BASIC

EPIDEMIOLOGY
 INTRODUCTION
EPIDEMIOLOGY

Derived from the Greek words “epi”

(on, upon), “demos” (people), and “logos” (study).
 DEFINITIONS
1. American Society of Epidemiology:
The science or knowledge of the natural history of
disease.

2. Frost (1931):
The science of the mass-phenomenon of infectious
diseases, or as the natural history of infectious
diseases; concerned not merely with describing the
distribution of disease, but equally or more fitting into
a consistent philosophy.
3. Stallybrass (1931):
The science of the infective diseases, their prime
causes, propagation and prevention.

4. MacMahon:
The study of the distribution and determinants of
disease frequency in man.
5. Leavell and Clark:
A field of science which is concerned with the various
factors and conditions that determine the occurrence
and distribution of health, disease, defect, disability
and death among group of individuals.

6. Lilienfield (1976):
The study of the distribution of a disease or
physiologic condition in human populations and of
the factors that influence this distribution.
Components:
- Human population - Factors - Agent
 History
Early applications were largely dominated by
infectious disease. It was born with the great
epidemics that attracted first serious efforts to
explain the occurrence of these diseases.
examples:
1. Great plague/bubonic plague in Europe and Asia
2. Cholera epidemic in London as investigated by John
Snow
3. Typhoid fever as studied by William Bud
4. Smallpox
Hippocrates
The father of medicine, also recognized the influence
of environment and expressed his idea that diseases
may be connected with person’s environment.

Fracastorious
Italian doctor and poet, used epidemiologic method of
reasoning expressed in his book (De Res Contagiosa)
and stated that disease results from specific
contagious or seeds of disease.
John Graunt (1620-1674)
Famous for his uses of statistics specifically his notes
on high IMR, excess deaths of males over females.
He was believed to have made the first life table.

Farr (1807-1883)
Also noted for his work on statistics notably mortality
among Cornish metal workers, prisoners, married-
unmarried, organized first vital statistical systems.
From the 1950’s
epidemiology has been applied to chronic
disease and other conditions
examples: smoking and lung cancer, etc.
 Objectives
1. To identify the etiology or the cause of a
disease and the risk factors - factors that increase the
person’s risk for a disease.
- How is the disease transmitted?

2. Determine the extent of disease found in the

community.
- What is the burden of the disease in the community?

3. Study the natural history and prognosis of the

disease.
- Define the baseline natural history of a disease.
4. Evaluate new preventive and therapeutic
measures and new modes of health care delivery.
- What is the impact of length of hospital stay on health
outcome or quality of life?
- What is the impact of new approaches to health care delivery
on health outcome?

5. Provide the foundation for developing public

policy and regulatory decision relating to
environmental problems.
- Which occupations are associated with increased risk of
disease in workers?
- What is the effect of ozone depletion in human populations?
Aims of Epidemiology:

1. Prevention of disease

2. Maintenance of health

3. Promotion of health
 Components
(based in Lilienfield definition)
1. Human population
• group of people - sick or healthy
• may be defined by:
- geographic boundaries
examples: towns, cities, etc.

- characteristics or attributes
examples: working populations, school children, healthy individuals, etc.
 2. Distribution
Occurrence of the disease according to person, place and time:
2.1. Epidemic
 occurrence in a community of cases in excess of normal
expectancy “outbreak”
examples: SARS outbreak in China, Capillariasis in Agusan
2.2. Endemic
 constant or habitual presence of a disease/agent in a given place
examples: Schistosomiasis in Palo, Leyte, Malaria in Palawan
2.3. Pandemic
 epidemic of worldwide proportion
examples: HIV-AIDS, SARS
2.4. Sporadic
 few, unrelated cases in several areaS
 3. Factors
All that affect the causation and distribution of the diseases
3.1 Host
 The state of the host at any given time is a result of the
interactions of genetic endowment with environment over the
entire lifespan
a. Genetic factors: ABO blood groupings, Enzyme deficiencies,
G6PD deficiency
b. Result of past environmental exposures: Specific
immunity to infections Measles, Hepatitis B
c. Personality: Type A personality is predisposed to CHD
d. Social class membership: Lifestyle
 3.2. Agent
Properties of agent is important in disease occurrence:
1. Characteristic useful in classification and specific
identification of the organism:
• Morphology - size, shape and structure
• Chemical composition - RNA and/or DNA, Lipoprotein
• Antigenic properties - basis for specificity
2. Properties which relate to its perpetuation as species
1. Viability - spores in Bacillus anthracis
2. Growth requirements
3. Host range - infecting all animals
4. Vulnerability to chemotherapy
5. Evolution of drug resistant strains
6. Changes in antigenic character - Flu viruses
3. Host – related properties
Infectivity
 Infectiousness
 Ability to infect
Pathogenicity
 Ability to cause disease
 Depends on rapidity and extent of multiplication, tissue damage,
elaboration of toxin, etc.
Virulence
 Severity of the disease that occurs
 Criteria: permanent or serious sequelae, death
Immunogenecity
 Ability to induce specific immunity in the host
 Depends on: amount of antigen in the host, site of multiplication and
extent of dissemination
 3.3. Environment
Biological
o Infectious agent: Presence of Plasmodium falciparum in Palawan
o Reservoirs of infection: Presence of infected individuals
o Vectors: Presence of Anopheles mosquito in Palawan
o Plants/Animals: Rich vegetation where mosquitoes thrive
Social
o Economic, Politics, Social customs, Level of receptivity to
changes
Physical
o Heat/Light, Air/Atmosphere pressure/oxygen supply,
Water, Radiation, Chemical agents, Living space
Interrelations of factors in disease
development
(Ecologic Models)
A. The epidemiologic triangle
It implies that each of the three (3) factors must be
analyzed and understood for comprehension and
predictions of patterns of a disease.

Host

Agent Environment
B. The lever
The interaction of agent, host and environment is
compared to a lever balanced over a fulcrum.

A - Agent
H - Host
E - Environment
C. The Wheel
The model consists of a hub (host or human) which has genetic
make-up as its core. Surrounding the host is the environment,
schematically divided into three sectors - biological, social and
physical.
D. The Web of Causation
The essence of the concept is that effects never depend on a
single isolated cause, but rather develop as the result of chains
of causation at which each link itself is the result of a “complex
genealogy of antecedents”.