 Endemic- occurrence of expected number of cases among a group of 1) Prepare for field work- Research disease, prepare to travel,

people over time make arrangements with personal contacts

 Incidence- # of new cases in a population 2) Establish the existence of an outbreak- compare current number of
 Prevalence- # of cases in a population (per 10,000 or 100,000) cases to previous cases, use health records, documents, etc.
 Outbreak- more cases of a particular disease than expected in a given 3) Verify diagnosis- Review clinical and laboratory results for the
area over a given time cases, interview patients
 Epidemic- large numbers of people over geographic area distribution 4) Define and identify cases- establish case definition, have clinical info,
affected with the same disease characteristics of the people, place, time, etc.
 Pandemic- an epidemic spanning a very wide area 5) Describe and orient the data in terms of person, place, and time- use
 Vector- an animal intermediate that transmits a pathogen to humans epi curve to describe how many cases at what time
 Virulence- Degree or intensity of pathogenicity of an organism 6) Develop hypotheses- consider disease, interview people who are
 Compromised host- host with lowered resistance to infection ill, try and notice what certain characteristics make people have the
 Nosocomial infection- an infection that is traced back to a hospital disease
 Infectivity - capacity to cause infection in a susceptible host 7) Evaluate hypotheses- compare with established fact, use statistics, use
 Pathogenicity - capacity to cause disease in a host case-control or cohort studies
 Virulence - severity of disease that the agent causes to host 8) Refine Hypotheses- study environment, use data for more insight
9) Control and Prevention measures- immunization, medicine, isolation,
 Case definition- The onset of (symptoms) in a (person) at
carry out as soon as possible
(time and place)
10) Communicate findings- Oral briefing for local health authorities,
 Confirmed- diagnosis by lab verification
written report for archives
 Probable- many factors point to diagnosis, but no lab verification
 Suspected- some factors point to diagnosis
 Reservoir- site that harbors pathogenic organisms (human, animal, soil) Cohort Study- used for outbreaks in small, well-defined populations, moves
 Morbidity rate- # sick divided by # exposed forward or backward from exposure
 Mortality rate- # dead per 100000 population
 Case Fatality rate- # dead divided by # sick Disease? Yes No
 Modes of transmission: droplet (through air, flu, TB, SARS, Exposed (A) (B)
hantavirus), blood (sexual or injected, HIV, hepatitis), direct contact Unexposed (C) (D)
(touching, leprosy, chicken pox), oral-fecal (contaminated water, Attack Rate- exposed A/(A+B)
cholera, giardia), vector (spread by animal, malaria, lyme disease) unexposed C/(C+D)
 AIDS- acquired immunodeficiency syndrome, spread by blood/ Relative Risk- [A/(A+B)]/[C/(C+D)]
sexually, attacks immune system Relative Risk> 1: more likely
 Tuberculosis- caused by bacteria, cough, fever, fatigue, weight loss, Relative Risk<1: possible protective effect
treated by antibiotics, attacks respiratory system or other parts of body 0-----------------------1------------------------
 Malaria- caused by protozoan, spread by mosquitoes (anopheles), Possible protective effect More likely
cyclic fever and chills Case control Study- used when groups are not well-defined compares
 2 Triads: Person, Place, Time; Agent, Host, Environment people with the disease to people without, works backward
 Index Case: The first case in an outbreak Exposed Case Controls
↓ Patients
 Virus: Viruses are small, much smaller than bacteria. They are not
Yes (A) (B)
composed of cells. Viruses have 2 basic components: DNA or RNA
No (C) (D)
covered in protein. Viruses can only reproduce inside the cells of
other living organisms (rabies, AIDS, SARS, ebola, measles) Odds ratio: (A x D)/(B x C)
 Bacteria: Bacteria have 1 cell and no nucleus. DNA and ribosomes A= number of case patients exposed
float in the cell. They have flagella to help them swim. They have no B= number of control people exposed
cell organelles. Gram + bacteria have a strong cell wall with C= number of case patients unexposed
peptidoglycan and a capsule. Bacteria also have pili that help stick. (E. D= number of control people unexposed
coli, streptococcus, diptheria, MRSA, lyme disease)
Shapes: spherical (cocci) Arrangements: staph (clumps)  Cholera- Vibrio Cholerae (oral-fecal)
 Campylobacter Enteritis- campylobacter jejuni (oral- fecal)
Rod (bacilli) Strep (chain)
Spiral (spirilla or spirochete)  Chicken Pox- varicella zoster (droplet and direct contact)
 Chlamydia- Chlamydia trachomatis (sexually)
Immunity Inherited-develops before birth, inborn  E. coli- Escherichia coli (oral-fecal)
Acquired-Active/natural-exposed to antigen naturally  Malaria-plasmodium (vector, anopheles mosquito)
 Passive/natural-milk, placenta  MRSA- staphylococcus aureus (direct contact)
 Active/artificial-injections, vaccines of antigens  SARS-coronavirus (droplet)
 Passive/artificial-injections of antibodies  Leprosy-mycobacterium leprae (direct contact)
Lines of defense  Schistosomiasis- schistosoma (oral/contact with water)
1. Skin and secretions- acts as initial barrier, mucus catches pathogens,  Shingles-herpes zoster (contact, droplet)
enzymes kill pathogens  Strep throat-streptococcus(droplet)
2. Inflammatory response- injury/tissue damage releases chemical signal,  Tuberculosis- mycobacterium tuberculosis (droplet)
blood flow increases: heat, redness, pain, swelling  Tetanus-clostridium tetani (contact)
3. Phagocytosis- ingests and destroys microorganisms: neutrophils,  Ebola-filoviridae (contact/blood)
macrophages  Athlete’s foot- tinea pedis (contact)
4. Natural killer cells- kills tumor cells and infected cells with viruses  Jakob- Cruztfelt- prion(ingestion)
5. Interferon- infected cell makes protein and releases into  Tapeworm- nematode (ingestion)
bloodstream, interferes with reproduction  Hepatitis- hepatitis a, b, c virus (a: oral fecal, b: sexually)
Epidemiology  Giardia- giardia lamblia (direct contact)
⚫ Study of health of population
⚫ Uses scientific method
⚫ Studies distribution and causes of disease in human populations
⚫ Attempts to control these diseases investigates health concerns
in relation to disease
 Study design Strength
Case-control Good for rare disease or
long latency, examine
multiple exposures from a
single outcome; less
expensive and quicker to
conduct than cohort study
Cohort Examining multiple
outcomes for a single
exposure; examine rare
exposures (such as asbestos
but not for rare disease); can
calculate the incidence of
disease (while case control
cannot); best technique for
an outbreak in a small, well
defined population; most
accurate observational study
Cross- Relatively short duration;
sectional can study several outcomes;
least expensive
Experimental Most scientifically sound;
or best measure of exposure
Trial
Weakness
Possible error in
recalling past exposure
(Recall Bias). Possible
time-order confusion
Not good for rare
diseases; costly in time
and resources; possible
loss to follow up over
time; factor, which may
be many years in the past
or may be seen as
socially (un)desirable
Since exposure and
disease status are
measured at the same
point in time, it may
not always be possible to
distinguish whether the
exposure preceded or
followed the disease.
Time consuming and
Expensive; Unethical for
Harmful Exposures

Hill’s criteria

1. Strength of Association - relationship is clear and risk

estimate is high
2. Consistency - observation of association must be repeatable
in different populations at different times
3. Specificity - a single cause produces a specific effect
4. Alternative Explanations - consideration of multiple
hypotheses before making conclusions about whether
Types of epidemic an association is causal or not
 Point source - An epidemic in which all cases are 5. Temporality - cause/exposure must precede the effect/outcome
infected at the same time, usually from a single source or 6. Dose-Response Relationship - an increasing amount of
exposure. exposure increases the risk
 Continuous source - An epidemic in which the causal 7. Biological Plausibility - the association agrees with currently
agent (e.g. polluted drinking water, spoiled food) is accepted understanding of biological and pathological
infecting people who come into contact with it, over an processes
extended period of time.
8. Experimental Evidence - the condition can be altered, either
 Person-to-Person (a.k.a. Propagated) - An epidemic
prevented or accelerated, by an appropriate experimental
in which the causal agent is transmitted from person to
process
person, allowing the epidemic to propagate
Path of infection 9. Coherence - the association should be compatible with
Reservoir: existing theory and knowledge, including knowledge of
Susceptible Host: past cases and epidemiological studies
Portal of Entry:
Portal of exit:

Koch’s postulates

1) Collect samples from different people

2) Grow contents on Petri dishes
3) Look for similar organisms from each of the patients
4) Inoculate suspect organism into healthy animal
5) Wait for symptoms to occur
6) Isolate organism from diseased animals