Fundamentals of

Infectious Diseases
CMPH Sibu Posting
Year 3
UNIMAS
AP Dr. Jeffery Stephen
Updated 14.12.2021
Objectives
Definition of epidemiology
The epidemiologic triad
The definition of infectious/communicable diseases
Importance of studying the infectious diseases epidemiology
Infection cycle / chain of infection
Dynamics of disease transmission
Routes of transmission
Communicable disease natural history
Pattern of occurrence
Principles of Communicable Diseases Management
One Health Concept
Common classification of communicable diseases
Organisational structure at Health Department related to
Communicable Disease Control Program
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Definition of Epidemiology
Epidemiology is
the study of the distribution and
determinants of health-related states and
events in populations, and the application
of this study to control health problems
(Last, 1983).

Time Place Person

3
 Epidemiologic Triad ->
influent
human
disease in

TB Characteristics:
-toxicity, virulence, infectivity
-
has ability to survive Agent, -Susceptibility to antibiotics
outside
brely Pathogen -Ability to survive outside body

Disease

Host Environment
Characteristics: Characteristics:
-age -> older ppl risk a low immunity -climate eg: dengue
-prior exposure measels, chicken pox
->

-physical structure
-susceptibility -> depend host
on
-Population density
-Co-infection -> riBpts have to check
we
for HIV-tep B-Hep C -Social structure
-immune response & vsyphilis Hi
- I 4
itmurscompromised
Dangi, Ravi & George, Mathew. (2020). A Review on Theories and Models of Disease Causation for COVID-19.
https://www.researchgate.net/publication/341050523_A_Review_on_Theories_and_Models_of_Disease_Causation_for_COVID-19

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Definition of Communicable
diseases
A communicable disease is
an illness due to a specific infectious
(biological) agent or its toxic products
capable of being directly or indirectly
transmitted from
man to man, Hs, 7B, fypland
animal to man, materia, rabies
animal to animal, or africer swine fin
the environment (through air, water, food,
etc..) ->
tep to spirose's

6
Importance of studying Infectious
Diseases Epidemiology
dengue
Changes of the pattern of infectious isut

diseases Monsoon
search

Discovery of new infections

The possibility that some chronic
diseases have an infective origin
↳

7
 Dynamics of disease transmission

Source or Reservoir Modes of transmission Susceptible host

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 Dynamics of disease transmission

Source or Reservoir Modes of transmission Susceptible host

The source of infection: the person, animal, object or substance from which an
infectious agent passes or is disseminated to the host.
The reservoir is:
1. any person, animal, arthropod, plant, soil, or substance, or a combination of
these, in which an infectious agent normally lives and multiplies, on which it
depends primarily for survival, and where it reproduces itself in such a manner
that it can be transmitted to a susceptible host.
2. the natural habitat of the infectious agent Porta, 2008 9
 Disease Reservoir Source
Tuberculosis Man Sputum
HIV/AIDS Man Body secretions,
fluids
Malaria Man/Mosquito Infected blood
Rabies Dog/other Saliva
animals
Cholera Man Unsafe water &
food

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Types of reservoirs

Reservoir

Human Animal Non-living

reservoir reservoir reservoir

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Human reservoir
Case Carrier
·.

Endodontal
Clinical illness Type

Subclinical Duration
a

airut
Latent
Portal of exit
infection I

12
 Human reservoir
Case
Mild / moderate /severe
Clinical illness Typical / atypical

Epidemiologically mild cases are more important than moderate

or severe cases

Esteban WHY?
v Mild cases: Ambulating more, spread the infection (infectionsS
⑧

Severe cases: reduce mobility, confined to bed disolated themselvesS

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Human reservoir
only caught in laboratory
Case
In-apparent, covert, missed, abortive
cases

Infectious agent multiplies in the host

Subclinical but not manifest itself by signs and
symptoms

Not sick infectious disease

transmission

Only be detected in laboratories

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Human reservoir
Case
latent waiting to be activel

Does not shed the infectious agent, lies

dormant in the host without any
symptoms

Often without demonstrable presence

in blood , tissues or bodily secretions of
the host
Latent
infection eg:
-> TB

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Human reservoir
Case
Primary case: first case of communicable
disease introduced into the population
unit being studied ↳
first person

Index case: first case of a communicable

disease which comes to attention of an
investigator ↳ fire
firstpartby andpeatment
Secondary case: develop disease after
Latent contact with the primary or index case
infection ↳ family of primers are

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 Human reservoir
Carrier
specific infectious agent in absence of any
discernible clinical disease and serves as a

Type

Epidemiological importance:
escape recognition, Duration
live normal life among population or
community,
readily infect the susceptible individuals for
a long period of time under favorable Portal of exit
conditions

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Human reservoir
Carrier

Type Duration Portal of exit

Incubatory Temporary Urinary

Convalescent Permanent Intestinal

Healthy Respiratory

Others
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Human reservoir
Carrier

Type

Incubatory

Incubatory carriers those who shed the infectious

disease during the incubation period of the disease.
That is they are capable of infecting others before the
onset of illness.
Eg : Measles, mumps, pertussis, diphtheria Grid-19
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Human reservoir
Carrier

Type
those who continue to shed the disease
agent during the period of
convalescence.
Rastain still in thebody

Convalescent Eg : Typhoid 6 to 8 weeks after

↳ recovery
reverent

↳ distant

bettlin still in the ple body.

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Human reservoir
Carrier

They are the victims of sub clinical

Type
infection who developed carrier state
without suffering from overt disease,
but are nevertheless shedding the
disease agent.
Eg : Typhoid, cholera, meningococcal
meningitis
Healthy
subclinical may or may not act as a
Eg : Polio, Tuberculosis
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Human reservoir
Carrier

Duration

Temporary

Permanent

Longer the carrier state greater the risk to the community.

Carriers may excrete infectious agent intermittently or continuously.
Duration of carrier state varies with disease.
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 Human reservoir
Carrier

Duration

Temporary

Temporary carrier: Eg: Mumps, cholera, Polio

They spread infectious agent for a limited period of time,

they include

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Human reservoir
Carrier

Duration

Permanent

Is one who excretes the infectious agent over a longer period of

time.
Eg : Typhoid, Malaria, Hepatitis B & A

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 Human reservoir
Carrier

Portal of exit

Portal of Exit Example

Urinary
Urinary Typhoid
Intestinal Cholera Intestinal
Respiratory Tuberculosis
Nasal Diphtheria Respiratory

Others
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 Human reservoir

Human reservoir

Type:
cases Primary case
Incubatory carriers
Index case
Convalescent
Secondary cases
Healthy

According to spectrum of disease:

Clinical cases Duration: Portal of exit:
(mild/severe-typical/atypical) Temporary Urinary
Sub-clinical cases Chronic Intestinal
Latent infection cases Respiratory
others

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 Dynamics of disease transmission

Source or Reservoir Modes of transmission Susceptible host

Direct Indirect
transmission transmission
↑

Vehicle-borne
mouse
Direct contact Vector-borne:
Droplet infection Mechanical
biological
Contact with soil Air-borne
Inoculation into skin or mucosa Fomite-born
Unclean hands
Trans-placental (vertical) and fingers
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 Dynamics of disease transmission

Source or Reservoir Modes of transmission Susceptible host

Susceptibility :
1. vulnerability; lack of resistance to disease
2. Interaction between one of two (i.e. agent and host)
Porta, 2008

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 Chain of infection

https://apps.hhs.texas.gov/providers/NF/credentialing/cna/infection-control/module2/Module_2_Chain_of_Infection5.html 29
https://infectionprevention
andyou.org/protect-your-
patients/break-the-chain-
of-infection/

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 close contact
confined space
https://netec.org/2021/02/05/breaking-covid-19-chain-infection/ crowding
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Major routes of transmissions
1. Contact:
1. Direct (person-person) Vertical Transmission
2. Indirect (through an object)
2. Droplet
3. Airborne Horizontal
4. Vector borne Transmission

Parenteral
Transmission

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Transmission Models [Drake et al (2015)]

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Source: https://reflectionsipc.com/2015/12/16/surface-contamination-and-respiratory-viruses-with-pandemic-potential-sars-mers-and- 34
influenza-an-underestimated-reservoir/
Communicable disease natural
history
clinical dinical
->
to us disease
symup

35
Incubation period : the period of time between after exposed to the infection and the
appearance of symptoms of illness or disease

Latent period : the period of time between after exposed to the infection, but the pathogen is
hidden, inactive, or dormant; not fully actively replicating and causing any symptoms

Period of communicability : the time during which an infectious agent may be transferred
directly or indirectly from an infected person to another person, from an infected animal to
humans, or from an infected person to animals. Also known as the 'infectious period'. 36
 Symptoms of some common infections
System of the body Symptoms of infection
Skin Inflammation
Pain
Swelling
Heat
Respiratory tract Increased respiratory secretions
Cough
Urinary tract Pain (cystitis)
Frequency
Urgency
Central nervous system Confusion
Drowsiness
Stiff neck
Heachache
Gastrointestinal tract Abdominal pain
Vomiting
Diarrhoea 37
Stages of clinical disease

38
http://academic.pgcc.edu/~kroberts/Lecture/Chapter%2014/stages.html
Patterns of occurrence
Endemic infections
Epidemics infections
Pandemic infections
Emerging Infections

39
Patterns of occurrence
Sporadic: scattered, dispersed cases of a communicable
disease, without any connections in time and space
eg.: rabies, Zika, syphilis, food poisoning
Endemic: permanently or long-lastingly increased
presence of a disease in a given area
eg.: HFMD, malaria, HIV, TB
Epidemic: occurrence of some communicable disease-
cases in a community or region (also called outbreak)
eg: chicken pox, cholera, dengue fever
Pandemic: diffused spread of a communicable disease
on the continents or Earth
for ex.: influenza H1N1, MERs COV
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Principles of Communicable Diseases
Management

41
Disease Control and Prevention

woustre
Controlling the reservoir
Early diagnosis and treatment
Notification
Epidemiological investigation
Isolation
Treatment
Quarantine

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Disease Control and Prevention
Controlling the reservoir
Early diagnosis and treatment
WHY?

Helps in prompt treatment

Epidemiological investigation Eg.. To trace the source
of infection from known or index case to unknown or
primary source of infection
To study the time, place and person distribution
For the institution of preventive & control measures

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Disease Control and Prevention
Controlling the reservoir
Early diagnosis and treatment
Notification
Epidemiological investigation
Isolation To implement control
Treatment measure including the
Quarantine provision of medical care to
the patients

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Disease Control and Prevention
Controlling the reservoir
Early diagnosis and treatment
Notification
Epidemiological investigation
Isolation
theTreatment
identification of source of infection and of the factors
Quarantine
influencing its spread in the community which include

population

45
Disease Control and Prevention
Controlling the reservoir

radi
e
Early diagnosis and treatment
Notification
Epidemiological investigation
Isolation
Treatment
Quarantine Y
Separation for the period of communicability of infected persons, or
animals from others in such places and under such conditions as to
prevent or limit the direct or indirect transmission of the infectious agent
from those infected to susceptible or who may spread the agent to others.

46
Disease Control and Prevention
Controlling the reservoir
Early diagnosis and treatment
Notification
Epidemiological investigation
Isolation
Treatment Reduces the period of communicability,
Quarantine
secondary cases

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 Disease Control and Prevention

ore
Controlling the reservoir
Early diagnosis and treatment
Notification
Epidemiological investigation
Isolation The limitation of freedom of movement of
Treatment such well person or domestic animals
exposed to communicable disease for a
Quarantine* period of time not longer than the longest
usual I.P. of the disease in such manner as
*Venetian dialect to prevent effective contact with those not
trentino -days isolation so exposed.

48
Disease Control and Prevention
Interruption of transmission
Susceptible host

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Disease Control and Prevention
Interruption of transmission
Water borne diseases like Typhoid, Dysentery, Cholera
Hepatitis A can be prevented by provision of safe
drinking water supply
Food borne diseases can be prevented by improving
food sanitation like clean practices such as hand
washing, adequate cooking, prompt refridgeration of
prepared foods and withdrawal of contaminated foods
Prevention of vector borne diseases by adequate vector
control measures.

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Disease Control and Prevention
Susceptible host, protected by
Active immunization;
e.g vaccination
Passive immunization;
e.g Anti Rabies Serum for rabies, Anti Tetanus Serum for Tetanus
Combined (active & passive) immunization;
Immuglobulin + anti-rabies serum for rabies
Chemoprophylaxis;
antimalarial treatment (chloroquine for hunters/army)
Non specific measures;
- has brought down most of
the communicable disease like Tb, Cholera, child mortality

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Communicable disease intervention

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 Communicable disease intervention
Characteristics:
-toxicity, virulence, infectivity
Agent, -Susceptibility to antibiotics
Pathogen -Ability to survive outside body
Intervention:
Protect
Educate Interventions:
Alter exposure Remove breeding grounds
Disease Improve sanitation

Host Environment
Characteristics: Interventions: Characteristics:
-age Educate -climate
-prior exposure Change activity patterns -physical structure
-susceptibility Quarantine -Population density
-Co-infection Isolation -Social structure
-immune response 53
Nwabuko, Ogbonna, & Obiora, Thomas. (2020). Epidemiology in the News -the case of COVID-19 pandemic
disease. IOSR Journal of Dental and Medical Sciences. 19. 35-38. 10.9790/0853-1905043538. 54
 Classification of communicable
diseases
Zoonotic diseases:
Vaccine related
Rabies
Food water diseases:
Leptospirosis
borne diseases: Hepatitis B
Brucellosis
Cholera TB
HFMD
Food poisoning Measles
Dysentry Diptheria Vector borne
Hepatitis A Pertussis diseases:
Malaria
Dengue
Sexually transmitted diseases: Airborne diseases:
Filariasis
Gonorrhea TB
HIV Leprosy
Syphilis H1N1
Hepatitis B / C Avian Influenza
Chancroid

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