12/9/2022

UNIT 1:
INTRODUCTION TO EPIDEMIOLOGY

Assefa Tola (MPH, Assist. Prof)

Course Organization
Concepts and Communicable
principles disease
Epidemiology

Applications Measures of
Evaluation of Surveillance disease
evidence Screening
Outbreak management
occurrence

Epidemiological Measures of
study designs associations

1
 12/9/2022

Learning Objectives
After successfully completion of this session the students will be able to:
 Define Epidemiology
 Describe history and contribution of epidemiology
 Explain scope and purpose of epidemiological investigations
 Describe the basic assumptions of the Epidemiology
 List types branches of epidemiology

 Define communicable/infectious disease and some common terms in communicable disease

 Explain the Natural history of infectious diseases

 Discuss the components of infectious process

Definition of Epidemiology
 Epidemiology:
 Greek word: EPI (Upon), DEMOS (People) and LOGOS (Study of, Body of
Knowledge)
 The classical definition of epidemiology
Epidemiology is the study of frequency, distribution and determinants of
diseases and other health related states or events in the specified populations
and applications of this study to the promotion of health, and to the
prevention and control of health problems

2
 12/9/2022

Components of the definition

Epidemiology: “Frequency”

 “Frequency” refers to quantifying how often a disease or other events arises

in a population

 This Shows epidemiology to be mainly a quantitative science.

 Frequency of diseases is measured by morbidity rates and mortality rates

Components of the definition

Epidemiology: “Distribution”

 “Distribution” refers to the geographical distribution of diseases, the distribution

in time, distribution by type of persons affected

 The part of epidemiology concerned with the frequency and distribution of

diseases by time, person and place is named Descriptive Epidemiology.

3
 12/9/2022

Components of the definition

Epidemiology: “Determinant”

 “Determinants” are factors which determine whether or not a person will

get a disease.

 The part of epidemiology dealing with the causes and determinants of

diseases is Analytical Epidemiology.

Components of the definition

 “Population” the focus of epidemiology is mainly on the population rather than
individuals.

 “Health related conditions” are conditions which directly or indirectly affect or

influence health.

 These may be injuries, vital events, health related behaviors, social factors, economic
factors etc.

4
 12/9/2022

Epidemiology

 Epidemiology offers insights into why disease and injury afflict

some people more than others and why they occur more frequently
in some locations and times than in others.
 It is an applied science, with direct and practical applications.
 This knowledge is necessary for finding the most effective ways to
prevent and treat health problems.

Branches of Epidemiology
1. Descriptive 2. Analytical
epidemiology Epidemiology

is concerned with describing the deals with the causes

frequency and distribution of diseases or determinants of
and other health related conditions by diseases
time, place, and person.

It asks the questions:

how? Why?
It asks the questions: who?
Where? When?

10

5
 12/9/2022

Brief history of Epidemiology

Although epidemiological thinking has been traced to the time of Hippocrates, who lived around 5th century B.C. and
hypothesized effect of env’tal factors on the occurrence of disease (determinants of disease) the discipline did not flourish until
1940s:

John Grant (1620-1674) the first to quantify patterns of birth, death and disease occurrence, noting male-female
disparities, high infant mortality, urban-rural differences, and seasonal variations
James Lind (1747) – a ship surgeon who used an "experimental" approach to prove the cause of scurvy by
showing it could be treated effectively with fresh fruit

Pierre Charles Alexandre Louis:1787-1872 called the “Father of Epidemiology”, Systematized the application of
numerical thinking (“la methode numerique”) and championed its cause.

In 1854, John Snow linked an epidemic of cholera to a specific drinking water pump, the "Broad Street Pump".
Cholera epidemic controlled by removed the handle of that pump 44 years before vibrio was identified

Investigation of the relationship between cigarette smoking and lung cancer in 1950 by Doll and Hill who
identified 20 lung cancer pts and their controls in London hospitals who were matched by age, gender, and hospital.

The Framingham Heart Study: initiated by the US Public Health Service in 1948o prospectively investigate the
epidemiology and risk factors for cardiovascular disease

11

Spot map of deaths from cholera in Golden Square

area, London, 1854 (redrawn from original)

12

6
 12/9/2022

Evolution in Epidemiology
Multi-level causality (21st Century): focus on risk-factors as
well as causal pathways at the societal level and with
pathogenesis at the molecular level

Chronic disease era (Modern Epidemiology): focus on

risk-factor at individual level (since WW II)

Germ theory: infectious disease era (late 19th c –the 1st half
of the 20th c.)

Miasma theory: focus on environment; the theory that all disease was
due to bad air – contaminations (miasma) (the first half of 19th c.)

13

Contributions of epidemiology
Identification of water as a major
reservoir and vehicle of communicable
diseases such as cholera and typhoid
fever (1849-1856)

Identification of the AIDS

syndrome, prediction that
the cause was a sexually
transmitted virus (1981- Identification of
3) and development of arthropod vectors for
preventive measures many diseases
before the virus was
identified.
Cigarette smoking
found to be the
major cause of lung
Eradication of cancer, emphysema
smallpox from the and cardiovascular
world in 1978 diseases (1951-
1963)

14

7
 12/9/2022

Scope of epidemiology
 The use of epidemiology in advancing health sciences and improving public health practices has been greatly
expanded in the last few decades.

Genetic markers of disease risks recently

▲+ Past 25 yrs.
Health related behavior
▲+ Middle of
Chronic diseases, injuries, birth defects MCH,
20th century
Env’tal and Occupational health
▲+
Endemic communicable diseases & Non
communicable diseases Since 5th
▲+ century

Epidemic of communicable diseases

15

Purposes/use of Epidemiology

 Prevention & control of diseases: the ultimate purpose

 Elucidation of the natural history of disease: Completing the clinical picture
 Community health diagnosis: Description of the health status of the
population
 Establishing the determinants of /causation of disease
 Provide understanding of what causes or sustain disease in populations.

16

8
 12/9/2022

Purposes/use of Epidemiology

 To evaluate both existing and newly developed preventive and

therapeutic measures (intervention) and modes of health care delivery
 Providing a scientific foundation for regulatory decisions relating to
health or environmental problems
 Guide health and healthcare policy and planning and Monitoring of
health programs
 Assist in the management and care of health and disease in individuals.

17

Basic Epidemiologic Assumptions

A. Human disease does not occur at random:

• Disease is not randomly distributed throughout a population

• Epidemiology uses systematic approach to study the differences in disease distribution in
subgroup
• Why certain individuals/group acquire disease and others not?
• There are patterns of occurrence in which some factors (exposures) increase the risk of
acquiring/developing a particular disease among group of individuals.
B. Human disease has causal and preventive factors:

• identified through systematic investigation of populations or group of individuals within a

population in different places or times.
• Allows for study of causal and preventive factors

18

9
 12/9/2022

NATURAL HISTORY OF DISEASE

19

Natural history of disease

• It refers to the progression of disease process, in the absence of intervention.

• It begins with exposure to causative agent capable of producing disease.

• Without intervention, the process ends with recovery, disability or death

• Halted at any time in the progression by intervention, host factors, other

influences

20

10
 12/9/2022

Natural history of disease

• Fig. NATURAL HISTORY OF DISEASE (Source: Centers for Disease Control and Prevention. Principles of
epidemiology, 2nd ed. Atlanta: U.S. Department of Health and Human Services;1992)

21

Natural history of disease

 There are four stages in the natural history of a disease.

 These are:

1. Stage of Susceptibility:

 disease has not yet developed, but the groundwork has been laid by the presence of
factors that favor its occurrence.

 Susceptible person is lacking sufficient resistance to particular pathogenic agent to

prevent disease if or when exposed.

 Example: unvaccinated child is susceptible to measles.

22

11
 12/9/2022

Natural history of disease

2.Presymptomatic disease stage:

 no manifestations of the disease but pathologic changes (damages) have started to occur in
the body.

 extending from the time of exposure to onset of disease symptoms, is usually called the
incubation period for infectious diseases,

 Most screening programs attempt to identify the disease process during this phase

 The disease can only be detected through lab or special tests

Eg. Ova of intestinal parasite in the stool of apparently healthy children.

23

Natural history of disease

3.Clinical disease stage:

 the person has developed signs and symptoms of the disease.

 Marked with the onset of symptoms and most diagnoses are made during the
stage

 The clinical stage of different diseases differs in duration, severity and outcome.

 The outcomes of this stage may be recovery, disability or death.

• Eg. Common cold has a short and mild clinical stage and almost everyone
recovers quickly
24

12
 12/9/2022

Natural history of disease

4. Stage of Disability or death:

 Disability is limitation of a person's activities including his role as a parent, , etc

 Some diseases run their course and then resolve completely either spontaneously
or by treatment.

 In others, the disease may result in a residual defect(disabled). Still, other

diseases will end in death.

 Eg. Trachoma may cause blindness

25

Natural history of disease

Healthy person

Sub-clinical
stage
Recovery

Clinical
disease

Recovery Disability Death

A schematic diagram of the natural history of diseases and their expected outcomes.

26

13
 12/9/2022

Typical course of infectious disease

TIME

Susceptible Subclinical Death

Disease
Host
Clinical
Disease
No
infection
Recovery
Incubation
period

Exposure Onset

27

Natural history of disease of TB

Pulmonary TB
(5%)
______________
HIV (~40%)
TB
Infection
(30%)
Reactivation TB
(5%)
_______________
HIV (~2-10%/year
Exposure +PPD
(95%)
______________
HIV (~60%)
No TB
Infection Life long
(70%) containment
(90%)
________________
HIV (?%)

28

14
 12/9/2022

The Spectrum of Illness from Communicable Disease

29

Distribution of clinical severity for three classes of infections

30

15
 12/9/2022

Induction + latency = incubation

TIME

Susceptible Subclinical Clinical

Host Disease Disease

Induction

Latency

Incubation
Clinical onset
Exposure Disease onset

31

INFECTIOUS DISEASE EPIDEMIOLOGY

32

16
 12/9/2022

COMMUNICABLE DISEASE
 Despite the great scientific advances that have reduced morbidity & mortality
from communicable diseases over the past decades, communicable diseases
continue to account for a major proportion of acute illnesses, even in
technologically advanced countries

 Communicable diseases are characterized by the presence of the infectious

agent in addition to susceptible human population.

33

Trend in epidemiology

34

17
 12/9/2022

Communicable disease
Definition of some common terms:
 Infectious diseases is an illness due to a specific infectious agent or its toxic
products
 Incubation period- is the time interval between entry and development of signs
and symptoms of disease
 Induction period is the period of time from causal action until disease initiation.
 Latent period- the time interval from infection to development of infectiousness

35

Communicable disease
Definition of some common terms:
 Infectivity refers to the proportion of exposed persons who become infected.
 Pathogenicity refers to the proportion of infected individuals who develop
clinically apparent disease.
 Virulence refers to the proportion of clinically apparent cases that are severe
or fatal.
 Carriers: persons who are infectious but have subclinical disease with incubating
disease or inapparent infection

36

18
 12/9/2022

INFECTIOUS or COMMUNICABLE DISEASE

 Communicable disease: is disease caused by 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 inanimate environment.

37

Purpose of infectious disease epidemiology

 What is infectious disease epidemiology used for?

1. Identification of causes of new, emerging infections, e.g. HIV, SARS
2. Surveillance of infectious disease
3. Identification of source of outbreaks
4. Studies of routes of transmission and natural history of infections
5. Identification of new interventions

38

19
 12/9/2022

CHAIN OF INFECTION
 Infection: implies that the agent has achieved entry and begun to multiply in the host
and leads to disease.
 Infection is not equivalent to disease, as some infections do not produce clinical
disease.
 A model used to understand the infection process is called the chain of infection, or
chain of infection, or transmission cycle.
 Each link must be present and in sequential order for an infection to occur.
 Understanding the characteristics of each link provides with methods to prevent the
spread of infection.

39

CHAIN OF INFECTION
 Components of the infectious disease be described by the following components,
which constitute process
1. Causative
agent
2. Reservoir
6. Susceptible
host

3. Portal of
5. Portal of exit
entry
4. Mode of
transmission

40

20
 12/9/2022

Infectious agent/etiology

 Infectious agent/etiology: is an organism that is capable of producing infection

or infectious disease.

 Six group of infectious microorganism or pathogen thar can cause disease are

Metazoa protozoa, fungi, bacteria, Rickettsia, and viruses.

 In order to survive the agent must be able to: multiply, emerge from the host,

reach the new host and infect the new host

41

Infectious agent/etiology

 Generally, the agent must be present for disease to occur; however,

presence of that agent alone is not always sufficient to cause disease.

 A variety of factors (eg. agent, host and env'tal) influence whether

exposure to an organism will result in disease,

 The specific characteristics of each agent are important in determining

the nature of the infection

42

21
 12/9/2022

Infectious agent/etiology
 The pathogenicity of the agent: its ability to produce disease, measured by the
ratio of the number of persons developing clinical illness to the number exposed.

 Virulence: a measure of the severity of disease, which can vary from very low to
very high which is measured by the proportion of clinically apparent cases that are
severe or fatal.

 Infective dose: the amount required to cause infection in susceptible subjects

measured by the proportion of exposed persons who become infected.

43

Infectious agent/etiology

44

22
 12/9/2022

Outcomes at Each Stage of Infection

45

RESERVOIRS
 Reservoir is the habitat of an infectious agent where it normally lives, transforms,
grows/develops and/or multiplies and multiplies.

 Reservoir can be
 A living thing: human, animal, arthropod, or plant or
 Nonliving things: soil, air, water etc.,

 Solutions, instruments and other items used in clinical procedures can also serve
as reservoirs for potentially infectious microorganisms.

 A disease can have more than one reservoir

46

23
 12/9/2022

RESERVOIRS
 Generally, reservoir can be classified as
1. Human reservoirs: sexually transmitted diseases, measles, mumps, streptococcal
infection, most respiratory pathogens, and etc
2. Animal reservoir (zoonoses): Anthrax (cattle), rabies (dogs), brucellosis (cows
and pigs), trichinosis (swine)
3. Non-living reservoir: Many fungal agents, such as those causing histoplasmosis,
live and multiply in the soil, tetanus (soil)

47

RESERVOIRS
 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.

 Epidemiologically, carriers are more important than overt clinical

cases because identification may require sophisticated investigation
but important to control transmission e.g. AIDS
48

24
 12/9/2022

RESERVOIRS
 Carriers may be classified as:

1. Incubatory carriers: transmitting the disease during incubation period, i.e. from
first shedding of the agent until the clinical onset.
 Examples: Measles, mumps

2. Convalescent carriers: transmitting the disease during convalescence period i.e.

from the time of recovery to when shedding stops.
 Examples: Typhoid fever

49

RESERVOIRS
 Carriers may be classified as:
3. Asymptomatic carriers: transmitting the disease without ever showing
manifestation of the disease.
 Examples: Amoebiasis
4. Chronic carriers: transmitting the disease for a long period/indefinite
transmission.
 Examples: Viral hepatitis, Typhoid fever.
 Number: carriers might occur in large number or even out number sick patients
and serve as a significant reservoir of infection
50

25
 12/9/2022

Carriers in the transmission of disease

 Difficulty in recognition: cases of a disease are relatively easy recognized and can
be treated and rendered are less important in the spread of disease
 Hence clinically apparent imply tip of iceberg and in apparent imply bottom of
iceberg.
 In fact, this situation is called hippopotamus effect or iceberg phenomena.

51

Hippopotamus effect or iceberg phenomena

 Many cases of illnesses not recognized, not reported and therefore remain hidden
 Many cases
 Self treatment
 Treatment by traditional healers
 Treatment by quacks
 Only few cases (the tip of the icebergs) got reported
 This necessitates screening, case finding, contact tracking and other epidemiological
approach

52

26
 12/9/2022

Portal of exit

 Port of exit is the way/path the infectious agent leaves the reservoir.

 usually corresponds to the site where the pathogen is localized.

 It includes all body secretions & discharges: saliva, tear, breast milk, vaginal
and cervical discharges, excretions (urine, faeces), blood and tissues.

 Through respiratory tract(tubercle bacilli and influenza viruses), feces(cholera

vibrio), placenta(syphilis),way of the skin through cuts or needles (hepatitis B) or
blood-sucking arthropods (malaria)…etc

53

Mode of transmission
 This refers to the mechanism by which an infectious agent is transferred from an
infected host (reservoir) to a susceptible host.

 After an agent exits its natural reservoir, it may be transmitted to a susceptible

host in numerous ways which can classified into:

1. Direct transmission: Immediate transfer of the agent from a reservoir to a

susceptible host.

2. Indirect transmission: Transmission of an infectious agent to a susceptible host

through the aid of a vehicle, a vector or suspended air particles.
54

27
 12/9/2022

Portal of entry
 It refers to the manner in which a pathogen enters a susceptible host.

 It must provide access to tissues in which the pathogen can multiply or a toxin can
act.

 Often, infectious agents use the same portal to enter a new host that they used
to exit the source host

 fecal-oral” route, skin (hookworm), mucous membranes (syphilis), and blood

(hepatitis B, HIV)

55

Susceptible host
 Host- a person or animal that harbors an infectious agent under natural conditions.

 The final link in the chain of infection

 Susceptibility of a host depends on genetic or constitutional factors, nutritional

status, specific immunity and nonspecific factors that affect an individual’s ability

to resist infection or to limit pathogenicity.

 People are exposed to disease causing agents every day but do not always get

sick.
56

28
 12/9/2022

Susceptible host
 The chain of infection may be interrupted if the agent does not find a susceptible

host.

 Host resistance at the community (population) level is called herd immunity

 The concept of herd immunity suggests that if a high enough proportion of

individuals in a population are resistant to an agent, then those few who are

susceptible will be protected by the resistant majority, since the pathogen will be

unlikely to “find” those few susceptible individuals.

57

Time course of an infectious disease

1. Pre-patent period: The time interval between biological onset and the time of first
shedding of the agent.

2. Incubation period: Interval between biological onset and clinical onset.

3. Communicable period: The time interval during which the agent is shed by the host.

4. Latent period: The period between exposure and infection

 The time in which the disease progress without clinical manifestation

 It includes incubation period and between recovery and relapse in clinical disease).

58

29
 12/9/2022

Time Course of a Disease in Relation to Its Clinical Expression and

Communicability

59

Spread of Disease in community

 Person to person transmission is one of the main methods of disease spread in a

community

 Three important aspects of person-to-person spread of disease are

1. Herd immunity

2. Generation time

3. Secondary attack rate

60

30
 12/9/2022

Herd immunity
 It is the resistance of a community (group) to invasion and spread of an infectious
agent, based on the immunity of a high proportion of individuals in the
community

 The high proportion of immunes prevents transmission by highly decreasing the

probability of contact between reservoirs and susceptible hosts

61

Herd immunity
 Group immunity that limits the spread of disease.

 Best operates when:

1. Single reservoir is involved

2. Mode of transmission is direct

3. There is total immunity

4. No shedding of agent by immune host

5. Uniform distribution of immunes

6. No over crowding

62

31
 12/9/2022

Generation time
 Generation time: the period between exposure/infection and the maximum
communicability of the exposed host regardless of whether the disease is
apparent or inapparent.

 With person-to-person spread, the interval between cases is determined by the

generation Time

 It is the time between the receipt of infection by a host and maximal

communicability of that host

63

Generation time
 In general, the generation time is roughly equivalent to the incubation period

 However, the two terms are not identical

 The time of maximal communicability may precede or follow the end of the
incubation period

 Incubation period can only be applied to infections that result in manifest

disease

 Since infectious agents can be spread by persons with inapparent infection as

well as clinically manifest cases
64

32
 12/9/2022

Generation time
 The concept of generation time is essential in studies of the dynamics of
transmission of infection

 Generation time is a modelling term describing the time duration from the onset
of infectiousness in a primary case to the onset of infectiousness in a secondary
case infected by the primary case.

65

Estimating the Transmission Probability

 Transmission probability is the probability successful transfer of the agent will
occur so that the susceptible host becomes infected

 Two common ways of estimating transmission probability are:

1. Secondary attack rate
2. Binomial Model

66

33
 12/9/2022

SECONDARY ATTACK RATE

 A secondary attack rate (SAR) is a measure of the frequency of new cases of a

disease among the contacts of known cases.

 SAR: is calculated as number of new cases among contacts of index cases during
the period over total number of contacts with the index cases

67

SECONDARY ATTACK RATE

 This is an important measure of spread of disease among contacts of an index

case.

 It has great use in epidemic situations.

 SAR is not rate it is proportion

 Index case: The case that brings a household or any other group (community) to
the attention of the public health personnel.

68

34
 12/9/2022

SECONDARY ATTACK RATE

 Primary case is the individual who introduces the disease into the family or group
under study, not necessarily the first diagnosed case in a family or group

 The index case is excluded from both numerator and denominator, and the co-
primaries cases that are related to the index case so closely in time that they are
considered to belong to the same generation of cases

 The first step in assessing SAR is to define for the disease under study the time
interval after the index case that would include the secondary cases

69

Time periods for estimating the household Secondary attack rate

70

35
 12/9/2022

SECONDARY ATTACK RATE

 The presumed beginning of infectiousness of the index case is defined as time 0

for each household

 Secondary cases are those with time of onset between the end of minimum

incubation period (E1) relative to the beginning of the index case (t=0) and the

end of maximum incubation period (E2) relative to the time of the maximum

infectious period of the primary case, t=I

 Thus, secondary cases are those occurring in the interval (E1, I+E2)
71

SECONDARY ATTACK RATE

 Co-primary case a case recorded onset time less than one minimum

incubation period, E1, the co-primary cases are presumably not infected by

the primary case

 Tertiary and higher cases are those occurring after the maximum allowable

time interval for the secondary cases

 Tertiary case infected by a secondary case

72

36
 12/9/2022

Basic reproductive number (Ro)

 Another important parameter in infectious disease is the basic reproductive
number (Ro)

 Ro is the expected number of new infectious hosts (cases) that one infectious case
will produce during the period of infectiousness

 Ro does not include the new cases produced by the secondary cases, or further
down the chain

 It also does not include secondary cases who do not become infectious

73

Basic reproductive number (Ro)

 Examples: if Ro=9 for measles in a population, then one person with measles

introduced to that population would be expected to produce 9 new secondary

infectious cases before recovering, if the population were completely susceptible.

 If the person produced 2 additional cases who did not become infectious, Ro

would still be 9

74

37
 12/9/2022

Basic reproductive number (Ro)

75

Basic reproductive number (Ro)

 In general, for an epidemic to occur in a susceptible population, Ro must be > 1

 If Ro < 1, an average case will not produce itself, so an epidemic will not spread

(extinction)

 If Ro = 1 endemic (stable disease prevalence)

 Since Ro is an average, it is possible that a particular infectious person will

produce more than one infective case, even when Ro < 1, so there may be a

small cluster of cases.

76

38
 12/9/2022

Basic reproductive number (Ro)

 For micro-parasitic infections, Ro is a composite of 3 important aspects of
infectious diseases:
1. The rate of contacts (c)
2. The duration of infectiousness (d) and
3. The transmission probability per potential infective contact (p)

 Ro = number of contacts per unit time X transmission probability per contact X

duration of infectiousness

77

Basic reproductive number (Ro)

 The contact rates in rural areas will be lower than contact rates in urban areas,
so we expect the Ro of measles to be lower in rural than in urban areas

 Ro of malaria will be high during the season of high mosquito density but low
during the season when there are few mosquitoes.

 By definition, Ro assumes that all contacts are susceptible

 In real populations, however, there are often people who are already immune to
a parasite.

78

39
 12/9/2022

Effective reproductive number (R)

 R unlike Ro assumes that all contacts by the infective case are not with
susceptible individuals.

 Thus
• R= Ro x (proportion of susceptible population)

 Example: if Ro is 9 and 50% of the population is immune

• R= 9 . 0.5 = 4.5
• So effectively a case of the disease will produce only 4.5 cases
79

LEVELS OF DISEASE OCCURRENCE

AND DISEASE PREVENTION

80

40
 12/9/2022

Levels of Disease Occurrence

 Diseases occur in a community at different levels at a particular point in time.

 Some diseases are usually present in a community at a certain predictable level, this is
called the expected level, but at times disease may occur in excess of what is expected

 Expected levels

A. Endemic: a persistent level of low to moderate occurrence

B. Hyper-endemic: a persistently high level of occurrence

C. Sporadic: occasional cases occurring at irregular intervals time

81

Levels of Disease Occurrence

 Excess of what is expected

A. Epidemic: occurrence of disease in excess of what is expected in a given area

over a particular period of time

B. Outbreak: this is an epidemic of shorter duration covering a more limited area

same as epidemic, often used by public health officials

C. Pandemic: an epidemic spread over several countries or continents, affecting a

large number of people.

82

41
 12/9/2022

Levels of Disease Occurrence

Epidemic/Outbreak
Number of cases

Hyper-endemic

Endemic

Time

83

Disease prevention
 The major purpose in investigating the epidemiology of diseases is to learn how
to prevent and control them.

 Disease prevention means to interrupt or slow the progression of disease.

 The aim is to push back the level of detection and intervention to the precursors
and risk factors of disease for this

 Epidemiology plays a central role in disease prevention by identifying those

modifiable causes.

84

42
 12/9/2022

Disease prevention

 The important tasks of health workers are:

 Preventing people from getting sick,
 Preventing sick people from getting worse,
 Preventing becoming disabled or chronically sick or dying.
 There are three levels of prevention
 Primary prevention
 Secondary prevention
 Tertiary prevention

85

PRIMARY PREVENTION

 Primary prevention is aimed at preventing healthy people from becoming sick.

 Primary prevention keeps the disease process from becoming established by

eliminating causes of disease or increasing resistance to disease.

 The main objectives and components of primary prevention are:

1. Promoting health

2. Preventing exposure and

3. Preventing disease

86

43
 12/9/2022

A. Health promotion (Primordial):

 This consists of general non-specific interventions that enhance health and
the body’s ability to resist disease
 Good examples of health promotion including:
 Improvement of socioeconomic status
 Provision of adequate food
 Provision housing and clothing and
 Education

87

B. Prevention of exposure
 Prevention of exposure is the avoidance of factors which may cause disease if
a person is exposed to them.

 Relatively to specific compared to primordial prevention

 The provision of safe & adequate water

 Proper excreta disposal

 Provision of vector control

 Provision of a safe environment at home

88

44
 12/9/2022

C. Prevention of disease
 Prevention of disease is the prevention of disease development after the
individual has become exposed to the disease causing factors.

 The timing is between exposure and biological onset (mark initiation of disease
process)

 Example:
• Immunization can be taken as a good example.

89

C. Prevention of disease
 Immunization does not prevent an infectious organism from invading the immunized host,
but does prevent it from establishing an infection.
 Immunization can be active & Passive immunization
A. Active immunization involves exposing the host to a specific antigen against which it
will manufacture its own antibodies after three weeks interval.
 Example: EPI
B. Passive immunization involves providing the host with the antibodies necessary to
fight the disease. It is commonly given after exposure.
 Examples: rabies, tetanus.

90

45
 12/9/2022

SECONDARY PREVENTION
 Secondary prevention involves detecting people who already have the disease
as early as possible and treat them.

 The objective of secondary prevention is to stop or slow the progression of

disease and to prevent or limit permanent damage.

 It is carried out after the biological onset of the disease, but before permanent
damage sets in.

 Secondary prevention thus involves the detection and treatment of those people
in the sub clinical stage.
91

SECONDARY PREVENTION
 Strategy at this stage is through early detection and treatment of disease.

 Early detection depends on the clinical stage and availability of investigation

facilities.

 Examples: Prevention of blindness from trachoma

 Early detection and treatment of breast cancer to prevent its progression to

the invasive stage.

 These may be achieved through screening for early detection and early
treatment
92

46
 12/9/2022

TERTIARY PREVENTION
 Tertiary prevention is targeted towards people with chronic diseases
and disabilities that cannot be cured.

 Tertiary prevention is needed in some diseases because primary and

secondary prevention have failed, and in others because primary and
secondary prevention are not effective.

93

TERTIARY PREVENTION
 In a patient who can not be cured, tertiary prevention have many objectives
 It has two primary objectives:
1. Treatment to prevent further disability or death and
2. To limit the physical, psychological, social, and financial impact of disability,
thereby improving the quality of life.
 The strategy at this stage in general is rehabilitative
 Rehabilitation is the retraining of the remaining functions for maximal
effectiveness.
94

47
 12/9/2022

95

Advantages and Disadvantages of strategies for primary prevention

96

48
 12/9/2022

THANK YOU !!

97

49