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EPIDEMIOLOGY OF COMMUNICABLE DISEASE

Dr. Nelson E. Hora

“Chain of Infection”
• 6 links
I. II. III. IV. V. VI. Etiologic agent Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host

4. Metazoa Protozoa Fungi Bacteria Rickettsia Viruses Prions . 2. 5. 3. Etiologic Agents • seven categories of biological agents that can cause infectious diseases: 1. 7.I. 6.

I. Etiologic Agent • Host-Parasite (Infectious Agent) Interactions – Infectivity • Ability of an agent to invade and multiply (produce infection) in a host – Pathogenicity • Ability to produce clinically apparent illness – Virulence • Proportion of clinical cases resulting in severe clinical manifestations (including sequelae) – Immunogenicity • Infection’s ability to produce specific immunity .

enhancement of host susceptibility to drugs of otherwise minimal toxicity 6. Etiologic Agent • Pathogenetic Mechanisms 1. immunologic enhancement or allergic reaction leading to damage to the host 4. production of toxin 3. direct tissue invasion 2. immune suppression . persistent or latent infection 5.I.

II. Reservoir • Human • Animals • Environment .

II. Colonization 2. Inapparent infection (covert or subclinical infection) 3. including those with colonization only. are potential sources of infection to others . Infectious disease  All infected persons. Reservoir • Human Reservoir – Levels 1.

a potential source of infection to others – Type of Carrier • • • • Inapparent throughout Incubatory carrier Convalescent carrier Chronic carrier . nevertheless. Reservoir • Human reservoir – Carrier – an infected person who does not have apparent clinical disease but is.II.

infections transmissible under natural conditions form vertebrate animals to man • Environmental Reservoirs – Plant. soil and water .II. Reservoir • Animal Reservoirs – Zoonoses .

Portal of Exit • The route by which the disease agent may escape from the human or animal reservoir 1. Skin 5. Respiratory 2.III. Transplacental . Alimentary 4. Genitourinary 3.

Direct 2. Indirect • . Mode of Transmission • Necessary to bridge the gap between the portal of exit form the reservoir and the portal of entry into the host Two Basic Modes 1.IV.

IV. Mode of Transmission • . Direct transmission – Consists of essentially immediate transfer of an infectious agent form an infected host or reservoir to an appropriate portal of entry – Include spray by droplets .

Direct transmission – Person-to-person spread of disease • Three important aspects – Generation time – Herd immunity – Secondary Attach Rate .IV. Mode of Transmission • .

Mode of Transmission number of new cases in group minus initial Secondary attack case(s) rate = number of susceptible persons in group minus initial case(s)* during specified time period .IV.

IV. Mode of Transmission • Indirect transmission – Vehicle borne – Vector borne – Air borne • 2 types of particles implicated – Dust – Droplet nuclei .

Portal of Entry • Usually the same as the portal of exit form the reservoir .V.

Susceptible Host • Susceptibility is affected by: – Genetic factors – General resistance factors – Specific acquired factors .VI.

THE INFECTIOUS DISEASE SPECTRUM • Some do not become infected at all • Some become infected but develop no symptoms • Some become infected and develop mild or moderate symptoms • Some become infected and develop severe symptoms • Some die as a result of their infection .

THE INFECTIOUS DISEASE SPECTRUM • Part of this variation is due to the capacity of the agent to produce disease and to differing levels of resistance of the hosts. .

• So when moderate or severe cases are reported they may represent the “tip of the iceberg” . since these people will not seek health care.THE INFECTIOUS DISEASE SPECTRUM • The existence of the infectious disease spectrum can make it challenging to find out the extent of transmission in a particular population. • Most cases with inapparent or mild symptoms will never be discovered or reported.

.THE INFECTIOUS DISEASE SPECTRUM • Another challenge is posed by the fact that many diseases look alike. • A variety of agents may produce essentially similar clinical syndromes. • That is why laboratory identification of the specific disease agent is so important in any epidemiological investigation.