DYNAMICS OF DISEASE

TRANSMISSION

GRACE A. LAPITAN, RMT

 
MODE OF TRANSMISSION

An infectious agent may be transmitted

from its natural reservoir to a susceptible
host in different ways. There are
different classifications for modes of
transmission.
 MODE OF TRANSMISSION

 Direct - an infectious agent is transferred from a reservoir to

a susceptible host by direct contact or droplet spread.
Direct contact - occurs through skin-to-skin contact, kissing, and sexual
intercourse (person-to-person)

Droplet spread - refers to spray with relatively large, short-range aerosols

produced by sneezing, coughing, or even talking
 MODE OF TRANSMISSION

Indirect - refers to the transfer of an infectious agent from a reservoir

to a host by suspended air particles, inanimate objects (vehicles), or
animate intermediaries (vectors).

Airborne - occurs when infectious agents are carried by dust or droplet nuclei
suspended in air.
 MODE OF TRANSMISSION

Vehicleborne – single exposure, multiple exposure, continuous exposure

to inanimate objects, food, water, biologic products (blood)

Vectorborne (mechanical or biologic) - mosquitoes, fleas, and ticks

may carry an infectious agent through purely mechanical means or may
support growth or changes in the agent
EPIDEMIOLOGIC TRIAD OF THE DISEASE, CLINICAL
AND SUBCLINICAL DISEASE, CARRIER STATUS
 EPIDEMIOLOGIC TRIAD OF THE DISEASE, CLINICAL
AND SUBCLINICAL DISEASE, CARRIER STATUS

 Clinical Disease- a disease with recognizable clinical

signs and symptoms
 Subclinical Disease- a disease which lacks detectable
signs and symptoms
 Carrier Status - is a state with inapparent infection
but capable of transmitting the pathogen to others
 TYPES OF CARRIER:
Asymptomatic or passive or healthy carriers are those who never
experience symptoms despite being infected.
Incubatory carriers are those who can transmit the agent during the
incubation period before clinical illness begins.
Convalescent carriers are those who have recovered from their illness
but remain capable of transmitting to others.

Chronic carriers are those who continue to harbor a pathogen.

 OCCURRENCE OF DISEASE
Level of Disease:

Sporadic refers to a disease that occurs Hyperendemic

infrequently and irregularly.   refers to
persistent, high
Endemic refers to the constant presence levels of
and/or usual prevalence of a disease or disease
infectious agent in a population within a occurrence.
geographic area. 
 OCCURRENCE OF DISEASE

Epidemic refers to an increase, often sudden, in the number of

cases of a disease above what is normally expected in that
population in that area. 

Pandemic refers to an epidemic that has spread over several

countries or continents, usually affecting a large number of people.
 DISEASE OUTBREAKS
 
Outbreak  carries the same definition of epidemic, but is often used for a
more limited geographic area. 

1.“determinants” generally includes the causes (including agents),

risk factors (including exposure to sources), and modes of
transmission, but does not include the resulting public health
action.
 DISEASE OUTBREAKS
 
2. Incubation period is a stage of subclinical disease, extending
from the time of exposure to onset of disease symptoms.

3. attack rate in the outbreak setting, the term is often used as a

synonym for risk. It is the risk of getting the disease during a
specified period, such as the duration of an outbreak and is useful in
comparing the risk of disease in groups with different exposures.
 DISEASE OUTBREAKS
 
A variety of attack rates can be calculated:
- Overall attack rate is the total number of new cases
divided by the total population.
- A food-specific attack rate is the number of
persons who ate a specified food and became ill
divided by the total number of persons who ate that
food.
 DISEASE OUTBREAKS
 
- A secondary attack rate is sometimes calculated to
document the difference between community
transmission of illness versus transmission of illness
in a household, barracks, or other closed
population. 
 WHO, WHEN, WHERE IN EXPLORING
THE OCCURRENCE OF DISEASE

Three(3) essential characteristics of disease

that we look for in the investigation:
1.WHO(Person)- Person characteristics that are usually described
which include both host characteristics (age, race, sex, and
medical status) and possible exposures (occupation, leisure
activities, and use of medications, tobacco, and drugs).
WHO, WHEN, WHERE IN EXPLORING
THE OCCURRENCE OF DISEASE

2.WHERE(Place)- assessment of an outbreak by place not only

provides information on the geographic extent of a problem, but
may also demonstrate clusters or patterns that provide important
etiologic clues.
WHO, WHEN, WHERE IN EXPLORING
THE OCCURRENCE OF DISEASE

3. WHEN(Time)- a special type of histogram is used to depict

the time course of an epidemic. This graph, called an epidemic
curve, or epi curve for short, provides a simple visual display
of the outbreak’s magnitude and time trend.
 STEPS IN OUTBREAK INVESTIGATION

1. Prepare for field work- preparations can be grouped into two broad
categories: (a) scientific and investigative issues, and (b)
management and operational issues.

2. Establish the existence of an outbreak- an outbreak or

an epidemic is the occurrence of more cases of disease than
expected in a given area or among a specific group of people over a
particular period of time. 
STEPS IN OUTBREAK INVESTIGATION

3.Verify the diagnosis- (a) to ensure that the disease has been
properly identified, since control measures are often disease-
specific; and (b) to rule out laboratory error as the basis for the
increase in reported cases.
 STEPS IN OUTBREAK INVESTIGATION

4.Construct a working case definition- A case definition includes

clinical criteria and — particularly in the setting of an outbreak
investigation — restrictions by time, place, and person

5. Find cases systematically and record information- the data

collection form should include identifying information,
demographic, clinical, risk factor, and reporter information
 STEPS IN OUTBREAK INVESTIGATION

6. Perform descriptive epidemiology- this process, in which the outbreak

is characterized by time, place, and person.

7. Develop hypotheses- depending on the outbreak, the hypotheses may

address the source of the agent, the mode (and vehicle or vector) of
transmission, and the exposures that caused the disease
 STEPS IN OUTBREAK INVESTIGATION

8. Evaluate hypotheses epidemiologically- from an

epidemiologic point of view, hypotheses are evaluated in one
of two ways: either by comparing the hypotheses with the
established facts or by using analytic epidemiology to
quantify relationships and assess the role of chance.
 STEPS IN OUTBREAK INVESTIGATION

9. As necessary, reconsider, refine, and re-evaluate hypotheses-

When analytic epidemiology is unrevealing, rethink your
hypotheses. Consider new vehicles or modes of transmission.

10. Compare and reconcile with laboratory and/or environmental studies

- Coordinate with the laboratory and bring back physical evidence to be
analyzed.
 STEPS IN OUTBREAK INVESTIGATION

11. Implement control and prevention measures-In most outbreak

investigations, the primary goal is control of the outbreak and prevention
of additional cases.

12. Initiate or maintain surveillance- Once control and prevention

measures have been implemented, they must continue to be monitored.
 STEPS IN OUTBREAK INVESTIGATION

13. Communicate findings- summarize the investigation, its findings,

and its outcome in a report, and to communicate this report in an
effective manner. This communication usually takes two forms: an
oral briefing for local authorities and a written report
Investigation and Control of Epidemiology

Conceptually, control measures come after

hypotheses have been confirmed, but in
practice control measures are usually
implemented as soon as the source and mode
of transmission are known, which may be early
or late in any particular outbreak investigation.
 REFERENCES

Source/s:
https://www.cdc.gov/csels/dsepd/ss1978/lesson6/section2.html Lecture on
Introduction to Epidemiology, Dankmar Bohning, May/June 2011
https://www.rxlist.com>definition
Epidemiology, Leon Gordis, 5th Edition
Thank you and
stay safe!!!