DISEASES AND

EPIDEMIOLOGY
The Stages of Infectious Diseases
1. Incubation Period
• time between infection and occurrence of the first symptoms or
signs of disease
• length of the incubation period depends on:
• the virulence of the infective agent
• the infective dose (initial number of pathogens)
• state and health of the patient’s immune system
• nature of the pathogen and its reproduction time
• site of infection
The Stages of Infectious Diseases
2. Prodromal Period
• a short time of generalized, mild symptoms (such as
malaise and muscle aches) that precedes illness
• not all infectious diseases have a prodromal stage
The Stages of Infectious Diseases
3. Illness
• most severe stage of an infectious disease
• signs and symptoms are most evident during this time
• patient’s immune system has not yet fully responded to the
pathogens, and their presence is harming the body
The Stages of Infectious Diseases
4. Decline
• body gradually returns to normal as the patient’s immune
response and/or medical treatment vanquish the pathogens
• fever and other signs and symptoms subside
• immune response and its products (such as antibodies in the
blood) peak during this stage
• if the patient doesn’t recover, then the disease is fatal.
The Stages of Infectious Diseases
5. Convalescence
• the patient recovers from the illness; tissues are repaired and
returned to normal
• length of a convalescent period depends on:
• amount of damage
• nature of the pathogen
• site of infection
• overall health of the patient.
Portals of Exit
 Modes of Infectious Disease Transmission
✓ Contrast contact, vehicle, and vector transmission of pathogens
✓ Contrast droplet transmission and airborne transmission
✓ Contrast mechanical and biological vectors

By definition, an infectious disease agent must be transmitted from either a

reservoir or a portal of exit to another host’s portal of entry.

Transmission categorized into three groups:

• contact transmission
• vehicle transmission
• vector transmission
Contact Transmission
• the spread of pathogens from one host to
another by:
• direct contact
• indirect contact
• respiratory droplets
 Direct contact transmission
• involves body contact between hosts touching, kissing, and sexual
intercourse are involved the transmission of such diseases as
warts, herpes, and gonorrhea
• touching, biting, or scratching can transmit zoonoses such as
rabies, ringworm, and tularemia from an animal reservoir to a
human
• transfer of pathogens from an infected mother to a developing
baby across the placenta
• within a single individual if the person transfers pathogens from a
portal of exit directly to a portal of entry
 Indirect contact transmission
• occurs when pathogens are spread from one host to
another by fomites which are inanimate objects that
are inadvertently used to transfer pathogens to new
hosts.
• Needles, Toothbrushes, paper tissues
• Toys, Money, Diapers
• Drinking glasses, bedsheets
• Medical equipment
Droplet transmission
• pathogens can be transmitted within droplet nuclei (droplets of
mucus) that exit the body during exhaling, coughing, and sneezing
• if pathogens travel more than 1 meter in respiratory droplets, the
mode is considered to be e airborne transmission), rather than
contact transmission.
Vehicle transmission
• spread of pathogens via:
• Air
• drinking water
• Food
• bodily fluids being handled outside the body.
Vehicle transmission
Airborne transmission
• the spread of pathogens farther than 1 meter to the respiratory
mucous membranes of a new host via an aerosol
• a cloud of small droplets and solid particles suspended in the air.
• may contain pathogens either on dust or inside droplets
• can come from sneezing and coughing, or they can be generated by such
means as air conditioning systems, sweeping, mopping, changing clothes
or bed linens, or even from flaming inoculating loops in microbiology labs
Vehicle transmission
Airborne transmission
• the spread of pathogens farther than 1 meter to the respiratory
mucous membranes of a new host via an aerosol
• a cloud of small droplets and solid particles suspended in the air.
• may contain pathogens either on dust or inside droplets
• can come from sneezing and coughing, or they can be generated by such
means as air conditioning systems, sweeping, mopping, changing clothes
or bed linens, or even from flaming inoculating loops in microbiology labs
Vehicle transmission
Waterborne transmission
• important in the spread of many gastrointestinal diseases,
including giardiasis, amebic dysentery, and cholera
• water can act as a reservoir as well as a vehicle of infection
Fecal-oral infection
• major source of disease in the world
• some waterborne pathogens, such as Schistosoma worms and
enteroviruses are shed in the feces that enter through the
gastrointestinal mucous membrane or skin, and subsequently
can cause disease elsewhere in the body.
Vehicle transmission
Foodborne transmission
• involves pathogens in and on foods that are inadequately
processed, undercooked, or poorly refrigerated
• foods may be contaminated with:
• normal microbiota (e.g., E. coli and S. aureus),
• zoonotic pathogens such as Mycobacterium bovis and Toxoplasma
• parasitic worms that alternate between human and animal hosts.
• milk is particularly rich in nutrients that microorganisms), it would
be associated with the transmission of many diseases from infected
animals and milk handlers if it were not properly pasteurized
Vehicle transmission
Because blood, urine, saliva, and other bodily fluids can
contain pathogens, everyone—but especially health care
workers—must take precautions when handling these fluids in
order to prevent bodily fluid transmission.
Special care must be taken to prevent such fluids—all of
which should be considered potentially contaminated with
pathogens—from contacting the conjunctiva or any breaks in
the skin or mucous membranes.
Examples of diseases that can be transmitted via bodily fluids
are AIDS, hepatitis, and herpes, which as we have seen can
also be transmitted via direct contact
Vector transmission
Biological vectors
•transmit pathogens, but also serve as hosts for the multiplication of a
pathogen during some stage of the pathogen’s life cycle
•typically biting arthropods, including mosquitoes, ticks, lice, fleas,
bloodsucking flies, bloodsucking bugs, and mites
•After pathogens replicate within a biological vector, often in its gut or
salivary gland, the pathogens enter a new host through a bite
•the bite site becomes contaminated with the vector’s feces, or the
vector’s bite directly introduces pathogens into the new host
Vector transmission
Mechanical vectors
• are not required as hosts by the pathogens they
transmit; such vectors only passively carry pathogens to
new hosts on their feet or other body parts.
• houseflies and cockroaches may introduce pathogens
such as Salmonella and Shigella into drinking water and
food or onto the skin
Epidemiological Studies
Descriptive epidemiology
• involves the careful tabulation of data concerning a disease
• relevant information includes:
• location and time of cases of the disease
• information about the patients, such as ages, gender, occupations, health
histories, and socioeconomic groups.
• Because the time course and chains of transmission of a disease are an important
part of descriptive epidemiology, epidemiologists strive to identify the index case
(the first case) of the disease in a given area or population. Sometimes it is
difficult or impossible to identify an index case because the patient has
recovered, moved, or died.
Epidemiological Studies
Analytical epidemiology
• investigates a disease in detail, including analysis of data acquired in
descriptive epidemiological studies, to determine the probable cause,
mode of transmission, and possible means of prevention of the disease
• may be used in situations where it is not ethical to apply Koch’s postulates.
• often analytical studies are retrospective; that is, they attempt to identify
causation and mode of transmission after an outbreak has occurred
• Epidemiologists compare a group of people who had the disease with a group who
did not. The groups are carefully matched by factors such as gender, environment,
and diet, and then compared to determine which pathogens and factors may play a
role in morbidity
Epidemiological Studies
Experimental Epidemiology
• involves testing a hypothesis concerning the cause of a disease
• application of Koch’s postulates is an example of experimental
epidemiology
• also involves studies to test a hypothesis resulting from an analytical
study such as the efficacy of a preventive measure or certain
treatment
Hospital Epidemiology: Nosocomial
Infections
Types of Nosocomial Infections
• Exogenous nosocomial infections
• caused by pathogens acquired from the health care environment
• Endogenous nosocomial infections
• members of the normal microbiota can become opportunistic pathogens
as a result of hospitalization or medical treatments such as chemotherapy
• Iatrogenic infections
• (literally meaning “doctor induced” infections)
• a subset of nosocomial infections that ironically are the direct result of
modern medical procedures such as the use of catheters, invasive
diagnostic procedures, and surgery
The interplay
of factors that
result in
nosocomial
infections
Hospital Epidemiology: Nosocomial
Infections
Prevention of Nosocomial Infections
• Disinfection
• medical asepsis
• good housekeeping
• Handwashing
• Bathing
• cleansing of the surgical field, use of sterile instruments
• and use of sterile gloves, gowns, caps, and masks
• isolation of particularly contagious or susceptible patients