Disease causation-HDA - Ecology

2.1.
Disease causation/causality
The central goal in epidemiology is characterizing/

etablishing the relationship Between cause and effect.
It is both philosophical and practical (scientific) question
 in medicine it can be difficult , but very important to

attribute causality between factor and disease.
Two forms of reasoning : Deduction V s Induction

2.1.Disease causation/causality
Deduction
 reasoning from general to specific
Example: all cats are vertebrate, my pet is a cat therefore my
cat is a vertebrate
Rarely a useful or attributable form of reasoning in medicine
Induction
 Generalizing from particular case to all causes
Example: my cat ate grass and barfed , there for eating grass
causes barfing in all cats
 More commonly used in medicine, but not without its
shorting, if you do not believe that
Association
- Problem to attribute a factor as a cause for a problem/disease
 The first step is to establish causality, however it may/may
not
 Association could be real or spurious

 Association can indicate causality or can be an
epiphenomenon
Drinking coffee
Drinking coffee
Smoking
Pancreatic cancer
Pancreatic cancer
causal Epiphenomenon
Associatio Smoking & Coffee drinking &
n cancer cancer
Methods of acceptance and rejection
 People accept or reject because of different reasons
Tenacity : close minded , belief despite evidence

Authority: differing others , tend perpetuate mis info.
Intuition and self evidence: just seems right
Scientific inquires: Reputable, objective observation
evidence based medicine.
If you do not accept the last one this is not your place
Models of causality
• Concept of disease occurrence
 A critical premise of epidemiology is that disease and
other health events do not occur randomly in a population,
 but are more likely to occur in some members of the

population than others because of risk factors that may
not be distributed randomly in the population.
 As noted earlier, one important use of epidemiology is to

identify the factors that place some members at greater
risk than others.
Causation
 A number of models of disease causation have been proposed
 Some time considered as etiological epidemiology since the

purpose is to identify the cause of a disease
 Analytical, it analyses the statistical association b/n disease and

various factor
 Explanatory because it explain the casual mechanism

Types of casual relationship

 When dealing with major infectious disease of animals, there is a
tendency to view causality in fairly simplistic way
 One Agent = One disease (rabies virus is the cause of rabies)
 Nevertheless when one looks beyond the major infectious

diseases, as general rule, the relation b/n cause and effect
becomes complex
 Disease may be the out come of variously associated causes

(multifactorial etiology) thus the cause may be:
Necessary, Sufficient, neither or both***
Types of casual relationship count…

 Cause A is sufficient if it inevitably produce effect
B
 It should be also noted that disease can be linked in

more or less complex ways with one or more causes
 This variability in the relationship between cause and

effect points to the existence of a causality
gradient leading from the cause to the risk factor,
via the casuals factor

Terminology of causality
 Risk is the probability of a disease occurring at a given point in

time or during a given period
 A risk factor is any factor associated with disease with an

increase in the probability of health phenomenon’s occurrence
 When a statistical association exists between a disease and

element, in the absence of a casual link this element can be
described as a risk marker
1.Necessary and sufficient
– Without factor, disease does not develop
– Example: HIV, Rabies
2.Necessary but not sufficient

– Multiple factors, including main factor, required
– Example: Development of tuberculosis requires
M. tuberculosis and other factors, such as immuno suppression,
to cause disease
– Bacteria still necessary, but not sufficient to cause the
disease
3.Sufficient but not necessary

– Factor can produce disease, but not necessary
– Example: Both radiation exposure and exposure to benzene
are sufficient to cause leukemia, but neither are necessary if
the other present.
4.Neither sufficient nor necessary

– Complex models of disease etiology
– Example: High fat diet and heart disease, hypertension,
diabetes, certain kinds of cancer
– Calf scour, mastitis
Possible relationship between a Cause A and effect B
A A
Necessary sufficient Conclusion Example
+ + A is necessary &sufficient to Rabies virus (A)&
produce B Rabies (B)
A B
+ _ A is necessary but not In many pigs the

sufficient to produce B erysipelas bacterium
A +X B (A) must be associated
with stress X in order
to produce the
disease( B)
_ + A is necessary but sufficient Fever can be due to

to produce B different causes
A/X/Y B Non of each associated
_ _ A is neither necessary nor Various multifactorial

sufficient to produce B Syndrome
The two meanings of the term risk factors
Factor A Disease B
Statistical
Association
 in a specific case, once a risk

Factor has been identified as being
Responsible for disease ‘s occurrence
No causality Causality It becomes a Causal factor
demonstrated
Responsible for the

Risk marker Risk factor Occurrence of observed
Health phenomenon
Causation/causality of disease
Discussion
Assume a farmer purchase a cow from herd with
tuberculosis and introduce it to his tuberculosis free
dairy farm
1. casual factor
2. cause
3.risk factor
4. risk marker
illustration of causality gradient (TB)
Factor A Effect B Nature of the Causality
factor degree of
certainty
Tubercle tuberculosis cause Maximum
bacillus
Purchased of Outbreak of Causal factor

diseased animal the disease
Purchased of Risk factor

animal from
infected herd
Purchase of Risk marker
animals
Distinguishing between statistical association and casual link is

very important , because
The presence of statistical association is not always sufficient to

conclude that there is a casual link between the effect and cause.
Hill’s causal criteria
Guidelines for judging whether an association
is causal
1. Strength of Association
2. Consistency
3. Specificity
4. Temporality
5. Biological gradient
6. Plausibility
7. Coherence
8. Experimental evidence
9. Consideration of other alternative
Establishing casual links between two events

 The concept of the existence of casual link, between an agent or
factor and disease, has evolved over time
Koch’s postulate can be applicable to many infectious disease

1 - the agent must be present in every case of the disease
2 - the agent must not be found in other disease or in the absence
of the disease (specific)
3 - the agent must be isolated in pure culture and must induce the
disease in other susceptible animal ( sufficient)
Then in 1965 Hill propose his criteria

The 9 guidelines
Criteria principles
Temporal relation ship Exposure to the factor must have occurred
before the disease developed
Strength of Association larger the relative risk or odds ratio, the higher
the likelihood that the relationship is causal
Dose-Response Relationship With increasing dose, there is increasing risk of
disease
Replication of the Findings In d/f population and circumstance
Biologic plausibility Consistency of epidemiologic plausibility with

existing biologic knowledge (theories )
Cessation of exposure Upon elimination or reduction of exposure to the
factor, the risk of disease declines
Specificity of the Association The weakest of the criteria
Consistency with other If a relationship is causal, the findings should be

knowledge (coherence ) consistent with other data
Consideration of alternate Rule out
Disease Ecology
 Ecology is the study of the environment and of the interrelationships
between organism and their environment
 Ecosystem is a natural unit which includes all biological and physical

components of a given area and the relationship linking them
together
Why Ecology ?
 Ecological principle come in to epidemiology when it was realised

that the transmission of disease agent was sometimes more
complicated than by contact or by food or water and also the same
infection could exist in nature in more than one species of animal
Why Ecology ? Count….
 Observation some parasites require a succession of

d/f host
 Similarly some diseases are transmitted by

invertebrate vector
 There are several Zoonotic diseases shared by man

&lower vertebrates
 thus ecological approach is very important to study

such type of complex disease transmission and
maintenance
Disease Ecology count…
• Ecology of disease describe the relationship between disease

and the rest of the ecosystem
• The study of disease ‘s ecology (natural history) is frequently a

part of epidemiological investigation with the objectives of :
1. An increase in the understanding of pathogenesis, maintenance

and transmission of disease
2. The use of knowledge of a disease’s ecology to predict when

and where a disease may occur, to enable the development of
suitable control technique
 Environmental factors influence significantly animal population
health/disease and epizootiological situation.
 Disease occurrence is related to the environment of the species

concerned.
 Natural environmental factors are inorganic (physical and

chemical) and organic (biological).
 They can be divided in atmospheric, geospheric, hydrospheric,

biospheric and nutritional
In a nutshell
• Researchers trying to identify environmental drivers of disease

emergence are challenged by the complexity, scale, and natural
variability of the systems involved
• Traditional approaches to studying cause-and-effect relationships

(eg experiments and hypothesis testing) are often not possible,
• when study units are large and complex (populations or

ecosystems) and risk factors have non-linear, hierarchical effects
The influence of environment
Influence on animal population
 Environment represents the conditions of life of all animals.
• From epizootiological point of view the most important are those that
influence animal health and resistance
• The impact of abnormal interaction between the damaging environment and

animals can provoke different reactions
• such as stress (alarm) reaction or adaption to new conditions. Sudden

major changes of these factors have negative effect.
• Movement of an animal species into a new environment may result in

disease if there is a pathogen present which has a well balanced
relationship with species which has been there
• Example trypanosomosis for the European cattle breed etc..
Influence on etiological agents
 Environment represents the conditions of life of all etiological
agents being outside of animal or vector body.
 Extreme conditions reduce their ability to survive, reproduce,

adapt and act as pathogens. Favorable conditions have opposite
effect.
Influence on vectors of etiological agents
• Extreme conditions reduce their ability to survive, reproduce,
spread, adapt and act as pathogens vectors.
• Favorable conditions have opposite effect
Influence on epidemiological situation
 Environmental factors favorable for animals and

unfavorable for etiological agents and their vectors
create conditions for maintenance of good and
improvement of bad epizootiological situation
 Environmental factors unfavorable for animals and

favorable for etiological agents and their vectors create
conditions for worsening of epizootiological situation
Influence on epidemiological situation count..
 Environmental factors influence on the existence and

characteristics of etiological agents sources and
 way of transmission, on the occurrence, frequency,

course and spread of animal diseases, their
distribution in space and time (e.g. periodicity,
seasonality) as well on their consequences
Influence of atmospheric factors
 Atmospheric factors comprise the components of

weather to which animals are exposed such as:
 rainfall, temperature, solar radiation, humidity and wind

(direction and speed).
 Abnormal (extreme) values of these factors may affect

the health of the host rendering it more susceptible to
disease.
 They can also affect the survival of etiological agents as
well as of the vectors
Influence of atmospheric factors count..
 Atmospheric pressure decreasing due to reduced

oxygen content (e.g. low pressure in high mountains)
 has influence on "vertical distribution" of animals,

vectors and etiological agents species and on their
occurrence density.
 Sudden decrease of air pressure can provoke a fall in

resistance and give the change to "sleeping"
etiological agents in animal body
Influence of atmospheric factors count…
 Precipitations, solar radiation and light in extreme values

have similar effect on animals and vectors as other
atmospheric factors.
 Climate represents the complex of atmospheric factors

acting on land fauna and flora. It can be differentiated in:
- macroclimate or weather of grand territories,

- mesoclimate of minor territories
- microclimate of local size (refers to restricted area
where the host, agents, vectors or intermediate host
actually live - stable, biotope, etc.)
Influence of geospheric factors
Geomorphological relief has the influence on the animal distribution
and grade of their territorial isolation due to natural barriers such as
mountains (deep valleys, large rivers, etc.).
• On the other hand the plains (lowlands) facilitate spread of diseases

• Soils by interacting with climate determine vegetation and the
environment in which animals live.
• The main effect of vegetation is on nutrition. Soils therefore act

indirectly as determinant of disease by causing starvation if there is
a little or no vegetation or nutritional imbalance.
• Soils have also effect on the ability of many etiological agents to

survive in the environment
Influence of geospheric factors

Soils constitute main substrate and natural shelter for
terrestrial animals, vectors and microflora
some etiological agents able to survive in these conditions

(B. tetani, B. anthracis).
Soil types are based on chemical composition, content of organic

substances, physical structure, temperature, humidity and soils
fauna (including microflora).
Influence of hydrospheric factors

Hydrospheric abiotic factors representing aquatic environment
surrounding animals such as fish, aquatic mammals,
a lot of species of inferior classes including some vectors and

etiological agents species. Water represents also the temporal
habitat for aquatic birds and amphibian animals
The influence of these environmental factors on animals and

etiological agents depends on water content (salt, pollution),
microflora, temperature, movement, hydrostatic pressure, etc.
conditions for different vectors and etiological agents requiring

for their living this environment (e.g. mosquitoes, Leptospira
spp.
Influences of Biospheric factors
Biospheric factors (biologic climate) are represented by flora and
fauna influencing the forms of interactions of animal populations
and etiological agents species.
All these belong to biospheric factors as their integral

component.
These factors have a key role in the origin, development and

result of animal disease and in particular epidemiological situation
Biosphere, also called as "zone of live" represents the

space where animals and plants live. Global biosphere
is composed by marine and terrestrial biomasses
Ecosystem
 Ecosystem is a complex composed of biotic communities and
their abiotic environment.
 The plant and animal life of a region are considered in relation to

the environmental factors that influence it;
 it is the fundamental unit in ecology, comprising the living

organisms and the non-living elements that interact in a defined
region (e.g. pasture, lake, desert, forest, river, marsh, etc.)
 Ecoton is the zone where two or more different ecosystems are

mixed creating particular conditions for more species of animals,
vectors and etiological
Types ecosystem
 Autochthonous: these are natural ecosystem like rain forest
and deserets
 Anthropurgic: these are man made ecosystem like town/
cultivated field
 Synathropic :the ecosystem that is in contact with man, not
far away from human settlements
Ecological climax
 When a succession of different species animals , plant

and microorganism in a geographic area of some size have
evolved in their relationship to one another to a state of
environmental homeostasis , the resulting balanced
ecosystem is known as ecological climax
Ecological climax count..
 When infections are present in an ecological climax,

they too are stable and therefore endemic also the
balance b/n host-parasite usually results in
unapparent infections
 Such stable situation can be disrupted by man

resulting into epidemic ( Blue tongue virus and
theileriosis in cattle)
Specific examples, understanding ecosystem helps
Example 1
• The environment of an ecosystem affects the survival rate of
infectious agents and of their hosts. Thus,
• infection with the helminth Fasciolahepatica is a serious problem
only in poorly drained areas, because the parasite spends part of
its life-cycle in a snail which requires moist surroundings.
Example 2
Each of the 200 antigenic types (serovars) of Leptospirainterrogans
is maintained in one or more species of hosts.
Serovarcopenhageni, for instance, is maintained primarily in rats.
Thus,
if this serovar is associated with leptospirosis in man or domestic
stock, then part of a disease control programme must involve an
ecological study of rat populations and control of infected rats.
Specific examples
Example 3
 In Africa, a herpesvirus that produces infections without signs
in wildebeest is responsible for malignant catarrhal fever of
cattle. Wildebeeste populations,
 therefore, must be investigated when attempting to control the
disease in cattle.
Example 4
• An ecosystem's climate also is important because it limits the
geographical distribution of infectious agents that are
transmitted by arthropods by limiting the distribution of the
arthropods. For example, the tsetse fly, which transmits
trypanosomiasis, is restricted to the humid parts of Sub-
Saharan Africa.
Specific examples
Example 5
• Infectious agents may extend beyond the ecosystems of their
traditional hosts. This has occurred in bovine tuberculosis in the UK,
where the badger population appears to be an alternative host for
Mycobacterium tuberculosis
• Infectious diseases that are transmitted by insects, ticks and other

arthropods, and which may be maintained in wildlife, present complex
ecological relationships and even more complex problems relating to
their control.
• Comprehensive epidemiological studies of these diseases help to

unravel their life-cycles, and can indicate suitable methods of
control.
Some terms in relation to ecosystem and ecology
Niche
• In ecology, a niche is a term describing the way of life of a
species. Each species is thought to have a separate, unique niche.
• The ecological niche describes how an organism or population

responds to the distribution of resources and competitors (e.g.,
by growing when resources are abundant, and
• when predators, parasites and pathogens are scarce) and how it

in turn alters those same factors (e.g., limiting access to
resources by other organisms, acting as a food source for
predators and a consumer of prey).
Niche
• Intraspecific competition: Competition between

members of the same species.
• Interspecific competition occurs when two species

live together, in which circumstance they either
might both thrive, or one may be exterminated by the
other
Some terms in relation to ecosystem and ecology
 Competitive exclusion is known to operate among virus infections at

the cellular level. Can be used as a control mechanism of some
pathogen or disease vectors
Example 1
The snail, Biomphalaria glabrata, which is an intermediate host for
schistosomiasis, has been replaced by the more competitive snail
Marisa cornuarietis, which is not an intermediate host for the
helminth.
d/f Niches in the body of animal for d/f GIT parasitites

Intracellular parasitism ( Advantage and disadvantage )
Biotope
• A biotope is the smallest spatial unit providing uniform conditions

for life.
• An organism's biotope therefore describes its location.
• This contrasts with a niche, which describes the functional

position of an organism in a community.
• A biotope can vary in size. For example, it may be the caeca of a

chicken for coccidia, or an area of poorly drained land for Fasciola
hepatica infection of cattle
Types of ecosystem
Autochthonous ecosystems
 derives from the Greek adjective autos, meaning 'oneself' or
'itself'; the Greek noun chthon, meaning 'the earth' or 'the land';
and the adjectival suffix -ous, meaning 'deriving from'.
 Hence an autochthonous ecosystem is one 'coming from the land

itself'. Examples are to be found in biomes such as tropical rain
forests and deserts.
Anthropurgic ecosystems
 Ecosystem is one created by man (strictly, it can also mean
'creating man'). Examples are those found:
 in cultivated pastures and towns. Some authors use
'anthropogenic' (Greek: gen- = 'be produced') in a similar context.
Types of ecosystem
A synanthropic ecosystem
• It is one that is in contact with man.
• An example is a rubbish tip, harbouring a variety of vermin.
• It follows that some synanthropic ecosystems, such as rubbish tips,

are anthropurgic.
• Synanthropic ecosystems facilitate the transmission of zoonotic

infections from their lower animal hosts to man
Examples.:the brown rat, Rattus norvegicus ( some serovar of leptospira )
Ecological interfaces
• An ecological interface is a junction of two ecosystems.
• Infectious diseases can be transmitted across these interfaces.
• An example is the transmission of yellow fever, an arbovirus disease

of man.
• The virus is maintained in apes in Africa in an autochthonous forest

ecosystem in the forest canopy.
• The canopy-dwelling mosquito, Aedesafricanus, transmits the virus

between apes.
• The mosquito A. simpsoni bridges the interface between the
autochthonous forest ecosystem and the anthropurgic cultivated
savannahs.
Ecological interfaces
• Several diseases can be propagated across the interface between

wildlife ecosystems and cultivated land stocked with domesticated
animals.
Ecological mosaics
• An ecological mosaic is a modified patch of vegetation, created
by man, within a biome that has reached a climax.
• Infection may spread from wild animals to man in such

circumstances.
• For example, the helminth infection, loiasis, is transmitted by
arthropods between man, living in small forest clearings, and
canopy-dwelling monkeys.
Landscape epidemiology
 It is the study of disease in relation to the ecosystem in which
they are found in landscape epidemiology
 In landscape epidemiology , the investigation involves the study

of ecological factors that affect the occurrence , maintenance
and transmission of the disease
 Nidality: the natural homes of diseases are known as their

nidality
 Nesogenic territory: It is an area that has ecological, social and

environmental conditions that can support a disease
 Nosoarea: is a Nesogenic territory in which a particular disease
is present
 Nidal disease : diseases that show strict geographical
boundaries
Disease Ecology
 help to map disease transmission risk
Disease’s:
1. Persistence,
2. survival,
3. Spread
4. Re-occurence or re-emergence ( never go)
5. Emerging
 Understanding of all of the above, necessitate
understanding of disease ecology
 Why do we eradicate small pox/Rider pest
 Why we can’t eradicate others ?
Disease Ecology
• The answer to this question lies in ecology
Definition
 Understanding relationships between pathogens, hosts and
their environment
 Concerned with disease
-Emergence
- re emergence
- persistence (survival)
- spread (dispersal)
By necessity disease ecology is multidisciplinary

- Helps or aids efforts to control, prevent and predict occurence
Major Factors Contributing to Emerging Infections
1. Human demographics and behavior

2. Technology and Industry
3. Economic development and land use
4. International travel and commerce
5. Microbial adaptation and change
6. Breakdown of public health measures
7. Human vulnerability
8. Climate and weather
9. Changing ecosystems
10. Poverty and social inequality
11. War and famine
12. Lack of political will
13. Intent to harm
Emerging infectious diseases (EID)
• Usually zoonotic
• Appear in areas undergoing ecological
transformation
• Result from adaptation to new hosts OR
• Reemerge as a result of antimicrobial
resistance
• Increased in the past 2 decades
Trends in EIDs
• 2008 study published in Nature
• EID events have risen significantly over time
• peak incidence in the 1980s (HIV pandemic).
• 60.3% EID events are zoonotic (which include vector-borne

diseases in this study)
• 71.8% zoonotic diseases originate in wildlife (for example,

severe acute respiratory virus, Ebola virus), and are increasing
significantly over time.
• 54.3% EID events caused by bacteria or rickettsia (bacteria that

only grow inside living cells), reflecting a large number of drug-
resistant microbes
• EID origins are significantly correlated with socio-economic,

environmental and ecological factors (SEE MAP)
Risks of Different Types of EIDs
Zoonotic (wildlife) Zoonotic (non-wildlife)
Drug-resistant pathogens Vector-borne pathogens

Examples of emerging infectious diseases of humans
Morens et al. 2004
Different examples
• Small simple ecology
Opportunities to control and
Anthrax (Bacillus anthracis ) prevent
-Vaccine cattle
vegetative form --proper disposal
Spore spread
Cow
Human
-inhalation
-coetaneous
- Git (oral)
Spores
Soil
Persist
Lyme Disease
– Vector-borne disease
– Lyme disease is caused by a spiral-shaped bacterium,
Borrelia burgdorferi
– Bacterium is carried by the black-legged tick
– These ticks move about on mammal hosts such as
deer and mice
– environmental factors that affect these non-human
hosts have implications for human exposure to Lyme
disease
– Lyme disease is very serious in the northeast U.S.; if
untreated it leads to severe joint and nervous system
problems
Lyme Disease Transmission
• The Lyme disease bacterium,
Borrelia burgdorferi, normally
lives on mice, squirrels and
other small animals.
• Transmitted among animals –
and to humans – through bites
of certain species of ticks.
• In the northeastern and north-
central US, the black-legged
tick (or deer tick, Ixodes
scapularis) transmits Lyme
disease.
• In the Pacific US, spread by the
western black-legged tick
(Ixodes pacificus).
• Other major tick species in US
have not been shown to
transmit Borrelia burgdorferi.
Life cycle of blacklegged ticks
• Live for 2 years
• 3 feeding stages: larvae,
nymph, adult.
• Tick eggs are laid in the spring
and hatch as larvae in the
summer.
• Larvae feed on mice, birds, and
other small animals in the
summer/fall.
• When a young tick feeds on an
infected animal, the tick takes
bacteria into its body along with
the blood meal, and it remains
infected for the rest of its life.
• After 1st feeding, the larvae
become inactive as they grow
into nymphs.
• In spring, nymphs seek
blood meals to grow into
adults. When nymph feeds, it
can transmit bacterium to a
new host (animal or a
human).
• Most human illness occurs
in late spring and summer
when nymphs are most
active and human outdoor
activity is greatest.
• Adult ticks feed on large animals or humans.

• In spring, adult female ticks lay eggs on the ground.
• Deer do not become infected by adult ticks, but deer are
important in transporting ticks and maintaining tick
populations.
Acorns and Lyme Disease: An Ecological
Chain Reaction
Acorns and Lyme Disease: An Ecological
Chain Reaction
• Oaks periodically produce large acorn crops,

followed by a few years of poor acorn
production. This phenomenon is called masting.
• Acorns are a high quality food for many
vertebrate consumers
• Masting results in a flush of resources available
to wildlife every 2-5 years
• Acorn production sets off a chain reaction that
affects the populations of gypsy moths (an
introduced forest pest that defoliates forests),
and black-legged ticks (vector of Lyme disease)
• In mast years, white-tailed deer specialize on acorns and
are attracted to oak-dominated forests.
• Autumn is also the peak activity period for the adult
stage of the black-legged tick.
• Deer are the preferred host for adult ticks;
• In oak forests, adult ticks take their final blood meal, drop
off the deer, and lay eggs (hatch the following summer).
• The density of larval ticks hatching from eggs in summer
is highly predictable based on acorn availability the prior
autumn. However, these ticks hatch from eggs free of
Lyme-disease;
• Larval ticks that feed on white-footed mice are much
more likely to acquire the Lyme-disease spirochete than
are ticks that feed on a variety of other vertebrate hosts.
• Therefore, the white-footed mouse is considered the
principal natural reservoir for Lyme disease.
• High acorn densities (in mast years) increases the
number of white-footed mice and white-tailed deer in oak
forests
• Mice harbor the Lyme disease bacterium. More mice=
more Lyme disease
• Lyme disease infection is higher in summers following
oak mast years (high acorn productions)
• Acorn biomass could be used to predict Lyme disease
risk.
• Mice eat gypsy moth larvae. More mice = fewer/less
severe gypsy moth outbreaks.
• Jones et al. (1998), Science
Cholera
• Vibrio cholerae
• Gram negative bacteria
abundant in freshwater and
estuaries around the world
• waterborne and attach to
crustacean zooplankton
• Toxin alters sodium pump in
intestinal cells  fluid loss
• gastrointestinal disease
• climatic and environmental
factors that affect water
sources and ecology of aquatic
food webs influence the
dynamics of cholera
Copepod Carrying Vibrio
cholerae
First Cholera Pandemic
• Endemic to areas north of Bay of Bengal

(Bangladesh and eastern India)
Cholera
The Disease
• Enters from water or
food
• Colonizes small
intestine
• Symptoms: nausea,
diarrhea, muscle
cramps, shock, severe
dehydration
Treatment
• Rehydration therapy,
antibiotics
Prevention
• Water treatment
– Filtration
– chlorination
World Cholera 2000-01
Why Has Cholera Re-emerged?
• Deteriorating sanitary facilities as larger
population moves into shanty towns
• Trujullo, Peru – fear of cancer from
chlorination so water untreated
• Use of wastewater on crops
• Africa – civil wars and drought caused
migrations into camps
How Has Cholera
Re-emerged?
• Simultaneous appearance along whole
coast of Peru
• Traveled in ship ballast?
• Traveled in plankton from Asia?
• Can remain dormant in local
zooplankton (copepods) until triggered
by ???
Cholera and El Niño
• Periodic warming of water near coast of
Central and South America
• Large plankton blooms, especially in
coastal waters with nutrients from sewage
runoff
Cholera and El Niño
• Cholera in Bangladesh also seen to fluctuate

with El Niño, but with 11 month lag
• Rita Colwell and multinational group studying
link between climate and cholera
• Satellite and surface data used to show
cholera incidence is related to sea surface
temperature
Cholera and Sea Surface
Temperature
Cholera Antibiotic Resistance
• Cholera is
becoming
resistant to
several
antibiotics
Will migratory birds continue to follow traditional flyways as the
climate changes, or will they adapt and perhaps in the process
transport avian influenza to new locations?
Graphic: UN Food and Agriculture Organization.
Malaria and Climate
• Vector-borne
• life-threatening, caused by 4 species
of Plasmodium parasites
• transmitted to people through the bites of infected
mosquitoes.
• A child dies of malaria every 30 seconds.
• 247 million cases of malaria in 2006, 1 million deaths, mostly
among African children.
• Malaria is preventable and curable.
• Approximately half of the world's population is at risk of malaria,
particularly those living in lower-income countries.
• Travelers from malaria-free areas to disease "hot spots" are
especially vulnerable to the disease.
• Malaria takes an economic toll - cutting economic growth rates by
as much as 1.3% in countries with high disease rates.
Factors that Increase Malaria
Transmission
• rainfall
• floods
• proximity of mosquito breeding sites to people
• types of mosquito species in the area
• Introduction of mosquito-borne parasite into
areas where people have had little prior
contact/immunity (causes large and devastating
epidemics)
• mass population movements driven by conflict
Symptoms and Treatment
• fever, headache, chills, vomiting (10-15 days after
infected). Can cause severe illness and is often fatal
without prompt treatment.
• DRUG TREATMENT/RESISTANCE:
– combination of drugs known as ACTs
– However, the growing resistance of parasite to these
meds is undermining malaria control
• VECTOR CONTROL:
– increasing mosquito resistance to key insecticides
DDT and pyrethroids, particularly in Africa;
– a lack of alternative, effective insecticides;
– changing behaviours of local malaria-bearing
mosquitoes, which can result from vector control
efforts (as insects move to more hospitable areas).
Determinants of diseases
Definition
A determinant is any characteristic that affects the health of a
population.
Example
 Diet, is a determinant of bovine hypomagnesaemia: reduced food
intake and low levels of plant magnesium, related to rapid grass
growth, are associated with an increased incidence of the disease
The importance Knowledge of determinants
 facilitates identification of categories of animal that are at particular

risk of developing disease.
 It therefore is a prerequisite for disease prevention,
 aid to differential diagnosis.
Classification of determinants
Determinants can be classified in three ways, as:
1. primary and secondary
2. intrinsic and extrinsic
3. associated with host, agent or environment.
Primary and secondary
 Primary determinants are factors whose variations exert a
major effect in inducing disease.
 Frequently, primary determinants are necessary causes
• Example , exposure to distemper virus is a primary
determinant of canine distemper.
Secondary determinants correspond to predisposing,
enabling and reinforcing factors.
 For example, sex is a secondary determinant of canine
heart valve incompetence: male dogs are more likely to
develop incompetence than females
Determinants of disease
2. Intrinsic and extrinsic determinants
Intrinsic determinants are internal to the host, for example:
 genetic constitution, including aberrant genes,
 species
 breed and sex.,
 also termed endogenous (Greek: endon = within).
Extrinsic determinants are , some determinants are external

to the host; for Ex.:
 transportation, which may result in physical trauma,
producing bruising of carcasses.
 Such determinants are extrinsic, also termed exogenous
(Greek: exo = outside).
Determinants associated with host, agent and

environment (Epidemiological triad)
Factors that Affect Infectious Agents of Disease

Infectivity Infectious
Virus, bacteria, fungi,
Pathogenicity prion, parasites
Virulence Chemical
Host Range Toxins, allergens
Physical
Lifecycle
Radiation, trauma
Reservoir Nutritional
Genetic Stability Deficiencies,
Vector imbalances
Host Factors that can be Associated with
Disease
Genetics
Age
Species
Immune function
Herd Immunity
Use
Diet
Gender
Environmental Factors that can be Associated with

Disease
Climate
Geography
Housing
Plants and other animals
Stressors such as noise, light, pollution
Feed
Use of the animals
Host as Determinants of Disease
Species susceptibilities and natural reservoirs
 Most disease agents are capable of infecting a range of
animal species,
 The severity of the disease resulting from such infections

may, however, vary between the species concerned.
 While certain host species may be refractory to infection

with certain disease agents,
 e.g. equines to the foot-and-mouth disease virus,
 very few disease agents are in fact restricted to one
host species.
Species susceptibilities and natural reservoirs

• The multi-species susceptibility to disease agents is
particularly important if the species concerned are able
to maintain the disease agent within their populations i.e.
to function as natural reservoirs of infection.
• The failure of programmes aimed at controlling a certain

disease in one species has often been blamed on the
presence of natural reservoir species, because they can
reintroduce the infectious agent.
Breed susceptibilities
 Within a host species, wide ranges of susceptibility to a
particular disease are often observed between different
breeds.
 In Africa, for example, certain breeds of cattle, horses,
sheep and goats are more tolerant of trypanosomiasis than
others.
 Bos taurus breeds of cattle are generally more susceptible

to ticks and tick-borne diseases than Bos indicus. It is
important,
It importance
Breed susceptibilities
Its importance
 This has led, in recent years, to the development of breeding
programmes designed to select for disease resistance.
 Breeding for disease resistance is probably most applicable as

a disease control option in instances where particular disease
agents are ubiquitous in the environment
 Differences in species or breed susceptibility to disease must be

taken into account when introducing new breeds or species into
new environments. because
- the newly introduced animal may be very much infected or
- it may also introduce new diseases to the local breed
Colour of coat , body size and confirmation
Age susceptibilities
 Differences in susceptibility to disease are often seen

between different age groups.
 For example, young animals are generally less

susceptible to tick-borne diseases than older animals.
 Many bacterial and viral diseases are fatal to young
animals
 There is, however, often a problem in distinguishing

between true age resistance in young animals and
passive resistance occasioned by the transfer of maternal
antibodies via the placenta or in the colostrum.
Age susceptibilities
 A false impression of age susceptibility may also be

created when a highly infectious disease occurs
frequently in a population.
 It may, for instance, appear that only young individuals

are affected by the disease in question.
 This may not be due to a difference in age susceptibility
but simply because the older individuals, who had been
infected previously, represent a surviving and immune
population.
Sex associations in disease

• In these associations the clinical signs of disease are
associated with sexual attributes,
• as in the case of diseases of the reproductive tract,

rather than with the fact that males may be more
susceptible than females or vice versa.
• Sexual differences in disease occurrence may be

attributed to hormonal, occupational, social and
ethological, and genetic determinants.
Genetic determinants
• Genetic differences in disease incidence may be inherited
either by being sex-linked, sex-limited, or
• sex-influenced. Sex-linked inheritance is commonly

associated with Mendelian inheritance, and occurs when
the DNA responsible for a disease is carried on either the
X or Y sex chromosomes.
• Canine haemophilia A and B, for example, are associated
with the X chromosome and are inherited recessively, the
defects being predominant in male.
• Factors associated with the host (Intrinsic factors)
1. Immunity
 The host (animal) has a number of different defence
mechanisms which deals with infectious agents
 Theses defence mechanism are classified in to three based
on the specificity of the response
First line of defense
 Skin and mucus membrane
 Surface temperature of skin is lower than the core
temperature of the animal body so many infectious agent
can not multiply
 Keratinized ,dead cells in out layer of skin prevent entrance
of pathogen
 Secretion ,excretion: do have anti microbial action
(HCL,Urine) prevent attachment and multiplication
Agent as determinants of disease
• Since infectious diseases of livestock are generally

regarded as being of prime importance in Africa,
• The following discussion is concerned principally with the
determinants associated with the so-called living disease
agent
• Infectious agents vary in their ability to infect and to
induce disease in animals.
• The ability of Agents (infectious) to induce disease is

related with the following characteristics
Infectivity, virulence and pathogenicity
Infectivity of the agent
• Infectivity is a measure of the ability of a disease agent to
establish itself in the host.
• This term can be used qualitatively, when an agent is referred to
as being of low, medium or high infectivity, or quantitatively.
• Attempts to quantify infectivity normally involve the use of a

statistic known as ID50.
• This refers to the individual dose or numbers of the agent

required to infect 50% of a specified population of susceptible
animals under controlled environmental condition.
• Infectivity of the agent

• Having become infected, the host may or may not
become diseased, and
• this is again determined by a range of intrinsic and
extrinsic determinants affecting the agent and the host.
• Two terms - virulence and pathogenicity - are often used
to describe the ability of the agent to cause disease.
Virulence and pathogenicity

• Virulence can be defined as a measure of the severity of
a disease caused by a specified agent.
• In its strict sense, virulence is a laboratory term and is

used to measure the varying ability of disease agents to
produce disease under controlled conditions.
• It is often quantified by a statistic known as LD50 which

refers to the individual dose or numbers of the agent
which will kill 50% of a specified population of
susceptible animals under controlled environmental
conditions.
Virulence and pathogenicity

• Pathogenicity is an epidemiological term used to
describe the ability of a particular disease agent of
known virulence to produce disease in a range of hosts
under a range of environmental conditions.
Host/agent relationships
• The relationships between infection and disease are
frequently dynamic in nature.
• They centre on the "balance" that can be achieved between

the resistance mechanism of the host and the infectivity and
virulence of the agent.
• Disease outbreaks caused by the introduction of an agent

into a susceptible host population which has not been
previously exposed to that agent normally result:
- in a disease of high pathogenicity with

- commensurate severe losses in the host population.
• Such a process is actually detrimental to the agent's survival,
because
killing off the host population it adversely affects:

1. its ability to reproduce , then
2. its chances of gaining access to new susceptible hosts.
• An agent can therefore improve its chances of survival by

increasing its infectivity and decreasing its pathogenicity,
• and some agents have a natural tendency to do this under

certain circumstances.
• The agents, in order to survive, develop methods of

circumventing the hosts' defences, through:
- short generation interval
- rapid multiplication
- rapid evolution
importance in the field of livestock disease control are:
- the carrier state ( true, incubatory and convalescent)
- antigenic variation ( antigenic drift and shift)
Importance
- To design control and treatment
Environmental determinants
• location, climate and husbandry. Particular attention has

been paid to environmental determinants of disease in
livestock enterprises,
• intensive production systems expose animals to

unnatural environments (e.g., chicken battery houses),
• in human medicine, where social and occupational

exposure to possible causal factors (e.g., to smoke in
relation to lung cancer) can occur.
• Moreover, the health and welfare of captive wild animals

may also be affected by their environment
• This are extrinsic determinants and of are important in
epidemiology in that they can have effects on:
 The host
 The agent,
 The interactions between the host and the agent.
 They can also affect any intermediate hosts or vectors
involved in the transmission of a disease,
 and thus determine the type and extent of the disease
transmission taking place
Climate
Two types of climate can be identified: macroclimate and
microclimate.
Macroclimate
• The macroclimate comprises the normal components of
weather to which animals are exposed: rainfall,
temperature, solar radiation, humidity and wind, all of
which can affect health
Effects of macroclimate some example
Temperature
• may be a primary determinant, for example low temperatures in
the induction of hypothermia, to which newborn animals are
particularly prone.
Wind and rain
 Can increase heat loss from animals.
 Cold stress predisposes animals to disease, for example by
reducing
efficiency of digestion, which may predispose to infectious
enteritis.
wind also can carry infectious
 Agents:e.g., foot-and-mouth disease virus and arthropod
 vectors :e.g. Culicoides spp. infected with bluetongue virus)
over long distances.
Effects of macroclimate some example
Microclimate
 House condition, T, skin,
Soil
• soil and climate determine the vegetation and the environment the
livestock kept
• Soil indirectly considered as determinant by causing Nutrition
• It can also affect the survival of an agent, water logging, pH
Man
 Creation of conditions favourable for survival of agents, vectors,
irrigation, water supplies
 Change in system and method of production will result a change in
the relative importance diseases( some appear some may disappear
)
 Man can also directly interfere in disease process through the use
of drug, vaccine, movement control.
Sources of infection
Knowing where the enemy is :

 How he move
 When and how he attacks , are all crucial for vanquishing him
 Analytical epidemiology gives the answers to such questions
 The questions can be formulated as follows
- individual animals
- the herd
- the area
The first question is where is the pathogen to be found, and how
long
Answers can be obtained by:
1.firstly by looking for the pathogen in infected hosts ( tissue,
organ, secretion) or In animal products and the environment
2. Secondly by studying the pathogen’s resistance to the various

inactivating factors under a variety of conditions such:
- different fomites,
- d/f initial concentration of the pathogen
- gradient of the inactivating factor ( ex : heat)
• Pathogens can have an incredibly wide variety of sources
• FMD , almost anything is possible
Sources of pathogen fall into four main categories
1. Living organisms
2. Carcasses
3. Animal products
4. The external environment
Living organisms
• It is important to define two terms : receptivity and
susceptibility of host
Receptivity
 It is the capacity to allow an infective agent to multiply with in,
for a given infective dose ( develop and replicate)
Example : cattle for African swine fever virus
 Receptivity dose not necessarily imply the appearance of
clinical signs
Susceptibility
 It is the aptitude to express the disease clinically after
exposure to a pathogen
 Receptive but not-susceptible ( wart hog for African swine
fever virus
Living organisms
• Receptive and susceptible ( african swine fever for pigs)
• In species with low receptivity , it may require many pathogen to
establish infection. The reverse is true
• In a given animal , receptivity can vary in time, conditions

(pathology, gestation or envi. Stress)
• So any host which is receptive can be the source of infection

• They do not present clinical signs ,( inapparent infection) or
subclinical cases ( But less role in contamination)
• Potentially insidious danger (iceberg)

• example bovine Tuberculosis and enzootic bovine leukaemia
Living organisms
Sick animals:
The role played by susceptible animals
 Shedding the pathogen in to the external environment
 Example in Brucella infected animal(abortus) = 1012 –
1013, FMD (pig), can infect 70, 000 cattle
 Presence of pathogen in blood (action of biting arthropods
)
 Before, during and after clinical signs
 Strict isolation and confinement
Living organisms
Incubating animals
 Releasing sufficient quantities of pathogen to be the source of
infection is possible in many diseases , just day or hours before clear
clinical signs are observed
 In FMD and Rabies the virus is found in the saliva in
80% of the cases before three days of clinical sign onset.
A knowledge of this phenomenon help to
- trace the animal s movement during the period of
preclinical excretion and to detect any animal that ca be
contaminated
Exaple , suspected rabies bite , quarantine , delay entry to
farm , or country etc… because of it
Living organisms
Recovered animals
 In most animal diseases , recovery coincide with
disappearance of the pathogen in the host . How ever some
exceptions are there
 FMD, some recovered animals may remain carriers for few
months
 Brucellosis, after abortion or other clinical signs the animal will
recover , but remain carrier ( lymph nodes)
 Herpes virus
Carcasses
 if a post mortem examination is required , it must be
done a place where there is effective disinfection , other
wise the area could be the source of infection.
 Anthrax , special care, due to spore formation
 In highly contagious infection , carcass should be
transported in a leak proof vehicle , to avoid
dissemination of infection
Animal products
A wide range of contaminated animal products can be illustrated by
the following far from exhaustive list:
 Milk and milk products , including cheese
 Carcass, cooked, uncooked meat
 Eggs
 bone and meat meal (BSE
 Serum for therapeutics use or for use in culture
 Tissue for hormone excretion
 Excreta in various form , manure, slurry, liquid manure
 Swill (Swine fever) , kitchen waste used in feeding animals (pig)
 Semen, embryos
Some could be the source of Zoonotic infection for human:
salmonellosis, campylobacter infection, brucellosis, listeriosis etc…
The environment
 An object presented in the environment can be contaminated by
infected animal or animal products.
 The pathogen are incapable of multiplying in the environment
 The survival and being a risk depends on the resistance of pathogen
1.Types of fomites can vary considerably ( fixed objects, localised
danger)
- ground farm building, pasture, track etc..
- farm equipments
- clothing, boots, farm materials
2.Mobile and inanimate fomites
Water : transport pathogen over several hundred meters or more
Air :
Transport vehicles
Human and domestic or wild animals acting as mechanical vectors
Modes of Disease Transmission
• The continued survival of infectious agents, with or without
the induction of disease, depends on their successful
transmission to a susceptible host, the instigation of an
infection there in and replication of the agent to maintain
the cycle of infection.
Definition
 Refers to the entrance and exit of a pathogen from one
individual to other
 How diseases get passes from individual to individual
• A knowledge of the Modes of Disease Transmission is

essential when selecting the most applicable prevention
control techniques.
Transmission may be either horizontal (lateral) or vertical.
Definitions
 Horizontally transmitted infections are those transmitted
from any segment of a population to another; for example,
influenza virus from one horse to a stable-mate.
 Vertically transmitted infections are transmitted from one

generation to the next by infection of the embryo or fetus
while in utero (in mammals) or in ovo (in birds, reptiles,
amphibians, fish and arthropods). Transmission by milk to
offspring is also considered, by some, to be vertical.
Horizontal transmission
• Infections can be transmitted horizontally either directly or
indirectly .
Direct transmission:
• occurs when a susceptible host contracts an infection,
either by physical contact with an infected host or by
contact with the latter's infected discharges (e.g., the
transmission of canine distemper in infected urine and
faeces).
 Occur b/n animals living together in many possible ways, like:
 Muzzle to muzzle
 Cutaneous or mucosal contac
Horizontal transmission
Indirect transmission
 involves an intermediate vehicle, living or inanimate, that transmits
infection between infected and susceptible hosts.
 This vehicle generally may be termed a vector, although the term is

usually restricted, by common usage, to living carriers .
 indirect transmission can involve a vector of a different species from

that of the initially infected host.
 The life-cycle of infectious agents therefore may be complex, with

several different hosts.
• Airborne transmission of infectious agents, frequently over long

distances, is often defined as indirect, although it is more correctly
classified as direct because no intermediate vehicle is involved.
Types of host and vector
• A variety of terms describe the range of host/parasite relationships,
and are used by the epidemiologist,
1. Primary (natural) host = maintenance host
2. Secondary (aberrant) host
3. Paratenic host
4. Intermediate host
5. Amplifier host
6. Hibernating host
7. Incidental (dead-end or accidental) host
8. Reservoir host
9. Mechanical vector
10.Biological vectors
Maintenance strategies of Infectious Agents
How the disease agent maintain in a population?
Conditions which help the parasite to exist in the host

 Helminths can resist HCl by strong cuticle
 Intracellular mode of life to avoid humeral antibodies
 Greater fecundity
Strategies to escape the effect of environment

 Excretion with moist substance to avoid
desiccation( feces, urine
 Avoidance of stages in the external environment
by: vertical, ventral, vector or sarcophagi transmission
Maintenance strategies of Infectious Agents
Rapidly in Rapidly out
 Before the host mount immunity

 Requires continuous supply of susceptible host
Persist with in the host

 TB, Tape worm, BSE
Extension of hosts
 Many infectious diseases infect more than one host
(Zoonosis)
 TB, Rabies
 62% of human diseases are zoonotics
 77% of animal diseases can affect human
 91% of animals diseases do have multiple hosts
Entry Routes into a Susceptible Host
Definitions
• The site or sites by which an infectious agent gains entry
to a host, and by which it leaves the host , are the agent's
routes of infection.
Chapter three
Disease events in
population
Chapter three
Disease events in
population
Pattern of disease
What it means
• The representation of the number of new
cases of a disease by a graph, with the
number of new cases on the vertical axis
and calendar time on the horizontal axis, is
the most common means of expressing
disease occurrence.
Disease events in population
A description of a disease problem should specify :
I. The disease and the population at risk.
II. give information on the distribution of events in time

(temporal) and space (spatial), and
III. include an attempt to quantify disease events.

Populations at risk
 These can be identified by studying the distribution of the
disease within host populations by species, breed, age and
sex.
 Descriptions of population densities and movements are

also of great value, particularly when the disease is
transmitted by contact
 Distribution of disease events in time and space. This

generally involves looking for the "clustering" of disease
events in time, space or both.
The clustering of disease events in space

 can often be demonstrated by the use of conventional
mapping techniques.
Clustering of disease in a certain space may indicate:
 the presence of a particular determinant or determinants

(e.g. a vector, a mineral deficiency etc) in an area.
 however, clustering in space occurs naturally in the
case of contact - transmitted diseases, and
 that it may also be a function of host-population density.
The clustering of disease events in time:
 May indicate that the host population was exposed to a common
source of the disease or its determinant.
 Outbreaks of diseases transmitted by such vehicles as water or

foodstuffs frequently exhibit clustering in time, as in the case of food
poisonings.
 Seasonal clustering of disease events often indicates the influence of

climatic determinants in some form or other.
 The distribution of disease events in populations in time and space

can be described by three basic descriptive terms. These are:
1. Endemic
2. Epidemic
3. Sporadic.
Endemic disease
 It is a disease that occurs in a population with predictable
regularity and with only minor deviations from its expected
frequency of occurrence.
 In endemic diseases, disease events are clustered in

space but not in time.
 Note that a disease may be endemic in a population at any

frequency level, provided that it occurs with predictable
regularity.
Endemic disease
• Additional terms can be used to describe endemic diseases according to
their frequency of occurrence.
1. Hyperendemic is an endemic disease that affects a high

proportion of the population at risk. affecting all age-groups
equally. - Rabies in Canada
2. Mesoendemic is an endemic disease that affects a moderate

proportion of the population at risk.
3. Hypoendemic is an endemic disease that affects a small

proportion of the population at risk.
affecting all age groups –TB in developed countries
An epidemic disease
 It is a disease that occurs in a population in excess of its

normally expected frequency of occurrence (i.e. endemic).
 In an epidemic disease:
- disease events are clustered in time and space.
- Note that a disease may be epidemic even at a low
frequency of occurrence, provided that it occurs in excess of
its expected frequency.
• When an epidemic occurs, the population must have

been subjected to one or more factors that were not
present previously.
Types of endemic diseases
1. Point source epidemic (common source epidemic)
 All individuals infected from same source at the same time
- Food borne illness
 In the case of a point epidemic a large number of cases have

been observed during a relatively short period of time, but the
disease disappears after that time.
2. Propagating epidemic
 One individual comes in and then infects others
- b/c not all infected from same source
Pandemic occurrence
 It is a large epidemic affecting several countries or even
one or more continents.
• By the 1970s, rinderpest was found only in north-west Africa and the Indian
subcontinent, but the disease became pandemic in Africa and the Middle
East during the early 1980s (Sasaki, 1991),
Factors affecting the shape of the curve
The shape of the curve and the time scale depend

on:
 The incubation period of the disease;
The infectivity of the agent;
 The proportion of susceptible animals in
the population;
The distance between animals (i.e.,
animal density).
.The threshold level is more generally defined in terms of the basic
reproductive number (basic reproduction ratio; basic reproductive rate)
RQ1: the average number of secondary cases caused by one typical
infectious individual during its entire infectious period (Diekmann et al.,
1990).number (basic reproduction ratio; basic reproductive rate) RQ1: the
average
Sporadic occurrence
• A sporadic outbreak of disease is one that occurs irregularly and
haphazardly.
• This implies that appropriate circumstances have occurred locally,
producing small, localized outbreaks.
• It is a disease that is normally absent from a population but which
can occur in that population, although rarely and without predictable
regularity.
 A sporadic pattern of occurrence elicits the question: "Where
is the disease when it apparently is not around?"
 One explanation might be that infection exists in the population

in apparently and only in occasional animals do signs of disease
evidence themselves.
Time (temporal pattern), curves
which one represent sporadic endemic, and
epidemic ?
Characteristics Relating to Time
• Secular change (long-term)

• Point epidemics (short-term)
• Cyclic trends
• Seasonal variation
Point epidemic
• Short-term changes occur over limited time

frames
 Hours
 Days
 Weeks
 Months
• Used for short-term exposures or diseases
with short incubation and/or illness durations
Point epidemic
• A minimum density of susceptible animals is required
to allow a contact epidemic to occur, this is called
threshold level.
• And is defined as mathematically by Kendall’s
threshold theorem
• the greater the density of animals, the steeper the

slope of the epidemic curve
Cyclic Trends
• Cyclic trends may be either long-term or

short term events.
• Some are “seasonal” while others are
cyclic due to other factors:
-weather condition
- migration
Cyclic Trends
Fluctuations may be caused by:
 changes in host density, management
practices,
survival of infectious agents
vector dynamics and
other ecological factors.
Place
• WHERE are the rates higher? lower?

• Geographic location of source
• Geographic location of reservoir
John Snow and Cholera
Place ( spatial distribution)
• Characteristics Relating to Place

International
• Variation within countries
– Urban-rural
– Local
• Building Maps (farming blocks)
Chapter 4
Nature of Animal Population
• Animal population and its characteristics and dynamics create the

background upon which health and disease processes develop.
• Animal population development changes, horizontal and vertical

movements influence significantly the location, development and
dynamics of population health and disease.
• 4.1. Categorization
• 4.2. Number and density of Animal
Population
• 4.3. Geographic Location
• 4.4. Movement
• 4.5. Organization
• 4.6. Turnover
• 4.7. Population Resistance
• 4.8. Management/Husbandry Practices
A description of a disease problem should specify :
I. The disease and the population at risk.
II. give information on the distribution of events in time

(temporal) and space (spatial), and
III. include an attempt to quantify disease events.

Reading Assignment
Disease event and pattern in a population
Veterinary epidemiology, Third edition
Page 137-157
Michael Thrusfield

Disease causation-HDA - Ecology

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Disease causation-HDA - Ecology

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2.1.

The central goal in epidemiology is characterizing/

It is both philosophical and practical (scientific) question

 in medicine it can be difficult , but very important to

Two forms of reasoning : Deduction V s Induction

 Association could be real or spurious

Tenacity : close minded , belief despite evidence

 but are more likely to occur in some members of the

 As noted earlier, one important use of epidemiology is to

 Some time considered as etiological epidemiology since the

 Analytical, it analyses the statistical association b/n disease and

 Explanatory because it explain the casual mechanism

Types of casual relationship

 One Agent = One disease (rabies virus is the cause of rabies)

 Nevertheless when one looks beyond the major infectious

 Disease may be the out come of variously associated causes

Types of casual relationship count…

 It should be also noted that disease can be linked in

 This variability in the relationship between cause and

Types of casual relationship count…

 Risk is the probability of a disease occurring at a given point in

 A risk factor is any factor associated with disease with an

 When a statistical association exists between a disease and

2.Necessary but not sufficient

3.Sufficient but not necessary

4.Neither sufficient nor necessary

+ _ A is necessary but not In many pigs the

_ + A is necessary but sufficient Fever can be due to

_ _ A is neither necessary nor Various multifactorial

 in a specific case, once a risk

Responsible for the

Purchased of Outbreak of Causal factor

Purchased of Risk factor

Distinguishing between statistical association and casual link is

The presence of statistical association is not always sufficient to

Establishing casual links between two events

Koch’s postulate can be applicable to many infectious disease

Then in 1965 Hill propose his criteria

Biologic plausibility Consistency of epidemiologic plausibility with

Consistency with other If a relationship is causal, the findings should be

 Ecosystem is a natural unit which includes all biological and physical

 Ecological principle come in to epidemiology when it was realised

 Observation some parasites require a succession of

 Similarly some diseases are transmitted by

 There are several Zoonotic diseases shared by man

 thus ecological approach is very important to study

• Ecology of disease describe the relationship between disease

• The study of disease ‘s ecology (natural history) is frequently a

1. An increase in the understanding of pathogenesis, maintenance

2. The use of knowledge of a disease’s ecology to predict when

 Disease occurrence is related to the environment of the species

 Natural environmental factors are inorganic (physical and

 They can be divided in atmospheric, geospheric, hydrospheric,

• Researchers trying to identify environmental drivers of disease

• Traditional approaches to studying cause-and-effect relationships

• when study units are large and complex (populations or

• The impact of abnormal interaction between the damaging environment and

• such as stress (alarm) reaction or adaption to new conditions. Sudden

• Movement of an animal species into a new environment may result in

 Extreme conditions reduce their ability to survive, reproduce,

 Environmental factors favorable for animals and

 Environmental factors unfavorable for animals and

Influence on epidemiological situation count..

 Environmental factors influence on the existence and

 way of transmission, on the occurrence, frequency,

 Atmospheric factors comprise the components of