Wolkite University

College of Medicine and Health sciences

Department of Public Health

Communicable/ infectious Disease Epidemiology

Samuel D[BSc, MPH/Epidemiology & Biostatistics]

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 Learning Objectives
At the end of this session, the students will be able to:

 Define the natural history of disease

 Describe stages of the natural history of disease

 Discuss the Components of chain of infection

 Describe levels of disease prevention and apply to specific

diseases

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 Content
 Natural history of disease and its stages

 Components of chain of infection

 Levels of disease prevention

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 Natural history of disease
 It refers to the progression of a disease process in an
individual over time, in the absence of intervention.
 The process begins with exposure to the causative agent

 Without medical intervention, the process ends with

recovery, disability, or death

 Course of a disease may be halted by preventive and

therapeutic measures, host factors, and other influences

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  There are four stages in the natural history of a disease

1. Stage of susceptibility

2. Stage of pre-symptomatic (sub-clinical) disease

3. Stage of clinical disease

4. Stage of recovery, disability or death

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1. Stage of susceptibility

 In this stage, disease has not yet developed, but the

groundwork has been laid by the presence of factors

Example: unvaccinated child is susceptible to VPD

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2.Stage of Pre-symptomatic (sub-clinical) disease
 In this stage there are no manifestations of the disease but
pathologic changes (damages) have started to occur

 The disease can only be detected through special tests

Example: Detection of antibodies against HIV in an apparently

healthy person.

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 3. The Clinical stage
 At this stage the person has developed signs and symptoms of
the disease.
 The clinical stage of different diseases differs in duration ,severity
and outcome.
Examples
1.Common cold: a short and mild clinical stage and everyone
recovers
2. Polio has: a severe clinical stage and many develop paralysis
3.Rabies: short & severe clinical stage & almost results in death
4.DM : longer clinical stage and eventually results in death

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 4. Stage of recovery, 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
Examples
1. Common cold: almost everyone recovers quickly
2.Trachoma: may cause blindness
3.Meningitis: may result in blindness/ deafness/ death

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 Stages in the natural history of a disease

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 Components of infectious disease cycle
Infection implies that the agent has achieved entry/penetrate
and begun to develop or multiply whether or not the process
leads to disease

Disease – any deviation from health, disruption of a tissue or

organ caused by microbes or their products

A communicable disease is one that can be transmitted

from one human to another or from animals to humans

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 Components of chain of infection
1. Biologic agents
2. Reservoir host
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host

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 Chain of infection

Causative
agent
Reservoir

Susceptible
host
Portal of
exit
Portal of
entry
Mode of
transmission

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 1. Biologic agents
 is any organism (or particle) capable of causing infection
and disease
 Protozoa,Bacteria,Fungi,Virus,…
 The progress of an infectious agent and disease outcome
can be quantified/characterized as follows:
1.Infectivity: ability of an organism to invade and infect a host
IR= number of infected individuals x 100
Number of susceptible host

 Indicate transmission tendency

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 2.Pathogenecity:refers to the proportion of infected
individuals who develop clinically apparent disease.

Pathogenicity= number of clinical cases

number of subclinical cases

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 3.Virulence: refers to the proportion of clinically apparent
cases that are severe or fatal and measured by case-
fatality-rate or hospitalization rate

Hospitalization rate = number of hospitalized cases x 100

Total number of cases

CFR = Number of deaths from a disease x 100

Number of clinical cases of that disease

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 2.Reservoir
 It is the habitat/location in which an infectious agent normally

lives, grows and multiplies.

 Can be humans, animals, plants or other inanimate objects

 Human reservoir is a person with symptomatic illness or

carrier

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 Carriers are people who have the infectious agent inside
them, have no symptoms of the disease, but are still able to
infect other people
The importance of carriers in the transmission of the disease
depends on their ;
1.Number-carriers may out number cases
2.Detect ability-carriers are difficult to be easily identified
whether they are infected or not
3.Mobility- carriers are freely move around and so have
many more contacts
4.Chronicity- chronic carriers can repeatedly re-introduce
the disease after it has been apparently controlled.
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 3. Portal of exit
 is the way the infectious agent leaves the reservoir
 Possible portals of exit include
1. Respiratory - TB, Measles
2. Alimentary - typhoid fever, amoebas, etc.
3. Genito-urinary - STDS
4. Skin - scabies
5. Transplacental - HIV, Syphilis

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 4. Modes of transmission
 Is the various mechanisms/methods by which agents are
conveyed/transferred to a host
1. Direct transmission
 immediate transfer of etiologic agent from host or reservoir
to susceptible person.
a) Contact spread - kissing, sexual transmission
b) Droplet spread - coughing, sneezing, etc.
c)Transplacental: Transmission from mother to fetus.

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 2. Indirect transmission - agent spread from reservoir via:

a) Vehicle - food, water, fomites

b) Vector - mechanical, biological,

c) Air- (dried residue of droplet nuclei, dust)

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 5. Portal of entry

 body structure where an infectious agent enters a host

 Many diseases are spread in multiple ways and have multiple

portals of entry

 The same as portal of escape from host or reservoir

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 6. Host

 The susceptible human host is the final link in the infectious

process.

 Host susceptibility can be seen at the individual level and at

the community level.

At the individual level:

Sex , age, body defence mechanism/Immunization status ,

socioeconomic status, behaviors(like smoking, exercise) ,…
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 At the community level:

Herd immunity

 is the resistance of a community (group) to invasion & spread

of an infectious agent based on the immunity of a high

proportion of individuals in the community

 The decreased possibility of a group or community developing

a disease because there is a specific level of immunity or

resistance to that disease in the population herd immunity
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threshold for each disease is different
 Levels of Disease Prevention
 Disease prevention means to interrupt or slow the
progression of diseases/disabilities.
 can occur at any time during the NHD
 Successful prevention depends upon:
1. a knowledge of causation
2. dynamics of transmission
3. identification of risk factors and risk groups
4. availability of prophylactic or early detection and treatment
5. an organization(body) for applying these measures
6. continuous evaluation and development of procedures
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 Prevention…
3 levels of disease prevention
Are complementary

Primary prevention

Secondary prevention

Tertiary prevention
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 Prevention …
1. Primary prevention
 action taken prior to the onset of disease(pre-pathogenesis
phase of a disease)
 the aim is to prevent the development of disease
 Primary prevention keeps the disease process from becoming
established by eliminating causes of diseases/ risk of exposure
to a risk factor or increasing resistance to disease
 May be accomplished by measures of Health promotion and
specific protection
Target: Total population/selected groups

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 Examples

 Law to ban or control the use of hazardous products

 Law to mandate safe and healthy practices (seatbelts)

 education about healthy and safe habits (e.g. eating well,

exercising regularly, not smoking)

 immunization against infectious diseases

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 Prevention …
2. Secondary prevention
 is concerned with detecting a disease in its earliest stages,
before symptoms appear, and intervening to slow or stop its
progression: "catch it early
 The aim is to cure patients and prevent the development of
advanced disease

Target: Patients

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 Prevention …
3. Tertiary prevention
 measures to reduce or limit disabilities, and to promote the
patients’ adjustment to irremediable conditions
 It is applied when the disease process has advanced beyond
its early stages(late stage of disease )/an ongoing illness
 The aim is to prevent severe disability and death
 physical, psychological, social,… impacts
 Intervention is treatment and rehabilitation
Example: HTN,DM
Target: Patients with advanced disease

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 Thank you for your attention!

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