Epidemiology and its uses

MDSC 1002
Dr S Pooransingh
 Learning Outcomes
At the end of the session you should be able to:
 
1. Define Epidemiology
2. Explain endemic, epidemic, pandemic
3.      List the uses of epidemiology
Recall from MDSC 1001:

Public Health is the science and art of

preventing disease, prolonging life and
promoting health through the organized
efforts of society

Focus is on populations rather than

individuals so this is different from the
rest of medicine
 Epidemiology
Greek

• Epi - what is among

• Demos - the people
• Logos - the study of

The study of what is among the people

 Epidemiology

Epidemiology is the basic science of Public

Health
 Define epidemiology
• The study of the distribution and
determinants of health related states or
events in specified populations and the
application of this to the control of health
problems… Last
What do epidemiologists want to know?

• How much disease?

• How is it distributed in populations?

• Epidemiologists relate how much disease and its

distribution to measures of other factors to which
populations are exposed to identify causes of
disease or promoters of good health …..

……so that preventive measures can be

implemented
Pathology - effects of disease …treatment

Epidemiology - causes of disease..prevention

 How much disease?

Numbers...for example:
• No. of deaths
• No. of cases
• No. of new cases

How is it distributed in the population?

Descriptive Epidemiology

- how you describe the data in

terms of time, place, person
 Cases

Person Time
Place
1200 25

1000 20
800
15
600
10
400
200 5

0 0
0-4 '5-14 '15- '45- '64+ 1 2 3 4 5 6 7 8 9 10
44 64
Age Group

Evaluate information

Pathogen?
Source? Transmission?
Source: WHO
 Define
• Endemic
• Epidemic
• Pandemic
 Endemic
• The constant presence of a disease or
infectious agent within a given geographic
area or population group
 Regional HIV and AIDS statistics and features  2010
Adults and children Adults and children Adult prevalence Adult & child
living with HIV newly infected with HIV (15‒49) [%] deaths due to AIDS

Sub-Saharan Africa 22.9 million 1.9 million 5.0% 1.2 million

[21.6 million – 24.1 million] [1.7 million – 2.1 million] [4.7% – 5.2%] [1.1 million – 1.4 million]

Middle East and North Africa 470 000 59 000 0.2% 35 000
[350 000 – 570 000] [40 000 – 73 000] [0.2% – 0.3%] [25 000 – 42 000]

South and South-East Asia 4.0 million 270 000 0.3% 250 000
[3.6 million – 4.5 million] [230 000 – 340 000] [0.3% – 0.3%] [210 000 – 280 000]

East Asia 790 000 88 000 0.1% 56 000

[580 000 – 1.1 million] [48 000 – 160 000] [0.1% – 0.1%] [40 000 – 76 000]

Latin America 1.5 million 100 000 0.4% 67 000

[1.2 million – 1.7 million] [73 000 – 140 000] [0.3% – 0.5%] [45 000 – 92 000]

Caribbean 200 000 12 000 0.9% 9000

[170 000 – 220 000] [9400 – 17 000] [0.8% – 1.0%] [6900 – 12 000]

Eastern Europe and Central Asia [1.3 million1.5 million

– 1.7 million]
160 000
[110 000 – 200 000]
0.9%
[0.8% – 1.1%]
90 000
[74 000 – 110 000]

Western and Central Europe 840 000 30 000 0.2% 9900

[770 000 – 930 000] [22 000 – 39 000] [0.2% – 0.2%] [8900 – 11 000]

North America 1.3 million 58 000 0.6% 20 000

[1.0 million – 1.9 million] [24 000 – 130 000] [0.5% – 0.9%] [16 000 – 27 000]

Oceania 54 000 3300 0.3% 1600

[48 000 – 62 000] [2400 – 4200] [0.2% – 0.3%] [1200 – 2000]

TOTAL 34.0 million 2.7 million 0.8% 1.8 million

[31.6 million – 35.2 million] [2.4 million – 2.9 million] [0.8% - 0.8%] [1.6 million – 1.9 million]

The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available
information.

Source WHO and UNAIDS

 Epidemic
• The occurrence of cases of illness, health
related events in a community or region
clearly in excess of normal expectancy

…Outbreak
Strengthen war
effort against
dengue death….
 Chikungunya
• Mosquito-borne viral disease

• First described during an outbreak in southern Tanzania in

1952…so it is a re-emerging disease

• ‘Chikungunya’ comes from a word in the Kimakonde

language of the Makonde people which means "to become
contorted" describing the stooped appearance of sufferers
with joint pain
 Note:
• A disease can belong to more than one
category:

e.g. Dengue is endemic in Trinidad and

dengue has caused epidemics in Trinidad
 Pandemic
• An epidemic occurring worldwide or over a
very wide area crossing international
boundaries usually affecting a large group
of people
Pandemic H1N1 2009
 Uses of epidemiology
1. Describe the spectrum of disease
2. Describe the natural history of disease
3. Identifying factors that increase or decrease the risk of
acquiring disease
4. Predict disease trends
5. Establish mechanisms of disease transmission
6. Testing efficacy of intervention strategies
7. Identify health needs of a community
8. Evaluate intervention programmes
9. Evaluate public health programmes
1.Describe the spectrum of disease
• Epidemiological studies - cohort (follow up)
studies

• BP  stroke, myocardial infarct, chronic kidney

disease

• Knowing the spectrum of disease allows the PH

physician / professionals to design effective
intervention strategies
 2.Describe the natural history of
disease
• Cohort studies
• Follow up of CD4 count in patients with
HIV  AIDS

HIV AIDS
CD4 CD4
 3.Identify factors that increase or
decrease the risk of acquiring disease
Factors could include:
• smoking
• alcohol
• genetics
• ethnicity e.g. chewing betel nut…oral cancer
• diet
• occupation e.g. asbestos exposure…mesothelioma
 Smoking and Lung Cancer
• Doll and Hill – smoking and lung cancer 1947,
1951
 Iodine deficiency
• Mountainous regions….soil poor in iodine

• Loss of physical and mental energy

• thyroid hormone

• Goitre and cretinism first described ~ 400

years ago

• Epidemiology  identifying and solving

problem

• Iodized salt …introduced in many countries in

1924

• Still present in developing countries

 4.Predict disease trends
• Infectious diseases – periodicity of pandemics

• Seasonality of dengue

• Mathematical modelling (R0) to predict numbers

for health service planning…e.g. stockpiles of
antivirals needed for influenza
 Influenza pandemics of the 20th century

1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
40-50 million deaths 1-4 million deaths 1-4 million deaths

H1N1 H2N2 H3N2

 Mortality Distributions and Timing of Waves of Previous Influenza Pandemics
Severity and subsequent waves of pandemic

Miller M et al. N Engl J Med 2009;10.1056/NEJMp0903906

 5.Establishing mechanisms of
disease transmission
Example - Zika

• Cases – interviews, diagnostics

• Contacts - vector-borne? person to person?

 6.Testing efficacy of intervention
strategies
• Randomised controlled trials
• Does it work?
• Efficacy = under ideal conditions
• Before used in the community
7.Identify health needs of a community

• Burden of disease
• Prevalence studies
• Surveillance systems
 8. Evaluate intervention programmes

• Despite being efficacious

• Need to ensure will work in real life
• Is it acceptable to the population?
• What about side effects? Route of
administration?
9.Evaluate Public Health programmes

• Cost effective --- value for money

• Impact
• For planning purposes

E.g. screening programmes

Thank You