INTRODUCTION TO CDC

LECTURE OBJECTIVES
• By the end of this lecture, the student should be able to
• Define and understand what is meant by communicable
diseases
• Define terms associated with Communicable Diseases
• List the various types of Pathogens and the features Micro and
Macro parasites
• Differentiate between infection and diseases
• Describe the different types of transmission
 DEFINITION
• QUESTION:
WHAT ARE COMMUNICABLE DISEASES?
 DEFINITION
• ANSWER:
A communicable disease is an illness that is transmitted from a person,
animal or inanimate source to another person either directly, with the
assistance of a vector or by other means.

R. Webber 2005. Communicable Disease Epidemiology and Control, 2nd

edition (Roger Webber)
 DEFINITION
• It is transmission component that distinguishes communicable
diseases from the non-communicable

• Communicable:
– epidemic (e.g. ebola)
– endemic (e.g. malaria)

• Non-communicable:
– acute (e.g. accidents)
– chronic (e.g. diabetes).
 Communicable vrs Non Communicable
• Previously the difference between communicable and non-
communicable diseases was quite clear

• This strict classification is currently becoming less well-defined as

new suspect organisms are discovered or diseases, by their very
nature, suggest a communicable origin.

• Various cancers are good examples

 Non-Communicable diseases associated with
organisms
• Hepatitis B virus and hepatocellular and is now being prevented by
routine vaccination.
• Epstein– Barr virus (EBV) seems to be a pathogenic factor in
Burkitt’s lymphoma, and there is also a causal relationship with
malaria.
• The EBV might also have a causal effect in nonHodgkin’s lymphoma
and nasopharyngeal cancer.
• Kaposi’s sarcoma may well be transmitted by the sexual route of
(HIV) infection, compared with those blood transmission
 Non-Communicable diseases associated with
organisms
• Schistosoma haematobium is a causative factor in bladder cancer
and their control also reduce cancer incidence.

• Helicobacter pylori, an organism that thrives in gastric secretions,

is probably a causative factor in gastric cancer.

• Cancer of the cervix, which is due to infection with the human

papilloma virus prevention is by vaccination,
 Non-Communicable diseases associated with
organisms
• Chlamydia pneumoniae has been found within atheroma lesions

• Even road accidents, are more likely to occur due to infection

with toxoplasmosis due to prolong the reaction time making the
victim more likely to have a road-traffic accident.
TERMS
 Contamination
• The presence of an infectious agent on a body surface, on or in
clothes, beddings, toys, surgical instruments or dressings, or
other articles or substances including water and food
 Infestation
• It is the lodgment, development and reproduction of
arthropods on the surface of the body or in the clothing, e.g.
lice, itch mite. This term could be also used to describe the
invasion of the gut by parasitic worms, e.g. ascariasis.
 Contagious disease
• A contagious disease is the one that is transmitted through
contact. Examples include scabies, trachoma, STD and leprosy.
 Host
• A person or an animal that affords subsistence or lodgement to
an infectious agent under natural conditions.
• Types include:
– obligate host,
– definitive (primary) host,
– intermediate host and a transport host.
 Host
• The definitive host is the person or animal
infected with the adult, or sexual, form of the
pathogen.
• The intermediate host is an animal or person
infected by a larval, or asexual, form of the
pathogen
• Strict or obligate parasite is an organism that
cannot live without a host. That is they have no
free-living existence. Examples: Treponema
pallidum, viruses, malarial parasite.
 Vector of infection
• An insect or any living carrier that transports an infectious
agent from an infected individual or its wastes to a susceptible
individual or its food or immediate surroundings. Both
biological and mechanical transmissions are encountered.
 Reservoir
• Any person, animal, arthropod, plant, soil, or substance, or a
combination of these, in which an infectious agent normally
lives and multiplies, on which it depends primarily for survival,
and where it reproduces itself in such a manner that it can be
transmitted to a susceptible host. It is the natural habitat of the
infectious agent.
Incidence and prevalence of infectious diseases
• Incidence of an infectious disease: number of new cases in a given time period
expressed as percent infected per year (cumulative incidence) or number per person
time of observation (incidence density).

• Prevalence of an infectious disease: number of cases at a given time expressed as a

percent at a given time. Prevalence is a product of incidence x duration of disease,
and is of little interest if an infectious disease is of short duration (i.e. measles), but
may be of interest if an infectious disease is of long duration (i.e. chronic hepatitis
B).
 Epidemic
• “The unusual occurrence in a community of disease, specific
health related behavior, or other health related events clearly
in excess of expected occurrence”
• (epi= upon; demos= people)
• Epidemics can occur upon endemic states too.
 Endemic
• It refers to the constant presence of a disease or infectious
agent within a given geographic area or population group. It is
the usual or expected frequency of disease within a
population.
• (En = in; demos = people)
 Hyperendemic and holoendemic
• The term “hyperendemic” expresses that the disease is constantly
present at high incidence and/or prevalence rate and affects all age
groups equally.

• The term “holoendemic” expresses a high level of infection beginning

early in life and affecting most of the child population, leading to a state
of equilibrium such that the adult population shows evidence of the
disease much less commonly than do the children (e.g. malaria)
Pandemic and Exotic
• An epidemic usually affecting a large proportion of the population,
occuring over a wide geographic area such as a section of a nation, the
entire nation, a continent or the world, e.g. Influenza pandemics.

• Exotic diseases are those which are imported into a country in which
they do not otherwise occur, as for example, rabies in the UK.
 Zoonosis, epizootic and enzootic
• Zoonosis is an infection that is transmissible under natural conditions
from vertebrate animals to man, e.g. rabies, plague, bovine
tuberculosis…..
• An epizotic is an outbreak (epidemic) of disease in an animal population,
e.g. rift valley fever.
• An Enzotic is an endemic occurring in animals, e.g. bovine TB.
 Nosocomial infections
• Nosocomial (hospital acquired) infection is an infection
originating in a patient while in a hospital or another health
care facility. It has to be a new disorder unrelated to the
patient’s primary condition. Examples include infection of
surgical wounds, hepatitis B and urinary tract infetions.
 Opportunistic infection
• This is infection by organisms that take the opportunity
provided by a defect in host defense (e.g. immunity) to infect
the host and thus cause disease. For example, opportunistic
infections are very common in AIDS. Organisms include Herpes
simplex, cytomegalovirus,
• M. tuberculosis….
 Eradication and Elimination
• Termination of all transmission of infection by the extermination of the infectious
agent through surveillance and containment. Eradication is an absolute process, an
“all or none” phenomenon, restricted to termination of infection from the whole
world.

• The term elimination is sometimes used to describe eradication of a disease from a

large geographic region. Disease which are amenable to elimination in the
meantime are polio, measles and diphtheria.
 INFECTION AND DISEASE
• Not every infection always causes disease.

• Disease cause by an infection outcome of an intricate interplay

between
– biology of the microorganism
– the biology of the host, and the
– environment.
 COMMUNICABLE DISEASE CONTROL
• The control communicable requires a multidisciplinary approach
• We need biologists to identify the underlying molecular mechanisms
of the infection
• We need medical doctors to prevent and treat the disease.
• We need public health specialists to understand what kinds of
strategies governments can put in place to curb the spread of the
disease.
• We need communication experts to understand how to disseminate
information thorough various media channels.
 QUESTION
• Can we eliminate and eradicate all communicable diseases?
Can we eliminate/eradicate communicable diseases?
• Pathogens are not static
• Pathogens are evolving in order to survive in the face of control
measures that we impose upon them.
• This has led to development of resistance to the drugs and vaccines.
• The truth is the fight against infectious disease will never cease to
exist.
• As long as there's life, there will be communicable diseases.
 PATHOGENS
• Almost all living organisms are parasites, even parasites have
parasites.

• “Great fleas have little fleas upon their back to bite 'em, and
little fleas have lesser fleas, and so ad infinitum”
 Taxonomic Classification of Pathogens
• Prions • Nematodes

• Viruses • Helminths

• Bacteria • Arthropods

• Protozoa
 FUNCTIONAL CLASSIFICATION OF PATHOGENS
• This reflects on fundamental biological features.

• The micro parasites (Small)

• The macro parasites (Larger)

 Macroparasites
• No replication within the host.

• The impact of macro-parasites depend on the number of parasites

within the host.

• They tend to cause more morbidity than mortality.

• Incite more complex immune response since moderate to lower

burdens are tolerated
• Tend to cause persistent infections
 Microparasites
• Replicate in the body

• If no treatment, mainly very short-term infection that leads to

a crisis from which you either die or recover

• Causes both acute and chronic infections

 Infection and Disease
• A unique feature of communicable disease is it can be shared
(Transmitted)
• Infectious diseases has two components
– Disease
– infection and there is a disease.
• Not all infections cause disease and not all disease is caused by
infection
• Not all infections can be shared. And not everyone is equally likely to
become infected.
 What is infection?
• Infection is a process which one organism often replicates and leaves
progeny in another organism.
• These organisms derive energy and nutrients, reproduce, often by
borrowing the machinery of the host
• Infections can be largely unnoticed and might even be helpful.
• The ones we are most likely to notice are those which cause diseases

• Infection then refers to the replication of organisms in or on our

bodies that might or might not cause disease
 What is Disease?
• A sick person or animal, usually showing signs and symptoms

• Disease is the inability of the cell or tissue to perform a normal

physiological function

• Often due to damage or loss of function of key molecules or

cells and leads to the visible symptoms (Cough).
 What is infectious/contagious
• Ability to transmit the diseases
• Transmission is critical (Without transmission the infection
cannot spread)
• The length of time an infected person can transmit the
organism to another organism is called the infectious period
• Pathogens need a hospitable environment to replicate.
• Individuals capable of supporting infection are termed
Susceptible.
• Individuals lacking resources or with strong defences are
termed resistant
• Disease, infection, infectious and susceptibility or resistant to
becoming infected are all critical to understanding
communicable diseases
 TRANSMISSION
• There are several ways by which communicable disease can spread.
– Direct
– Indirect.

• Direct transmission means, that the infection can be passed on

directly to the next host.

• Indirect transmission means that there is an intermediate contact

 Direct Transmission
• Airborne droplets transmission
• Contact transmission (Contact with bodily fluids)
• Direct contact transmission
– Vertical
– Horizontal
• Vertical direct contact transmission (pathogens are transmitted from
mother to child during pregnancy, birth, or breastfeeding).
• Other kinds of direct contact transmission are called horizontal
direct contact transmission.
 Indirect Transmission
• Fomite transmission
• Vector transmission
• Water borne transmission
• Food borne transmission
 Basic reproductive Number
• The basic condition for communicable disease to sustain in a
population is that the first person who is infected with the pathogen
must, on average, pass that infection on to at least one other person.

• If that fails to happen, the disease will die out.

• If more than one person gets infected, and they subsequently infect
more than one an epidemic will occur.
• This idea is described in epidemiology as the basic reproductive
number R0.
 Basic reproductive Number (R0)
• The formal definition for R0 is the average number of secondary
infections, generated by the first infectious individual in a population of
completely susceptible individuals.
 WHAT FACTORS CONTRIBUTE TO R0
• R0 increase with the length of infection (Duration of infection).

• The more susceptible hosts there are to infect, the greater the
potential there is for the first individual to transmit the infection.
•
• These two terms together give us the potential number of contacts
over the course of an infection.

• R0 will also depend on how transmissable a pathogen is.

 RO
• Transmissability is a property of both the pathogen and the
population of interest.
• What is the rate of potentially transmissable contacts?
• And how likely is a transmissable contact to result in successful
transmission?
• The likelihood that a potentially transmissable contact will
result in successful transmission Is largely a property of the
pathogen.
 Basic Reproductive Rate
• Although R0 is a useful characteristic for generalizing about
spread of communicable diseases. The specifics of the start of
any particular outbreak may depend very strongly on where
and in whom the first cases appear.