
® Officially eradicated in 36 Western-Pacific
Countries
® 2 Types of vaccines
Ø Inactivated or killed Polio Vaccine
(IPV)
• Salk IPV produces blood
antibodies against 3 types of
immunity, but it does not trigger
cell-mediated immunity in the
intestine.
Ø Live attenuated Oral Polio Vaccine
(OPV)
• OPV triggers cell-mediated
immunity protecting the
intestines
• Many children vaccinated with
OPV suffered parasitic
poliomyelitis due to poor
sanitation. Those children
suffered intestinal infections
when they were given OPV. The
infections interfered with the
OPV in the gut, leaving the
children vulnerable.
• The Health Department switched
to a vaccination where IPV is first
inoculated to produce antibodies
against 3 types of Poliomyelitis
and later given OPV as a booster
to achieve herd immunity.
CASE 4: SYPHILLIS
® Caused by Treponema pallidum subspecies
pallidum
® 3 Stages
Ø Primary Stage
• 3-90 days after exposure
• Produces a highly contagious
skin lesion called “Chancre”
• Subsides spontaneously.
• ® Vector: Tsetse Fly
Ø Secondary Stage
• 4-10 weeks after exposure
• Body Rash
• Subsides spontaneously
Transer: Vigilla, R.E.
Editor: Sacedon, A. & Ismael, Y.
BE-100 - LEC
M8.2 INTRODUCTION TO EPIDEMIOLOGY
Cristela Mae C. Candelario| March 03, 2022
Ø Tertiary Stage
• 3-15 years after exposure
• Affects internal organs
• Untreated infections may
provide some herd immunity
but does not protect
individual from progressive
damage to own body.
VIII. EFFECTS OF SANITATION
® Diarrhea
Ø No.1 killer of children
® Tuberculosis
Ø No.1 killer of adults
SANITARY REVOLUTION
® Began in England in the 19th century
® Reduced the infant mortality, increased
effective birth rate
® Cause of today’s worldwide population
problem.
DEMOGRAPHIC GAP
® Difference between birth rate and death rate
that develops when a country undergoes
demographic transition.
PARADOXICAL EFFECT OF SANITATION
CASE 1: HERD IMMUNITY PROBLEM
® The improvements of sanitation lowered the
herd immunity of the children against
poliomyelitis during the Industrial revolution
since children were not exposed to the
Poliovirus.
IX. VECTOR CONTROL AND LAND USE PATTERNS
® How positive intentions of land use can
unintentionally produce negative side effects
due to vectors.
CASE 2: AFRICAN TRYPANOSOMIASIS
® Also called “African Sleeping Sickness”
® Caused by Trypanosoma brucei.
® The control of the vector enabled the herders
to keep larger number of cattle, invertedly
overgrazing the area which resulted to
droughts and little vegetation. The drought
eventually caused mass starvation among
cattle and humans
4
 BE-100 - LEC
M8.2 INTRODUCTION TO EPIDEMIOLOGY
Cristela Mae C. Candelario| March 03, 2022

X. RIVER DAM CONSTRUCTION AND PATTERNS OF GLOBAL PANDEMIC

DISEASE
® Widespread outbreak involving multiple
continents
CASE: EFFECT OF ASWAN DAM ON PREVALENCE
OF SCHISTOSOMIASIS IN EGYPT XII. CONTRIBUTIONS OF EPIDEMIOLOGISTS
® Increased of Schistosomiasis cases in Egypt
due to the dam’s construction. 1. INVESTIGATING EPIDEMICS AND NEW
® Before dams are erected, the sea would move DISEASES
inland during the dry season, mixing with the ® Provided disease causation for other
river water. The salt levels in the river water scientists for laboratory experimentation
increases and invertedly supporting the growth
and development of the larvae of the blood
flukes responsible for schistosomiasis and
mosquitoes that transmit malaria and dengue.

XI. SYNERGISM OF FACTORS PREDISPOSING TO

DISEASE

SYNERGISM
® Interaction or combination of factors that
produces a greater effect than the sum of their
separate effects.
® For example, a malnourished child has more
difficulty making antibodies and repairing
tissue damage which makes the child
vulnerable to infectious diseases

ANTIGENIC SHIFT
® A process by which 2 or more strains in a
virus combine to form a new subtype of the
virus

ANTIGENIC DRIFT
® Accumulation of mutations within virus
genes over time

2. STUDYING THE BIOLOGIC SPECTRUM OF

DISEASE
® Known as the “Iceberg Phenomenon”
® Variation in the severity of a disease process
® Paramount to the field of epidemiology
® Prevents the misleading picture of disease
pattern and severity

Transer: Vigilla, R.E. 5

Editor: Sacedon, A. & Ismael, Y.
 BE-100 - LEC
M8.2 INTRODUCTION TO EPIDEMIOLOGY
Cristela Mae C. Candelario| March 03, 2022

3. SURVEILLANCE OF COMMUNITY HEALTH 6. PROVIDING EXPERT TESTIMONY IN COURTS OF

INTERVENTIONS LAW

® FIELD TRIALS ® Epidemiologists can be called to testify in court:

Ø Randomized trials of preventive ® Product hazards
measures ® Probable risks and effects of various
Ø Important phase of evaluating a new environmental exposures and medications
vaccine ® Lawmakers may rely on epidemiologic data:
® ONGOING/CONTINUED SURVEILLANCE Ø General environmental exposure
PROGRAMS Ø Occupational illness claims
Ø Ensure a vaccine’s continued safety and Ø Medical liability
effectiveness Ø Product liability
Ø Case for Poliomyelitis
• Current recommendation for ® Expert medical testimony often requires high
measles vaccine is initially at 15 level of epidemiologic expertise.
months of age, booster does at
4 to 6 years of age.

® SYNDROMIC SURVEILLANCE
Ø Epidemiologists contributing to national
security

4. SETTING DISEASE CONTROL PRIORITIES

® Disease control priorities should be based not only
on the currently existing size of the problem, but
also on the potential of a disease to spread to
others; its likelihood of causing death and
disability; and its cost to individuals, families, and
the community.

EXAMPLES:
Ø HIV/AIDS prioritization
Ø Type 2 diabetes
Ø Severe Acute Respiratory Syndrome
(SARS)
Ø Zoonotic infections like avian influenza
(H5NI)

5. IMPROVING THE DIAGNOSIS, TREATMENT, AND

PROGNOSIS OF CLINICAL DISEASE

® DIAGNOSIS
Ø Process of identifying the nature and
cause of a disease through
examination of clinical history, review
of symptoms, examination, and testing

® EFFECTIVE TREATMENT
Ø Determined by methods of clinical
epidemiology

® PROGNOSIS
Ø Improved understanding thru
epidemiology

® RISK ESTIMATION
Ø Forecasts the probability and impact of
risks

6. IMPROVING HEALTH SERVICES RESEARCH\

® Principles of epidemiology are used in planning
and evaluating medical care

EXAMPLES:
Ø Health planning
Ø Demographic projection techniques
Ø Analyses of disease frequency patterns
Ø Health program evaluation
Ø Cost benefit analysis

Transer: Vigilla, R.E. 6

Editor: Sacedon, A. & Ismael, Y.