DCN 50262

ENVIRONMENTAL PUBLIC
HEALTH AND SANITATION
Revision Previous Topic

Differentiate:

➢ Endemic

➢ Epidemic

➢ Pandemic

➢ Sporadic
Revision Previous Topic

Differentiate:

Endemic:
An endemic is a disease outbreak that is consistently present but limited to a particular
region, people: chickenpox, malaria, dengue

Epidemic
Unexpected increase in the number of disease cases in a specific geographical area,
cases rises above expected level: measles, polio

Pandemic
Refers to an epidemic that has spread over several countries or continents, usually
affecting a large number of people: COVID-19

Sporadic
Sporadic refers to a disease that occurs infrequently and irregularly: Tetanus, rabies
 TOPIC 3
CHAIN OF INFECTION, DISEASE
TRANSMISSION, CONTROL AND
PREVENTION

DCN50262-ENVIRONMENTAL PUBLIC
HEALTH AND SANITATION
By the end of this topic, student will be able to :

3.1 Identify the chain of infection and modes of disease

transmission

3.1.1 Explain the epidemiology triangle

a. Define host
b. Define environment
c. Define agent
By the end of this topic, student will be able to :

3.1 Identify the chain of infection and modes of disease

transmission

3.1.2 Explain chain of infection

3.1.3 Define fomite
3.1.4 Define reservoir
a. Human reservoir
b. Animal reservoir
c. Environmental reservoir

3.1.5 Define carrier

3.1.6 Define vector
3.1.7 Define portal of exit
3.1.8 Explain disease direct transmission
3.1.9 Explain disease indirect transmission
EPIDEMIOLOGY TRIANGLE
When colonist settled America, they introduced
smallpox to Native Americans. Epidemics became
rampant, and almost entire tribes died as result.

In 1500s, entire native population in Jamaica Island died

because of smallpox. (Variola Major & Variola Minor)

3 interrelated epidemiologic factors often contributed to

outbreak of the disease:

• Agents
• Host
• Environment
 EPIDEMIOLOGY TRIANGLE
AGENT
• The agent is the cause of the disease (pathogen: virus, bacterium,
parasite, or other microbe)

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

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

• Biological, Physical, Chemical

• Example (These include chemical contaminants (such as the L-

tryptophan contaminant responsible for eosinophilia-myalgia syndrome)

• Influence the chance for disease or its severity

• Evolution of pathogenic infectious agents (microbial adaptation & change)

 EPIDEMIOLOGY TRIANGLE
HOST
• The host is an organism usually a human or an animal that harbours the
disease-get the disease.
• A variety of factors intrinsic to the host, sometimes called risk factors
• Risk factor to host included: individual’s exposure, susceptibility, or
response to a causative agent.
• Opportunities for exposure are often influenced by behaviors such as
sexual practices, hygiene, and other personal choices as well as by age
and sex, drug use
• Susceptibility and response to an agent are influenced by factors such
as genetic composition, nutritional and immunologic status, anatomic
structure, presence of disease or medications.
 EPIDEMIOLOGY TRIANGLE
ENVIRONMENT
• Includes those surroundings and conditions external (extrinsic) to the
human or animal that cause or allow disease transmission
• External conditions, physical, biological, social contribute to
the disease process
• Physical factor (geology, climate & changing ecosystems)
• Biological factor such as insects that transmit the agent
• Socioeconomic factor such as crowding, sanitation, and the availability
of health services.
 EPIDEMIOLOGY TRIANGLE
• Epidemics occur when host, agent and environmental
factors are not in balance
• Due to new agent
• Due to change in existing agent (infectivity,
pathogenicity, virulence)
• Due to change in number of susceptible in the
population
• Due to environmental changes that affect transmission
of the agent of growth of the agent
CHAIN OF INFECTION
CHAIN OF INFECTION
• Transmission occurs when the agent leaves its reservoir or
host through a portal of exit, is conveyed by some mode
of transmission, and enters through an appropriate portal
of entry to infect a susceptible host. This sequence is
sometimes called the chain of infection.

• Chain of infection is a process in which a favorable condition

is required for microorganism to spread or transfer from
reservoir to a susceptible host
 INFECTIOUS AGENT
• Any microorganism that can cause a disease such as a
bacteria, virus, parasite, or fungus.
• Reasons that the organism will cause an infection are
virulence (severity), invasiveness (ability to enter tissues)
and pathogenicity (ability to cause disease).
 RESERVOIR

• The reservoir of an infectious agent is the habitat in which

the agent normally lives, grows, and multiplies.
• Reservoirs include humans, animals, and the environment.
• The reservoir may or may not be the source from which an
agent is transferred to a host.
• For example, the reservoir of Clostridium botulinum is soil,
but the source of most botulism infections is improperly
canned food containing C. botulinum spores.
 HUMAN RESERVOIR

• Many common infectious diseases have human reservoirs.

• Diseases that are transmitted from person to person without
intermediaries include the sexually transmitted diseases,
measles, mumps, streptococcal infection, and many
respiratory pathogens.
• Because humans were the only reservoir for the smallpox
virus, naturally occurring smallpox was eradicated after the
last human case was identified and isolated
 ANIMAL RESERVOIR
• Humans are also subject to diseases that have animal reservoirs.
• Many of these diseases are transmitted from animal to animal, with humans as
incidental hosts.
• The term zoonosis refers to an infectious disease that is transmissible under
natural conditions from vertebrate animals to humans.
• Long recognized zoonotic diseases include brucellosis (cows and pigs), anthrax
(sheep), plague (rodents), trichinellosis/trichinosis (swine), tularemia (rabbits), and
rabies (bats, raccoons, dogs, and other mammals).
• Zoonoses newly emergent in North America include West Nile encephalitis (birds),
and monkeypox (prairie dogs).
• Many newly recognized infectious diseases in humans, including ebola infection
and SARS, are thought to have emerged from animal hosts, although those hosts
have not yet been identified.
 ENVIRONMENTAL RESERVOIR

• Plants, soil, and water in the environment are also

reservoirs for some infectious agents.
• Many fungal agents, such as those that cause
histoplasmosis, live and multiply in the soil.
• Outbreaks of Legionnaires disease are often traced to
water supplies in cooling towers and evaporative
condensers, reservoirs for the causative
organism Legionella pneumophila.
 CARRIER
• A carrier is an individual who carries and is capable of passing on a
genetic mutation associated with a disease and may or may not
display disease symptoms.

• Carriers are associated with diseases inherited as recessive traits. In

order to have the disease, an individual must have inherited
mutated alleles from both parents.

• An individual having one normal allele and one mutated allele does
not have the disease. Two carriers may produce children with the
disease.
 CARRIER
• Asymptomatic or passive or healthy carriers are those who never
experience symptoms despite being infected.

• Incubatory carriers are those who can transmit the agent during the
incubation period before clinical illness begins.

• Convalescent carriers are those who have recovered from their illness
but remain capable of transmitting to others.

• Chronic carriers are those who continue to harbor a pathogen such as

hepatitis B virus or Salmonella Typhi, the causative agent of typhoid
fever, for months or even years after their initial infection.
 CARRIER
• One notorious carrier is Mary Mallon, or Typhoid Mary, who was an
asymptomatic chronic carrier of Salmonella Typhi. As a cook in New
York City and New Jersey in the early 1900s, she unintentionally
infected dozens of people until she was placed in isolation on an
island in the East River, where she died 23 years later.
• Carriers commonly transmit disease because they do not realize
they are infected, and consequently take no special precautions to
prevent transmission.
• Symptomatic persons who are aware of their illness, on the other
hand, may be less likely to transmit infection because they are either
too sick to be out and about, take precautions to reduce
transmission, or receive treatment that limits the disease.
 FOMITE
• Object acting as a carrier of infectious disease.
• Indirect contact transmission refers to person-to-person
transmission of disease via an intermediate fomite
• There are several ways fomites can be contaminated with
infectious disease, including contact with bodily fluids, body
parts, or other fomites and settling from airborne particles by
talking, sneezing, coughing, or vomiting
• To initiate infection via fomites, a virus must be able to
contaminate a fomite, persist on the fomite, come into contact
with a susceptible host, and to initiate infection in the
susceptible host.
 VECTOR
• Such as mosquitoes, fleas, and ticks may carry an infectious agent
through purely mechanical means or may support growth or
changes in the agent.

• Examples of mechanical transmission are flies carrying Shigella on

their appendages and fleas carrying Yersinia pestis, the causative
agent of plague, in their gut.

• In contrast, in biologic transmission, the causative agent of malaria

or guinea worm disease undergoes maturation in an intermediate
host before it can be transmitted to humans
 PORTAL OF EXIT
• Portal of exit is the path by which a pathogen leaves its host. The
portal of exit usually corresponds to the site where the pathogen is
localized.

• For example, influenza viruses and Mycobacterium tuberculosis exit

the respiratory tract, schistosomes through urine, vibrio cholera in
feces, Sarcoptes scabiei in scabies skin lesions, and enterovirus 70,
a cause of hemorrhagic conjunctivitis, in conjunctival secretions.

• Some bloodborne agents can exit by crossing the placenta from

mother to fetus (rubella, syphilis, toxoplasmosis), while others exit
through cuts or needles in the skin (hepatitis B) or blood-sucking
arthropods (malaria).
 DISEASE DIRECT TRANSMISSION
• Direct contact occurs through skin-to-skin contact, kissing, and sexual
intercourse.
• Direct contact also refers to contact with soil or vegetation harboring
infectious organisms.
• Thus, infectious mononucleosis (“kissing disease”) and gonorrhea are
spread from person to person by direct contact. Hookworm is spread by
direct contact with contaminated soil.
• Droplet spread refers to spray with relatively large, short-range aerosols
produced by sneezing, coughing, or even talking.
• Droplet spread is classified as direct because transmission is by direct
spray over a few feet, before the droplets fall to the ground.
• Pertussis and meningococcal infection are examples of diseases
transmitted from an infectious patient to a susceptible host by droplet
spread.
 DISEASE INDIRECT TRANSMISSION

• refers to the transfer of an infectious agent from a reservoir to a

host by suspended air particles, inanimate objects (vehicles), or
animate intermediaries (vectors).

• Indirect contact infections spread when an infected person

sneezes or coughs, sending infectious droplets into the air. If
healthy people inhale the infectious droplets, or if the
contaminated droplets land directly in their eyes, nose or mouth,
they risk becoming ill.
 ACTIVITY

Based on given Dengue Fact Sheet,outline the chain of infection by

identifying the reservoir(s), portal(s) of exit, mode(s) of transmission,
portal(s) of entry, and factors in host susceptibility.

1.Reservoirs:
2.Portals of exit:
3.Modes of transmission:
4.Portals of entry:
5.Factors in host susceptibility:
 ANSWER
Reservoirs: humans and possibly monkeys

Portals of exit: skin (via mosquito bite)

Modes of transmission: indirect transmission to humans by mosquito

vector

Portals of entry: through skin to blood (via mosquito bite)

Factors in host susceptibility: except for survivors of dengue infection

who are immune to subsequent infection from the same serotype,
susceptibility is universal
By the end of this topic, student will be able to :

3.1 Identify the chain of infection and modes of disease

transmission

3.1.8 Explain disease direct transmission

3.1.9 Explain disease indirect transmission
a. Explain water borne disease
b. Explain airborne disease
c. Explain soil borne disease
d. Explain vector borne disease
e. Explain rodent borne disease
f. Explain food borne disease
 DISEASE INDIRECT TRANSMISSION
WATER BORNE DISEASE

• Waterborne infections are particularly common in parts of the world where large
numbers of people don’t have access to clean drinking water or safe disposal of
sewage.

• Infected urine and feces from humans and animals can wash into lakes and
streams, where the pathogens multiply and reinfect people when they drink or
bathe in contaminated water.

• Some pathogens (including the bacteria that cause cholera, a serious diarrhea
disease) live naturally in environmental water sources, so they will always pose a
threat to health.

• Preventive strategy- improve drink water quality

 DISEASE INDIRECT TRANSMISSION
AIRBORNE DISEASE

• Most airborne infections are transmitted when a cough or sneeze

expels fine droplets of water (known as an aerosol) containing
millions of bacteria or viruses

• The aerosol droplets may be inhaled by a susceptible person, or

settle on surfaces where the pathogens contaminate hands, utensils,
clothing, water or food, which are then touched or consumed by
someone else.

• There are three common disease that are transmitted through the
airborne route, chickenpox (varicella), tuberculosis and measles.
 DISEASE INDIRECT TRANSMISSION
SOIL BORNE DISEASE

• Soil is a source of pathogenic, neutral and beneficial

microorganisms. Natural events and anthropogenic activity can affect
soil biodiversity and influence the balance and distribution of soil-
borne human pathogens.

• The potential of agricultural soil cultivation to enhance pathogen

transmission to human through the release of soil microbes into the
air attached to dust particles, contamination of waterways and
infection of food plants and animal.
 DISEASE INDIRECT TRANSMISSION
VECTOR BORNE DISEASE
• Vectors are living organisms that can transmit infectious pathogens between humans, or from animals
to humans.

• Many of these vectors are bloodsucking insects, which ingest disease-producing microorganisms
during a blood meal from an infected host (human or animal) and later transmit it into a new host, after
the pathogen has replicated.

• Often, once a vector becomes infectious, they are capable of transmitting the pathogen for the rest of
their life during each subsequent bite/blood meal.

• Disease that results from an infection transmitted to humans and other animals by blood-feeding
anthropods, such as mosquitoes, ticks, and fleas.

• Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
 DISEASE INDIRECT TRANSMISSION
RODENT BORNE DISEASE

• There are disease concerns with both wild (rats, mice) and pet (rats,
mice, hamsters, gerbils, guinea pigs) rodents and rabbits.

• Hantavirus Pulmonary Syndrome: This is a viral disease that is

transmitted by the rice rat. This disease is spread in one of three
ways: inhaling dust that is contaminated with rat urine or droppings,
direct contact with rat feces or urine, and infrequently due to the bite
of rat.
 DISEASE INDIRECT TRANSMISSION
RODENT BORNE DISEASE

• Leptospirosis: This is a bacterial disease that can be transmitted by

coming into contact with infected water by swimming, wading or
kayaking or by contaminated drinking water. Individuals may be at
increased risk of Leptospirosis infections if they work outdoors or with
animals.

• Rat-bite Fever: This disease may be transmitted through a bite,

scratch or contact with a dead rat.

• Salmonellosis: Consuming food or water that is contaminated by rat

feces bacteria can cause this disease.
 DISEASE INDIRECT TRANSMISSION
FOOD BORNE DISEASE

• Foodborne disease (also referred to as foodborne illness or food

poisoning) is any illness that results from the consumption of
contaminated food, contaminated with pathogenic bacteria, viruses,
or parasites.

• The causes are unhygienic practices in food production, harvesting,

and preparation.

• the significant ones such as Salmonella thyphi, Campylobacter,

Listeria, and Shiga toxin-producing Escherichia coli
Next week class:

3.2 Identify controlling disease transmission and level of

prevention

3.2.1 Explain methods controlling disease transmission

a. Isolation
b. Quarantine
c. Immunization
d. Vector control

3.2.2 Explain level of disease prevention in public health

a. Primary prevention
b. Secondary prevention
c. Tertiary prevention