Community & PubliC HealtH for mediCal laboratory SCienCe

WEEK 5| EPIDEMIOLOGY
Abdulaziz S. Ayob| 1 – YB – 7 | 2nd Semester |Bachelor of Science in Medical Laboratory Science

EPIDEMIOLOGY 3. Study the work of health services with a view of improving

them.
I. EPIDEMIOLGY 4. Estimate the risk of diseases, accidents, detects and the
A. C-E. A. WINSLOW changes avoiding them.
B. GOAL OF EPIDEMIOLOGY 5. Complete the clinical feature of chronic disease and
describe their natural history.
C. USES OF EPIDEMIOLOGY 6. Search for cause of health and disease.
D. DISEASE DEFINITIONS
E. DISTRIBUTION
F. JOHN SNOW Disease Definitions
II. TWO MAIN AREAS OF INVESTIGATION • Disease
III. THE AGENT FACTORS OF DISEASE – State of physiological/biomedical dysfunction
A. TYPES OF AGENTS • Illness
B. CHARACTERISTICS OF AGENT DISEASE – Subjective state/awareness of not being well
C. MODES OF TRANSMISSION
IV. THE HOST FACTOR OF DISEASE • Sickness
– state of social dysfunction (the “sick role”)
A. TWO FOLDS OF SPECIFIC RESISTANCE
V. THE ENVIRONMENTAL FACTORS OF DISEASE • Impairment
A. DISEASE CAUSATION – Any loss of abnormality of structure or function
B. INCUBATION PERIOD
C. ISOLATION AND QUARANTINE • Disability
– Restriction or inability to perform in the manner considered
• CATEGORIES OF ISOLATION
normal of an individual
D. QUARANTINE
• CATEGORIES OF QUARANTINE • Handicap
VI. TWO DIFFERENT EPIDEMIOLOGIC STUDY – Disadvantage that limits or prevents the fulfillment of a social
A. DESCRIPTIVE STUDY role
B. EXPERIMENTAL STUDY
“Distribution”
VII. THE NATURAL HISTORY OF COMMUNICABLE Epidemic
DISEASE AND THE LEVELS OF DISEASE PREVENTION - an increase in the frequency (incidence) of a disease above
A. PRE-PATHOGENESIS the usual and expected rate, which is called the endemic rate.
- thus epidemiology count cases of a disease, and when they
B. PATHOGENESIS detect the sign of epidemic, they ask who, when and where
questions.
• Who is getting the disease
EPIDEMIOLOGY • Where and when the disease is occurring
• From this information, they can often make informed guesses
John M. Last, Dictionary of Epidemiology as to why it is occurring.
“Study the distribution and determinants of health related
states and events in specified populations and the application
of this study to the prevention and control of health problems”. John Snow
- father of modern epidemiology
- Study about cholera
C-E. A. Winslow - Snow would not have been formulated his hypothesis without
The great public health leader of the early 20th century, called the data he gathered
epidemiology “the diagnostic discipline of public health.”
Notifiable disease - surveillance made by the government
What is the Goal of epidemiology?
before many people start dying.
The ultimate goal is to use this knowledge to control and
prevent the spread of disease.

Uses of Epidemiology
1. Study the history of the health population and the rise and
fall of diseases and changes in their character.
2. Diagnose the health of the community and the condition of
the people.

EPIDEMIOLOGY
 TWO MAIN AREAS OF INVESTIGATION Immunity - This is the total property of an individual to protect
himself from an infectious agent
1. Describes the distribution of health status in terms of age,
gender, race, geography, and time.
2. Patterns of disease distribution in terms of causal factor Two types of immunity
• In epidemiology of any disease or event, one studies the ❖Non specific resistance- present at the time of birth or has
factor which contribute to its causation and behavior- developed during maturation
AGENT, HOST, ENVIRONMENT
❖Specific resistance- acquired as a result of prior exposure
• Epidemiology concept maintains that
with a foreign substance
there can be no single cause of disease

TWO FOLDS OF SPECIFIC RESISTANCE

THE AGENT FACTORS OF DISEASE Active- what has been introduced to the individual is the
antigen and the body makes the antibody.
Agent ❖ Naturally acquired active immunity- when we get sick the
- is any element, substance or force whether living or non-living infective agent will gain entry to the body, act as stimulant for
thing; the presence or absence can initiate or perpetuate a antibody formation because the organism acts as antigen. The
disease process. immunity is lifelong (ex. Measles, chicken pox, hepatitis A)
Types of Agent: ❖ Artificially acquired active immunity- when the antigen
1. This could be living or non-living things, physical or has been deliberately introduce like injecting vaccines, they act
mechanical in nature such as extremes of temperature, light as antigen to stimulate antibody formation. It makes use of
electricity. vaccine which is suspension of killed or living organism (ex.
2. They could be chemicals- endogenous (within the body) or MMR,OPV,BCG)
exogenous (poison)

Characteristics of Agent of disease Passive- when what has been introduced to the body is
1. Inherent characteristics already antibodies that provide immediate protection against
- physical feature, biological requirement, chemical microorganisms.
composition, resistance ❖ Naturally acquired passive immunity- exhibited by the
2. Characteristic in relation to the environment transfer of antibodies from mother’s placenta to the fetus and
- refers to the reservoir and source of infection and modes of transfer of antibodies from breast milk to the baby.
transmission. ❖ Artificially acquired passive immunity- injection of
3. Characteristic directly related to man artificially prepared substance like immune serum of gamma
a. Infectivity globulin. These two are antibodies preparation (ex. Anti-
b. Pathogenicity tetanus antibodies, diphtheria antitoxin)
c. Virulence
d. Antigenicity
THE ENVIRONMENTAL FACTORS OF DISEASE
Modes of Transmission
1. Direct transmission - immediate transfer of infectious agent a Environment- sum total of an organism’s external surrounding
receptive portal of entry conditions and
2. Indirect transmission influences that affect its life and development
a. Vehicle borne- contaminated inanimate objects or materials • Physical Environment
b. Vector-borne- from other living organism (ex. Insects) • climate- certain disease have seasonal distribution
c. Mechanical vector • Geography and location
3. Airborne- dissemination of microbial aerosols to a suitable • Biologic Environment- living environment ofman consist of
portal of entry usually the respiratory tract plants, animals and fellow human beings.
a. Droplet nuclei- usually small residues which result from • Socio-economic environment
evaporation of fluid from droplets emitted by an infected host
b. Dust
DISEASE CAUSATION
• The occurrence of disease follows biologic laws which apply
THE HOST FACTOR OF DISEASE to both communicable and non-communicable diseases.
• Disease results from imbalance between the forces of the
1. Age agent and host
2. Sex • The nature and extent of imbalance depends on the nature
3. Race and characteristics of host and agent
4. Habits, Customs, and religions • The characteristics of two are influenced considerably the
5. Exposure to agent condition of the environment.
6. Defense mechanism of the host
Incubation Period
- Time between exposure to infectious agent up to the time of
❖Humoral Defense appearance of the earliest signs and symptoms
❖Cellular Defense

EPIDEMIOLOGY
1. Clinical incubation period - the time between exposure to
a pathogenic organism and the onset of symptoms of a
disease.
2. Biological Incubation Period - The time taken by the
parasite to complete its development in the definite host (from
the time of entry of the infective larvae to the presence of
microfilariae) is called the Intrinsic incubation period (Biological
incubation).
ISOLATION AND QUARANTINE
ISOLATION
As applied to patient, 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 effect of the direct or indirect transmission of the infectious
agent from those infected to those who are susceptible or who
may spread the disease agent.
Categories of Isolation
1. Strict isolation- - this category is designed to prevent
transmission of highly contagious or virulent infectious that may
spread by direct contact or droplet.
2. Contact isolation - for less highly transmissible or serious
infections, for disease or conditions which are spread primarily
by close or direct contact.
3. Respiratory isolation - to prevent transmission of infectious
diseases over short distance through the air
4. Tuberculosis isolation (AFB isolation) - for patient with
pulmonary tuberculosis who have a positive sputum smear or
chest x-rays which strongly suggest active tuberculosis
5. Enteric Precautions - for infectious transmitted by direct or
indirect contact with feces purulent material or drainage from
an infected body site
7. Drainage/secretion Precautions- to prevent infections
transmitted by direct or indirect contact with purulent material
or drainage from an infected body site.
8. Blood/body fluid Precautions
- to prevent infections that are transmittedby direct or indirect
contact with infected blood or body fluids.
QUARANTINE
- Restriction of the activities of a well persons or animals who
have been exposed to a case of communicable
diseases during its period of communicability to prevent
disease transmission during incubation of infection should
occur
Categories of Quarantine
1. Absolute or Complete Quarantine - Limitation of
movement of those exposed to a communicable disease for a
period of time not longer than the longest usual incubation
period of that disease.
2. Modified Quarantine - Selective, partial limitation of
freedom of movements of contacts
THE DIFFERENT EPIDEMIOLOGIC STUDIES
DESCRIPTIVE STUDY
Analytical Study:
- Ecological
- Cross-sectional
- Case-Control
- Cohort
EXPERIMENTAL STUDY
Randomized Control Trial
- It is an epidemiological experimental study of a new
preventative or therapeutic
regimen.
- For this reason, it is commonly referred toas prophylactic trial,
when testing theeffectiveness of a drug to prevent a disease, it
is referred to as prophylactic trail.
- Subject in a population are randomly allocated to groups,
usually called treatment and control groups, and the results are
assessed by comparing the outcome in the two or more
groups.
Field trials
- It involves people who are disease free but presumed to be a
risk.
- Since the subjects are disease- free and the purpose is to
prevent the occurrence of diseases that may occur with
relatively low frequency,
- field trials are often huge undertakings involving major
logistics and financial considerations.
Community trials
- In this form of experiment the treatment groups are the
communities rather than individuals.
- This is particularly appropriate for diseases that have their
origins in their social conditions, which in turns can most easily
be influenced by intervention directed at group behavior as well
as at individuals.
THE NATURAL HISTORY OF COMMUNICABLE DISEASE
AND THE LEVELS OF DISEASE PREVENTION
- The natural history of diseases comprises the body of
knowledge about the agent, host and environmental factors
relating to the disease process.
- It includes the initial forces/factors which initiated the process
in the environment or elsewhere through the resulting changes
which took place in man, until continuing equilibrium is
reached, or defect, disability, or death ensues.
PHASES
1. Pre-pathogenesis
- This is the phase before man is involved. Through the
interaction of the agent, the host and environmental factors, the
agent finally reaches man.
- It maybe said that everyone is in the period of pre-
pathogenesis of many diseases because agents are present in
the environment where man lives
2. Pathogenesis
- This phases includes the successful invasion and
establishment of the agent in the host
- After a period of incubation, whereby the agent multiplies and
develops, or get absorbed and fix in the tissue, sufficient tissue
or physiologic changes may have taken place to produce
detectable evidence of the disease process in man.
EPIDEMIOLOGY