Epidemiology of infectious disea

ses

Huan Zeng, Ph.D., A/Professor

School of Public Health and Management
zenghuan586@aliyun.com
 Questions
 What is an infectious disease?
 What factors may affect the transmission
of infectious disease?
 How to prevent and control the
infectious disease?
2003 SARS

2004-2005 Avian Influenza

2009 swine flu

2019 COVID-19
 Contents

Section 1 Definition

Section 2 Transmission

Section 3 Prevention and control

 Section 1. Definition

Infectious diseases are diseases caused

by transmissible agents and their toxic p
roducts.

Communicable disease
Transmissible disease
Infectious Diseases Epidemiology
 study the space/time/population distribution

 study the occurrence, development and transmission of i

nfectious diseases;
 Detect clinical features that help early diagnose the disea
se;
 Evaluate factors which effect the prevalence of infectious
diseases;
 Put forward measures to prevent and control the infectio
us diseases
 Protect the susceptible person
 Achievements
 On May 8,1980, WHO announced that the
smallpox( 天花 ) was eliminated.

 1991-2002, WHO declared that the Americ

a, Europe eliminated the polio （脊髓灰质
炎） .

 Other infectious diseases

China

1965-2001年全国法定报告传染病总发病率变化趋势
The morbidity trend of official reported infectious diseases in China 1965-2001
总病病率（1/10万）

8000
7000
6000
5000
4000
morbidity

3000
2000
1000
0
1965 1970 1975 1980 1985 1990 1995 2000
年份
 The challenge
Worldwide

 morbidity and mortality of some common infectious dise

ase have decreased

 the infectious disease is still a serious public health pro

blem worldwide

 WHO report, there are 48 most serious diseases, among

which 40 are infectious and parasitic diseases new

emerging infectious diseases
 TB
There are 1/3 people infected TB in the w
orld.

About 2,000,000 new cases are found ev

ery year.

In China ,there are about 500 million peo

ple infected with TB.
Cholera
Malaria
AIDS
SARS
Reasons:
1. the change of environment
2. the change of social conditions.
3. the increase of the global communication
4. the development of technology and industry
5. microbe variation and the failure of public heal
th measures
6. others
 Section 2

Transmission
 Transmission
 1. Source of infection
 2. Route of transmission
1) Air-borne infection
2) Water-borne infection
3) Food-borne infection
 3. Susceptible population
 4. Factors affecting epidemic process
 Three elements

 source of infection

 route of transmission

 susceptible people
Transmission chain

Route of transmission
 The epidemic process

It is the process that infectious dise

ases occur and spread in the
population.
 carrier

route of trans
source mission Susceptible
pathogen immune
people

patient die
 1. Source of infection
1)Patient: the most important source

2)Carrier:

do not have clinic symptoms but can release pathoge

n and infect others

3)infected animals
1. Source of infection
 1. Source of infection
 Patient: the most important source

Incubation period: In medicine, the time

from the moment of exposure to an
infectious agent until signs and
symptoms of the disease appear.

For example, the incubation period of

chickenpox （水痘） is 14-16 days.
 How to infer the exposure time :

1. Push backward an average incubation period fr

om the date of the median cases. it is the appr
oximate date of exposure.
2. Push backward a minimum incubation period f
rom the date of first case and then backward a
maximum incubation period from the date of la
st cases. The period between the two points is
the exposure time
 Incubation period: 14 (7~21)days

21 days
cases
Number of

14 days

7 days

Mar Apr
 The significance of incubation perio
d
(1) Infer exposure time and make sure the
source of infection and transmission
mode;
 The significance of incubation perio
d
(2)Determine the examination, quarantine o
r medical observation time for the
persons exposed to infection resource.
(1-2 days after the average incubation
period, or after the maximum incubation
period.)
The significance of incubation period
(3)Determine the time for immunization for
the people who contact the pathogen.
(during the incubation period)

(4)Evaluate preventive measures(after the

intervention, to see if the cases decrease
significantly during the maximum
incubation period)
The significance of incubation period
(5)Affect the prevalence characteristics of
disease
if the incubation period is short, breakout
easily, if the incubation is long, the
epidemic would last long.
 Communicable period: the period that th

e patients can release pathogen. It is the

important basis for determing the isolatio
n period of patients with communicable d
iseases.
 The incubation period determine the exami
nation, quarantine or medical observation t
ime for the persons exposed to infection
resource. (1-2 days after the average
incubation period, or after the maximum
incubation period.)
 Pay attention!!!
 Communicable period: the period that the p
atients can release pathogen. It is the impo
rtant basis for determing the isolation perio
d of patients with communicable diseases.
 1. Source of infection
2)Carrier:
do not have clinic symptoms but can release pathogen and
infect others
 incubatory carrier
 convalescent carrier( 恢复期带菌者 )
 healthy carrier

3)infected animals
 incubatory carrier （潜伏期病原携带者）
a person capable of transmitting an infectious
agent to others during the incubation period of
the disease.

 convalescent carrier （恢复期病原携带者）

a person who is clinically recovered from an
infectious disease but still capable of
transmitting the infectious agent to others.
healthy carrier （健康病原携带者）

An asymptomatic carrier (healthy carrier or

just carrier) is a person or other organism that
has contracted an infectious disease, but who
displays no symptoms.

Although unaffected by the disease themselves,

carriers can transmit it to others.
The carriers are hidden. A big difficulty!!!
 Three elements

 source of infection

 route of transmission

 susceptible people
 2. The route of transmission
The second link in the chain of infection

 After being released from the source of infection ,

before reaching the new susceptible host, the pat
hogens could stay in the outside environment for
a period. The process that the pathogens stay
outside is the route of the transmission.

AIDS
The route of transmission
The second link in the chain of infection

1. Air-borne transmission
2. Water-borne transmission
3. Food-borne transmission
4. Contact transmission
5. Soil-borne transmission
6. Iatrogenic transmission
7. Perinatal transmission
8. Multi-channel transmission
Air-borne transmission

Droplet transmission
Droplet nucleus transmission
Dust transmission
 Scarlet fever( 猩红热 )

Tuberculosis
( 肺结核 )

SARS
 Characteristics of air-borne
transmission
1. Easily transmitted, high morbidity
2. Morbidity is higher in the winter and spring
 Characteristics of air-borne
transmission
3. Morbidity is higher among the children.
4. Present in cycle in population with no
vaccination.
(measles)
5. Affected by the living condition and
density of the crowd.
Water-borne transmission

 Drinking water transmission

 Plague water transmission
 Characteristics of drinking
water transmission
1. Distribution of cases is in line with the supply
of drinking water. (1854 Broad Street cholera outbreak)

John Snow

Dot map

2. The disease can happen throughout the year if

the drinking water is polluted during the year.
 Characteristics of drinking
water transmission
3. No incidence differences between different
age, sex and occupations except the
breastfed babies.

4. The transmission could stop after taking me

asures to the water or people stop drinking
the polluted water.
 Characteristics of plague water
transmission
Schistosomiasis 血吸虫病 Oncomelania 钉螺 Cercariae 尾蚴

1.Patients have contact the plague water.

2.Incidence varies in different seasons, occup

ations and areas.
What are the occupations at high risks?
Characteristics of plague water
transmission

3. It can break out when a large susceptible

population contact plague water.

4. Transmission can be stopped by taking meas

ures to the plague water or protecting the su
sceptible population.
 A story in Shanghai
 In Spring, 1988, Shanghai
 Numerous people vomiting, Jaundice( 黄疸 )
 310,746 infected, 31 died

 Hepatitis A outbreak who is the Killer?

Anadara subcrenata 毛蚶
Characteristics of food-borne transmission
1. The patients have the history of taking the sam
e food. No polluted food, no disease.

2. It can break out when there is a large scale of p

olluted food.(short incubation period)

3. The transmission will stop when stopping

supply of polluted food.
 Summery and question

How this information could help us in prevention

and control of infectious diseases?

Do next: 1. Group discussion

2. Presentation
 Three elements

 source of infection

 route of transmission

 susceptible people
 3. Susceptible population

 In epidemiology a susceptible individual

(sometimes known simply as a susceptible)

is a member of a population who is at risk of
becoming infected by a disease.
 herd susceptibility:

it means the susceptible degree of the

whole population

it depends on the proportion of the

susceptible individuals.
Factors increasing herd susceptibility:

 new born increasing

 susceptible individuals moving in
 immunity of immune individuals naturally
decreasing
 death of immune individuals
Factors decreasing herd susceptibility
 planned immunization

 epidemic of infectious disease

 inapparent infection
4. Factors affecting the epidemic
process
 Natural factors

Climate and geography factors are t

he most important factors affecting t
he epidemic process.
 Social factors

Include all the activities of people su

ch as lifestyle, sanitary conditions, li
ving environment, immigration and s
o on.
Section 3: the prevention and control

Before the outbreak : prevention

After the outbreak : control
 1. Prevention
 Take measures for the pathogens and the
susceptible people before the occur of th
e infectious diseases

 Health education
 Immunity
 Sanitary condition
Health education
 it can cut off the transmission route by changi
ng the unhealthy habits and behaviors.

 Means of health education are various: media,

professional lectures and so on.
 Strengthen immunity

Many infectious diseases can be

prevented by immunization such as
smallpox ,measles, polio.
Improve sanitary condition

improve living conditions

supply clean water

 2. Strengthen surveillance

 The surveillance contents include the mo

rbidity and mortality of infectious diseas
e, the type and characteristic of the path
ogens, the type and the distribution of th
e host, the immunization level and the po
pulation data, ect.
In China ,the surveillance include regular sur
veillance and sentinel surveillance.

Regular surveillance covers with the A, B, C

three types official infectious disease （ 39
infectious diseases ）

There are many sentinel sites to surveil

specific diseases (such as HIV/AIDS).
Emergency measures for the outbreak of
infectious diseases

 Limit or stop meetings, theater performances, or

other social events

 suspension of business,classes

 Limit transportation or house use

 Stop use of contaminated water

 3. Global control

 1988, WHO determined “ to eliminate poli

o”.
 After 14 years, the cases decreased by 9
9.8%.
 2001, call for “to eliminate TB”
Transmission chain

Route of transmission
 4. The measures
measures for the source:
Patients:
find, diagnose ,report ,isolate and cure early
Carriers :
manage and follow up until the test of the path
ogen “Negative ” 2~3 times
Contact person:
isolate or medical observation for one incubati
on period
Animals:
isolate ,kill , burn or bury
Measures for the transmission route:

Disinfection:

prophylactic disinfection

epidemic focus disinfection

Measures for the susceptible individual:

immunization

medicine

individual protection
 5. Immunization

Immunization, or immunisation, is the

process by which an individual's immune
system becomes fortified against an agent
(known as the immunogen).
 Active immunization

 Passive immunization
Immunization saves lives

 Immunization saves t
he lives of approxima
tely 3 million people
each year, all over th
e world.
 Questions
 1. The three elements of transmission of infecti
ous diseases
 2. The factors affecting the epidemic process of
infectious diseases
 3. The epidemiological significance of incubatio
n period
 4. The significance of communicable period
 5. The characteristics of air/water/food-borne
transmission
 6. The measures to stop transmission(source,
transmission route, susceptible population)
The final question
measures for the source:
Patients:
find, diagnose ,report ,isolate and cure early
Carriers :
manage and follow up until the test of the path
ogen “Negative ” 2~3 times
Contact person:
isolate or medical observation for one incubati
on period
Animals:
isolate ,kill , burn or bury
Measures for the transmission route:

Disinfection:

prophylactic disinfection

epidemic focus disinfection

Measures for the susceptible individual:

immunization

medicine

individual protection
Thank yo
u
谢