Family Medicine and Community Health I

Semester
Epidemiology of Communicable and
Non-Communicable Disease
Zorayda Leopando, MD | 14 04 2018
Single Discipline Multidisciplinary
INTRODUCTION
Short Follow-up Prolonged follow-up
Philippine Health Agenda Framework Back to Normalcy Quality of life after
Goals: treatment
1. Attain health related SDG targets
2. Financial risk protection Top 10 causes of Morbidity
3. Better health outcomes 1. Acute respiratory infection
4. Responsiveness 2. ALTRI and Pneumonia
3. Hypertension
Values:
4. UTI
1. Equity
5. Bronchitis
2. Efficiency
6. Influenza
3. Quality
7. Acute watery diarrhea
4. Transparency
8. TB respiratory
Three (3) Guarantees: 9. Dengue fever
1. Service delivery network 10. TB other forms
2. All life stages and triple burden disease
Top 10 causes of Mortality
3. Universal health insurance
1. Diseases of the heart
Communicable Non Disease of Rapid 2. Diseases of vascular system
Diseases communicable Urbanization 3. Malignant neoplasms
Diseases and 4. Pneumonia
Industrialization 5. Accidents
HIV/AIDS Cancer Injuries 6. Diabetes mellitus
Tuberculosis Diabetes Substance of 7. Chronic lower respiratory diseases
Abuse 8. Tuberculosis
Malaria Heart Disease Mental Illness 9. Nephritis, nephrotic syndrome, nephrosis
Dengue Risk factors Pandemics 10. Certain conditions originating in perinated period
like: Obesity,
Diet, Sedentary
lifestyle
Leprosy Travel Medicine
Ebola Health
consequences of
climate
change/disaster
Zika Virus

EPIDEMIOLOGY
ü Science concerned with various factors and
conditions that influence the occurrence and
distribution of health, disease, defect, disability and
death among groups of individuals.

Communicable Non communicable

Diseases Diseases
Sudden Onset Gradual Onset Figure above: Morbidity
Single Cause Multiple Causes
Short Natural History Long Natural History
Short Treatment Prolonged Treatment
Schedule
Cure is Achieved Care Predominates

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Family Medicine and Community Health I
Epidemiology of Communicable and Non-Communicable Disease

Figure above: Mortality

NON COMMUNICABLE DISEASE
ü Current status and trends in risk factors The Causal Chain Explains The Risk Factor Approach
ü Common, preventable risk factors underlie most For Surveillance Of Non-Communicable Diseases:
NCD’s. These risk factors are a leading cause of the Behavioral Risk Physiological Disease
death and disability burden in nearly all countries, Factors Risk Factors Outcomes
regardless of economic development. Tobacco Body mass Heart disease
index
ü The leading risk factor globally for mortality is:
Alcohol Blood Stroke
1. Raised blood pressure (responsible for 13% of pressure
deaths globally) Physical Blood glucose Diabetes
2. Followed by tobacco use (9%) inactivity
3. Raised blood glucose (6%) Nutrition Cholesterol Cancer
4. Physical inactivity (6%) Respiratory
5. Overweight and Obseity (5%) diseases
ü Several risk factors have the highest prevalence in
high-income countries. These include: RATIONALE OF THE RISK FACTOR APPROACHES FOR NON-
COMMUNICABLE DISEASE
1. Physical inactivity among women
ü Non-communicable diseases are slowly evolving.
2. Total fat consumption
ü Early recognition is difficult.
3. Raised total cholesterol
ü A number of risk factors influence one or more non-
ü Some risk factors have become more common in
communicable diseases.
middle-income countries. These include:
ü Risk factors have the greatest impact on non-
1. Tobacco use among men
communicable diseases mortality and morbidity.
2. Overweight and Obesity
ü Effective modification of risk factors is possible
through primary prevention.
RISK FACTORS UNDER SURVEILLANCE
1. Tobacco use
2. Alcohol consumption
3. Raised blood pressure – systolic and diastolic
4. Obesity – height, weight, body mass index, waist
circumference
5. Diet – low fruit, high fat, added salt to served food
6. Physical inactivity
7. Diabetes mellitus – fasting plasma glucose
8. High serum cholesterol
NON COMMUNICABLE DISEASE: PREVENTION AND CONTROL
OF NCD’s

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ü Millions of deaths can be prevented by stronger FACTORS INFLUENCING DISEASE TRANSMISSION

implementation of measures that exist today. Agent
ü These include policies that promote government- 1. Infectivity
wide action against NCD’s: 2. Pathogenicity
1. Stronger anti-tobacco controls 3. Virulence
2. Promoting healthier diets 4. Immunogenicity
3. Physical inactivity Host
4. Reducing harmful use of alcohol 1. Age
5. Along with improving people’s access to 2. Sex
essential health care. 3. Behavior
COMMUNICABLE DISEASE 4. Nutritional status
ü An illness due to a specific infectious (biological) 5. Health status
agent or its toxic products that is transmitted to a
Environment
susceptible host by direct or indirect contact,
1. Weather
through a vehicle or vector, or as an airborne
2. Housing
infection. 3. Geography
EPIDEMIOLOGIC TRIAD 4. Working condition
Epidemiologic Triad 5. Air quality
ü Disease is the result of forces within a dynamic 6. Disaster/war
system consisting of:
CHAIN OF INFECTION
1. Agent of infection
ü A process that begins when an agent leaves its
2. Host
reservoir or host through a portal of exit, and is
3. Environment
transported by some mode of transmission, then
enters through an appropriate portal of entry to
infect a susceptible host.
AGENT
INCUBATION PERIOD
ü The period from exposure to infection to the onset
of symptoms or signs of infectious disease.
ü The length of incubation period depends on:
1. Portal of entry
DISEASE 2. The rate of growth of the organism in the host
3. The dosage of the infectious agent
4. The host resistance
PERIOD OF COMMUNICABILITY
HOST ENVIRONMENT ü The time during which an infectious agent may be
transmitted directly or indirectly from an infected
person to a susceptible person or animal.
ü Its length varies from one disease to another

CHAIN OF TRANSMISSION
1. Agent
2. Source of Reservoir
3. Portal of Exit
4. Mode of Transmission
5. Portal of Entry
AGENT
ü Microorganisms are responsible for disease
production (viruses, bacteria, protozoa, yeast)
ü Agent factors that affect disease transmission:

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1. Infectivity SOURCE OR RESERVIOR

- The ability of an agent to invade and ü The reservoir of an agent is the habitat in
multiply (produce infection) in a which an infectious agent normally lives,
susceptible host. grows, and multiplies.
- Secondary Attack Rate: the proportion ü “Any person, animal, arthropod, plant, soil
of exposed susceptible persons who or substance, or a combination of these, in
become infected. which an infectious agent normally lives
and multiplies, on which it depends
Secondary Attack Rate= Number of secondary cases x 100 primarily for survival, and where it
reproduces itself in such a manner that it
Number of susceptibles can be transmitted to a susceptible host. It
is the natural habitat of the infectious
- Examples: High Infectivity: Measles,
agent.”
Chicken pox
Low Infectivity: Leprosy
2. Pathogenicity
- Is the ability of the organisms to
produce specific clinical reaction after
infection
- It refers to the proportion of infected
persons who develop clinical disease.
- Examples: High Pathogenicity:
Measles, Chickenpox
Low Pathogenicity: Polio,
Tuberculosis, Hepatitis A
- It can be measured by:

Ratio of clinical to sub clinical case= Clinical cases

Sub clinical cases

3. Virulence
- It refers to the ability of organisms to
produce severe pathological reaction.
- It is the proportion of persons with
clinical disease who become severely
ill or die (mortality)
- Examples: Rabies, Hemorrhagic
fevers caused by Ebola and Marburg
viruses
Case fatality rate= Total number of deaths from a disease x 100
Total Number of cases of the disease
4. Immunogenicity
- Ability of an organism to produce an
immune response that provides
protection against re-infection with
the same or similar agent.
- Can be life-long or for limited periods
- Important information for
development of vaccines.
CASES
ü A case is defined as “a person in the population or
study group identified as having the particular
disease, health disorder, or condition under
investigation”
ü Classified as:
1. Primary case
- The case that brings the infection into
a pop
2. Index case
- The first case identified
3. Secondary case
- Infected by a primary case
ü According to spectrum of disease:
1. Clinical cases (mild/severe-typical/atypical)
2. Sub-clinical cases
3. Latent infection cases

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ü There are over a 100 zoonotic

diseases that can be conveyed
from animal to man.
1. Brucellosis (cows & pigs)
2. Anthrax (sheep)
3. Plague (rodents)
4. Rabies (dogs & bats)
c. Non-living reservoir
ü Water, soil and inanimate matter
can also act as reservoir of
infection.
ü Pools of water are the primary
reservoir of Legionnaire’s
bacillus.
PORTAL OF EXIT
CARRIERS ü Portal of exit is the path by which an agent
ü A person or animal without apparent disease who leaves the source host.
harbors a specific infectious agent and is capable of ü Examples: Respiratory tract, GIT, Skin &
transmitting the agent to others.
mucous membrane
ü It occurs either due to inadequate treatment or
immune response, or the disease agent is not MODE OF TRANSMISSION
completely eliminated, leading to a carrier state. ü Once a pathogen exited the reservoir, it needs
a mode of transmission to the host through a
Carriers are dangerous because: receptive portal of entry.
ü They do not show any clinical manifestations so ü Types of Transmission:
they carry normal life. a. Horizontal Transmission
ü The carrier and his contacts are not aware of their 1. Direct Contact
condition, so they take no precautions. - Requires close association
ü They can remain infectious for a long time leading between infected and
to repeated introduction of the disease to contacts. susceptible host
Types of Carriers - Skin to skin contact, kissing,
1. In apparent carrier sexual intercourse
Ø The carrier state that may occur in an - Droplet Transmission: large
individual with an infection that is in droplets within 1 meter (3
apparent throughout its course. feet)
2. Incubatory and Convalescent carriers - Transmit Infection via:
Ø The carrier state may occur during the a. Coughing, sneezing,
incubation period and convalescence of an talking
individual with a clinically recognizable b. Medical procedures
disease. 2. Indirect Contact
3. Healthy (chronic) carriers • Vehicle Borne
Ø They continue to harbor an agent for an - Vehicle is any
extended time (months or years) following substance that
the initial infection. serves as an
ü Types of Reservoir: intermediate means
a. Human reservoir to transport and
b. Animal reservoir introduce an
ü Zoonosis is an infection that is infectious agent into
transmissible under natural a susceptible portal
conditions from vertebrate of entry.
animals to man.

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- Transmission by an
inanimate reservoir
(food, water, soil,
formites)
• Vector Borne
- An insect or any
living carrier that
transports an
infectious agent from
an infected
individual or its
wastes to a PORTAL OF ENTRY
susceptible ü An agent enters a susceptible host through a
individual or its food portal of entry.
or immediate ü The portal of entry must provide access to
surroundings. tissues in which the agent can multiply or a
- Arthropods, toxin can act.
especially fleas, ticks ü Often, organisms use the same portal to enter
and mosquitoes. a new host that they use to exit the source.
- Transmits disease by
SUSPECTIBLE HOST
2 general methods: ü A susceptible host is the final link in the chain
a. Mechanical of infection.
transmission- ü The host is a person or other living organism
Arthropod that can be infected by an infectious agent
carries pathogen under normal conditions.
on fett or ü Susceptibility of the host depends on:
appendages. a. Genetic factors
b. Biological b. General factors
Transmission- c. Host defense (specific acquired immunity)
Pathogen
reproduces in TYPES OF IMMUNITY
vector. Two types of Immunity:
3. Airborne 1. Innate (Non-adaptive)
- Very small particles of ü First line of immune response
evaporated droplets or dust ü Relies on mechanisms that exist before
with infectious agent may: infection.
1. Remain in air for a long 2. Acquired (Adaptive)
time. ü Second line of response (if innate fails)
2. Travel farther than ü Relies on mechanisms that adapt after
droplets infection
3. become aerosolized ü Handled by T & b lymphocytes
during procedures ü Once cell determines one antigenic
b. Vertical Transmission determination
• Transplacental ü Types:
a. Humoral Immunity (Antibody
• During delivery
mediated immune system): B Cells
b. Cell Mediated Immunity: Cytotoxic T
cells
Acquired Immunity
1. Active 2. Passive

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ü Immunity not PREVENTING INFECTION

coming from the
person
1. Decrease host susceptibility
a. Naturally a. Naturally Acquired
Acquired ü Maternal antibodies a. Maintain skin and mucous membrane as first
ü Acquire the ü colostrum line of defense
disease b. Reinforce or maintain natural protective
ü Subclinical mechanisms such as coughing, pH of
immunity secretions, resident flora.
b. Artificially b. Artificially c. Maintain nutrition and encourage rest and
Acquired Acquired sleep to promote tissue repair and production
ü Vaccination ü Injection of of lymphocytes and antibodies.
Immunoglobulin d. Educate patient about immunization.
2. Limit or eliminate the microbiologic agent
a. Physical and chemical methods to destroy or
General factors which defend against infection (Innate
reduce undesirable microbes in a given area.
Immunity)
1. Skin • Primary targets are microorganisms
capable of causing infection or
2. Mucous membranes
spoilage:
3. Gastric acidity
- Vegetative bacterial cells and
4. Cilia in the respiratory tract
endospores
5. Cough reflex
- Fungal hyphae and spores,
Herd Immunity yeast
ü It is the state of immunity of a group or a - Protozoan trophozoites and
community. cysts
ü The resistance of a group or a community to an - Worms
infectious agent, based on the immunity of a high - Viruses
proportion of individual members of the group. - Prions
ü If herd immunity is sufficiently high, the
occurrence of an epidemic is highly, unlikely. Relative Resistance of Microbes
1. Highest resistance
ü High level of immunity (by vaccination coverage)
makes elimination of a diseases possible. • Bacterial endospores
ü It was crucial in Polio and Diptheria. • Prions
ü Herd immunity may be determined by serologic 2. Moderate resistance
survey. • Pseudomonas sp.
• Mycobacterium tuberculosis
• Staphylococcus aureus
• Protozoan cysts
3. Least resistance
• Most bacterial vegetative cells
• Fungal spores and hyphae, yeast
• Enveloped viruses
• Protozoan trophozoites

Terminology and Methods of Control

1. Sterilization
- A process that destroys all viable
microbes, including viruses and
endosprores
- Microbicidal

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2. Disinfection
- A process to destroy vegetative pathogens,
not endospores
- Inanimate objects

3. Antiseptic
- Disinfectants applied to exposed body
surfaces

4. Sanitization
- Any cleansing technique that mechanically
removes microbes

5. Degermation Figure Above: Surgical Hand washing

- Reduces the number of microbes
PATTERN OF OCCURRENCE AND DISTRIBUTION OF DISEASE
PREVENTION OF TRANSMISSION
Handwashing (for everyone)
• Is the single most important procedure for
preventing the transfer of microorganisms &
therefore preventing the spread of nosocomial
infections.
• CDC (Centres for Disease Control and Prevention)
recommends at least 20 seconds hand washing.
This will remove most transient organisms from
the skin
• Elements of handwashing:
1. Friction
2. Soap
3. Water
• Medical vs. Surgical Handwashing
Figure above: Medical Hand washing
1. Sporadic
- The word sporadic means “scattered
about”.
- The cases are few and separated widely in
time and place that they show no or little
connection with each other, nor a
recognizable common source of infection.
- However, a sporadic disease could be the
starting point of an epidemic when the
conditions are favorable for its spread.
2. Endemic
- It refers to the constant presence of a
disease or infectious agent within a given
geographic area or population group.
- It is the usual or expected frequency of
disease within a population.
- Hyperendemic: expresses that the
disease is constantly present at high
incidence and/or prevalence rate and
affects all age groups equally.
- Holoendemic: expresses a high level of
infection beginning early in life and
affecting most of the child population,
leading to a state of equilibrium such that
the adult population shows evidence of the
disease much less commonly than do the
children.
3. Epidemic/Outbreak
- The unusual occurrence in a community of
disease, specific health related behavior,
or other health related events clearly in
excess of expected occurrence.
- Epidemics can occur upon endemic states
too.

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4. Pandemic
- Affects a large proportion of the
population, occurring over a wide
geographic area such as a section of a
nation, the entire nation, a continent or the
world.
- Exotic diseases: are those which are
imported into a country in which they do
not otherwise occur.
ERADICATION AND ELIMINATION
ü Termination of all transmission of infection by the
extermination of the infectious agent through
surveillance and containment.
ü Eradication: is an absolute process, an “all or
none” phenomenon, restricted to termination of
infection from the whole world.
ü The term elimination is sometimes used to
describe eradication of a disease from a large
geographic region.

“Never get tired in doing what you love -JACJ”

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