Chapter 11

EPIDEMIOLOGY AND
PUBLIC HEALTH
Burton's Microbiology
for the Health Sciences
  Epidemiology
 Interactions among pathogens, hosts
and the environment
CHAPTER  Chain of infection
11  Reservoirs of infection
OUTLINE  Modes of transmission
 Public health agencies
 Bioterrorism and biological warfare
 Water supplies and sewage disposal
Epidemiology
Introduction
Introduction
Epidemiology
-Epidemiology can be defined as
the study of disease.
-Epidemiologist study the factors
that determinants of diseases in
human populations.
-Epidemiologists also develop
ways to prevent, control or
eradicate disease in populations.
Epidemiologic
Terminology
Communicable and Contagious Diseases
Zoonotic Diseases
Incidence and Morbidity Rate
Prevalence
Mortality Rate
Sporadic Diseases
Endemic Diseases
Epidemic Diseases
Pandemic Diseases
Epidemiologic
Terminology
• A communicable disease is an infectious disease that can be transmitted from
one person to another.
• A contagious disease is a communicable disease that is easily transmitted
from person to person.
• A zoonotic disease is one that humans acquire from animal sources.
• The incidence of a particular disease is the number of new cases of that
disease in a defined population during a specific time period.
• The morbidity rate is the number of new cases of a particular disease that
occurred during a specified time period per a specifically defined population
(usually per 1,000 , 10,000 or 100,000 population.
Epidemiologic Terminology
• Prevalence
-Period prevalence is the number of cases of the disease
existing in a given population during a specific time
period (e.g. during year 2006)
-Point prevalence is the number of cases of the disease
existing in a given population at a particular moment in
time.
• Mortality rate is the ratio of the number of people who died of a particular
disease during a specified time period per a specified population.
Epidemiologic Terminology
• A sporadic disease is one that occurs only occasionally within the
population of a particular geographic area example, tetanus.
• An endemic disease is one that always present within the
population of a particular geographic area; example, gonorrhea.
• An epidemic disease is defined as a greater than usual number of
cases of a disease in a particular region, usually within a short
period of time; example, the Legionnaire’s disease epidemic of
1976.
Epidemiologic Terminology
• A pandemic is a disease that is occurring in epidemic proportions
in many countries simultaneously. Examples include:
-Influenza
• Example, the Spanish Flu pandemic of 1918; more than 20
million people were killed worldwide (500,000 in the U.S.)
-HIV/AIDS, Tuberculosis, and Malaria
Interactions between
Pathogens, Hosts,
and Environments
Interactions between Pathogens, Hosts,
and Environments
• Whether an infectious disease occurs depends on:
-Factors pertaining to the pathogen (e.g., virulence of
pathogen, mode of entry, number of organisms).

-Factors pertaining to the host; these include health

status, nutritional status, hygiene, age, travel, and lifestyle etc.

-Factors pertaining to the environment such as physical factors

(e.g., climate, season, geographic location), availability of
appropriate reservoirs, sanitary and housing conditions, and
availability of potable water.
 Chain
of
Infections
Chain of Infection
• There are 6 components in the infectious disease process:
-a pathogen
-a source of the pathogen (a reservoir)
-a portal of exit
-a mode of transmission
-a portal of entry
-a susceptible host
Chain of Infection
Reservoirs
of
Infections
Living Reservoirs
Human Carriers
Animals
Arthropods
Nonliving Reservoirs
Reservoirs of Infection
• The source of microorganisms that cause infectious diseases are many and varied;
they are known as reservoirs of infection or simply reservoirs.

• Living reservoirs – humans, pets, farm animals, insects, and arachnids.

• Human carriers:
-Passive carriers
-Incubatory carriers
-Convalescent carriers
-Active carriers
Reservoirs of Infection
• Animals
• Infectious disease that humans acquire from animal sources are called zoonotic
diseases or zoonoses.
• Zoonoses may be acquired by direct contact with an animal, inhalation or ingestion of
the pathogen, or injection of the pathogen by an arthropod.
• Examples:
-Rabies
-Lyme disease
-Others
Reservoirs of Infection
• Arthropods
• Many different types of arthropods serve as reservoirs of infection, including insects
(e.g., fleas, mosquitoes, lice) and arachnids (e.g., mites and ticks).
• When arthropods are involved in the transmission of infectious diseases they are
referred to as vectors.
• Examples:
-Malaria
-Lyme disease
-Others
 Reservoirs of Infection
• Non living Reservoirs
-Air, soil, dust, contaminated
water and foods, insects, and
infected humans.
-Fomites –inanimate objects
capable of transmitting
pathogens (e.g., bedding,
towels, eating and drinking
utensils, hospital equipment, etc.
Inanimate Vectors of Infections (Fomites)
 Modes
of
Transmission
Modes of Transmission
• Direct skin-to-skin contact
• Direct mucous membrane-to-mucous membrane contact by kissing or sexual
intercourse
• Indirectly by airborne droplets of respiratory secretions, usually by sneezing or
coughing
• Indirectly by contamination of food and water by fecal matter
• Indirectly by arthropod vectors
• Indirectly by contaminated fomites
• Indirectly by transfusion of contaminated blood or blood products or by parenteral
injection using nonsterile syringes or needles
Modes of Disease Transmission
 Public Heath
Agencies
The World Health Organization
The Centers for Disease Control and Prevention
Public Health
Agencies
• World Health Organization (WHO)
• A specialized agency of United
Nations founded in 1948;
• Mission: to promote technical
cooperation for health among • Investigates outbreaks of Ebola virus, etc.
nations, carry out programs to
control and eradicate disease and • Eradicate smallpox
improve the quality of human life. • Attempting to eradicate polio and
dracunculiasis
Public Health Agencies
• Centers for Disease Control and Prevention (CDC)
-A federal agency administered by the U.S. Department of Health and
Human Services, Atlanta, GA. Established in 1946
-Mission: to promote health and quality of life by preventing and
controlling diseases, injury, and disability.
-Certain infectious diseases, known as nationally notifiable diseases
must be reported to the CDC.
-Publishes Morbidity and Mortality Weekly Report (MMWR)
Public Health Agencies
• Measures for prevention and control of epidemics:
-Increase host resistance through the development and administration
of vaccines that induce active immunity and maintain it in susceptible
person.
-Ensure that persons exposed to a pathogen are protected against the
disease.
- Segregate, isolate and treat those who have contracted a contagious
infection to prevent the spread of the pathogen to others.
-Identify and control potential reservoirs and vectors of infectious
diseases.
Bioterrorism and
Biological
Warfare Agents
Anthrax
Botulism
Smallpox
Plague
Bioterrorism and Biological Warfare Agents
• Microbes purposely used to harm others in wartime are called
biological warfare (bw) agents.
• Pathogens used to create fear, chaos, illness and death are called
bioterrorism agents.
• Examples:
-Bacillus antracis
-Clostridium botulinum
-Smallpox virus (Variola major)
-Yersinia pestis
Water Supplies
and Sewage
Disposal
Sources of Water Contamination
Water Treatment
Sewage Treatment
Primary Sewage Treatment
Secondary Sewage Treatment
Tertiary Sewage Treatment
Water Supplies and Sewage Disposal
• Water is the most essential resource for the
survival of humanity!
• Sources of water contamination:
-Rainwater and groundwater (from
wells) can become contaminated by soil
microbes and raw fecal material.
Water Supplies and Sewage Disposal
• Water Treatment
-The major steps in water treatment are sedimentation,
coagulation, filtration and chlorination.
-Water is tested for contamination by checking for the
presence of coliform bacteria (coliforms), such as E coli
and other members of the family Enterobacteriaceae.
• Sewage Treatment
-Raw sewage consists mainly of water, fecal material,
garbage and bacteria.
-Includes primary, secondary and tertiary sewage
treatment.
Thank you