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NATURAL HISTORY

AND SPECTRUM OF
DISEASE
CONCEPTS OF DISEASE
OCCURRENCE
Critical premise of epidemiology is that disease and other health
events do not occur randomly in population, but are more likely to
occur in some members of the population than others because of
risk factors that may not be distributed randomly in the population
Critical premise of epidemiology is that disease and other health
events do not occur randomly in population, but are more likely
to occur in some members than others because of risk factors
that may not be distributed randomly in the population
Disease is the result of imbalance interaction between
Host
Agent
Environment
FAKTOR HOST

Host adalah manusia atau makhluk hidup lain yang menjadi


tempat perkembangan penyakit
Faktor host yang berhubungan dengan penyakit
Genetic, umur, jenis kelamin, ras, status perkawinan
Status fisiologi : Kelemahan, kehamilan, pubertas, stress dan
kondisi psikologi, status gizi, struktur anatomi, komorbiditas
Status imunologi : Hipersensitivitas, riwayat infeksi sebelumnya,
vaksinasi, antibody
Perilaku : Higiene pribadi, diet, kontak interpersonal, pekerjaan,
rekreasi, perilaku seksual
FAKTOR AGENT

Agen adalah unsur, makhluk hidup, atau mikroorganisme yang


dapat menyebabkan penyakit
Faktor agent yang berhubungan dengan penyakit
Biologi : Bakteri, virus, parasite, jamur, rickettsia
Kimia : Makanan yang terkontaminasi, pestisida, zat adiktif,
limbah industry, obat dan racun
Nutrisi : Hiperkolesterolemia, defisiensi vitamin
Fisik : Panas, radiasi, cahaya, suara, getaran, mekanik
Infectivity, pathogenicity, virulence

Infectivity
The ability of an agent to cause infection in susceptible host
In theory, depends on the minimum number of agent entered
Pathogenicity
The ability of an agent to cause disease
In theory, depends on virulence factor, port de entry, and the
number of agent entered
Virulence
The ability of an agent to cause death
Describes the severity of disease after infection has occurred
FAKTOR LINGKUNGAN

Lingkungan adalah semua factor luar dari individu


Faktor lingkungan yang berhubungan dengan penyakit
Lingkungan fisik : Udara, suhu, kelembapan, iklim, factor
geografi, sumber air dan makanan
Lingkungan biologi : Kepadatan penduduk, hewan, tumbuhan
Lingkungan social ekonomi : Paparan tertentu, ketegangan dan
tekanan, bising, perang, bencana alam, kemiskinan
CHAIN OF INFECTION
RESERVOIR

Reservoir is the habitat in which the agent normally lives, grows,


and multiplies
Human reservoirs (carrier stage)
Hepatitis B virus, Salmonella typhi, smallpox
Animal reservoirs (zoonosis)
Brucella, Bacillus anthracis, Yersinia pestis, Taenia solium
Environmental reservoirs
Plant, soil, water
Histoplasma capsulatum, Legionella pneumophila
PORTAL OF EXIT

Portal of exit is the path by which pathogen leaves its host


Usually corresponds to the site where pathogen is localized
M. tuberculosis exit the respiratory tract
Vibrio cholera exit in feces
Some blood-borne agent exit by crossing placenta, through cuts
or needles, or blood-sucking arthropods
TRANSMISSION

Direct transmission
Direct contact : Skin-to-skin contact, kissing, sexual intercourse
Droplet spreads : Spray with large, short-range aerosols
produced by sneezing, coughing, talking
Indirect transmission
Airborne : Carried by dust or droplet nuclei suspended in air
Vehicle : Food, water, biologic products, fomites
Vectors : Mosquitoes, fleas, ticks
PORT DE ENTRY

Portal of entry refers to the manner in which pathogen enters


susceptible host
Must provide access to tissues in which the pathogen can
multiply or toxin can act
Often, the agents use the same portal to enter that they used to
exit the source host
SUSCEPTIBLE HOST

Depends on genetic or constitutional factors, specific immunity,


and nonspecific factors that affect individuals ability to resist
infection or to limit pathogenicity
Person with sickle cell trait are partially protected from
particular types of malaria
Trans-placental transfer of antibody
NATURAL HISTORY OF DISEASE
Natural history of disease refers to the progress of disease
process in an individual over time without intervention
Without medical intervention, the process ends with recovery,
disability, or death
The process begins with exposure to or accumulation of factors
capable of causing disease
FASE SUSCEPTIBLE

Keseimbangan antara host, agent, environment mulai terganggu


Terjadi paparan antara individu dengan agen kausal
Belum ditemukan gejala dan tanda penyakit
Sistem imun masih kuat sehingga individu tampak sehat
FASE SUBKLINIS / ASIMPTOMATIK

Perubahan patologis mulai terjadi, belum muncul gejala klinis


Agen kausal menyebabkan transformasi atau disfungsi sel
Hanya dapat dideteksi dengan pemeriksaan khusus
Masa inkubasi (penyakit infeksi) dan masa laten (penyakit kronis)
Waktu sejak terjadi paparan sampai muncul gejala klinis
Window period dan sojourn time
Periode jendela : Waktu dimana sudah terjadi infeksi tetapi
belum terdeteksi oleh pemeriksaan laboratorium
Sojourn time : Waktu sejak penyakit terdeteksi oleh screening
sampai muncul gejala klinis
FASE KLINIS DAN FASE TERMINASI

Fase klinis
Mulai muncul gejala dan tanda penyakit
Jika tidak diberikan intervensi, maka semakin lama akan
semakin berat
Fase terminasi
Sembuh, cacat, atau kematian
Muncul komplikasi, rekurens, relaps
LEVEL OF PREVENTION

Prevention (pre event action) is the action aimed at eradicating,


eliminating, or minimizing the impact of disease and disability OR if
none of these are feasible, retarding the progress of the disease
and disability
Pre pathogenesis stage Pathogenesis stage
Primary prevention Secondary prevention Tertiary prevention
Health General and Early diagnosis and Disability
Rehabilitation
promotion specific protection prompt treatment limitation
PRIMARY PREVENTION
DEFINITIONS

The action taken prior to the onset of disease, which


removes the possibility that the disease will ever occur
Undertaken at the pre-pathogenesis phase
Accomplished by health promotion and protection
HEALTH PROMOTION

Penyuluhan kesehatan yang intensif


Perbaikan gizi dan penyusunan pola menu yang cukup
Pembinaan dan pengawasan tumbuh kembang anak dan remaja
Perbaikan hygiene dan sanitasi lingkungan seperti penyediaan air
bersih, pembuangan sampah, pembuangan tinja dan limbah
Rekreasi atau hiburan untuk kesehatan mental dan sosial
Olahraga secara teratur sesuai kemampuan individu
Nasihat perkawinan dan pendidikan seks yang bertanggung jawab
Pendidikan dan penyuluhan kesehatan
GENERAL AND SPECIFIC PROTECTION

Memberikan imunisasi pada kelompok yang berisiko


Isolasi terhadap penderita penyakit menular
Perlindungan terhadap kecelakaan di tempat umum atau tempat
kerja dengan alat pelindung diri
Perlindungan terhadap bahan yang bersifat karsinogenik, racun,
atau allergen
Pengendalian sumber pencemaran, misalnya dengan kerja bakti
membersihkan sungai dan selokan
Penggunaan kondom untuk mencegah penularan IMS
APPROACH FOR PRIMARY PREVENTION

Population (mass) strategy


It is directed at the whole population irrespective of an
individual risk levels
Socio-economic, behavioral and lifestyle changes
High-risk strategy
It aims to bring preventive care to individuals at special risk
Requires detection of individuals at high risk by the optimum
use of clinical methods
SECONDARY PREVENTION
DEFINITIONS

Action which halts the progress of a disease at its incipient stage


and prevents complications
Undertaken at the subclinical (asymptomatic) phase
Accomplished by early detection and prompt treatment
EARLY DIAGNOSIS AND PROMPT
TREATMENT
Mencari kasus sedini mungkin dengan pemeriksaan
Melakukan general medical check up secara berkala
Mencari dan mengawasi semua orang yang berhubungan dengan
pasien dengan penyakit menular
Screening untuk deteksi dini kanker : Mammografi, Sadari (periksa
payudara sendiri), pap smear
Memberikan pengobatan pada tahap awal penyakit
TERTIARY PREVENTION
DEFINITIONS

All the measures available to reduce or limit impairments and


disabilities, and to promote the patients adjustment to
irremediable conditions
Undertaken when the disease process has advanced beyond its
early stages
Accomplished by disability limitations and rehabilitation
DISABILITY LIMITATION

Pengobatan dan perawatan yang sempurna sehingga pasien


sembuh dan tidak terjadi komplikasi
Pencegahan terhadap komplikasi dan kecacatan
Perbaikan fasilitas kesehatan sebagai penunjang untuk
pengobatan dan perawatan intensif
Mengurangi beban social pada pasien sehingga dapat
meneruskan pengobatan dan perawatan
REHABILITATION

Medical rehabilitation
Procedures to restore the anatomic structure, anatomic and
physiologic functions to as near normal as possible
Vocational rehabilitation
Involving training and education so as to enable the person to
earn a livelihood
Social rehabilitation
Restoration of the family and social relationships
Psychological rehabilitation
Restoration of the personal dignity and confidence