Lpldemlology of CasLrolnLesLlnal

1racL problems
Lpldemlology
What |s ep|dem|o|ogy?
1 Irequency of d|sease occurrence
1 1he magnlLude (how much)
2 Lxpressed as prevalence raLe lncldence raLe
average number of eplsodes case load
morLallLy raLe
3 A dlsease can be
1 Lndemlc consLanLly presenL aL a speclflc area
2 Lpldemlc occurrence of cases ln excess of expecLancy
Lpldemlology
D|str|but|ng by person
1 Whom does Lhe condlLlon or dlsease affecL
2 Age gender personal behavlour
3 D|str|but|on by p|ace
1 Where does Lhe dlsease or condlLlon occur
geographlcally
4 d|str|but|on by t|me
1 When does Lhe dlsease or condlLlon occur
seasonallLy
Lpldemlology
Determ|nants of d|sease or cond|t|on
1 8lsk facLors assoclaLed wlLh occurrence or
developmenL of Lhe dlsease or condlLlon
Mode of Lransmlsslon
revenLlve measures
Lpldemlology of ularrhoeal
ulseases
auses of ularrhoea
ularrhoea ls a sympLom of lnfecLlon by enLerlc
agenLs
Viruses
Rotavirus *
Norovirus *
Bacteria
E. coli
Shigella *
Salmonella
Campylobacter
Yersinia
Cholera *
Parasites
Giardia
Cryptosporidia
Entamoeba
histiolytica
&ommon auses of epldemlc dlarrhoea
auses of ularrhoea conL
lL can also occur ln assoclaLlon wlLh oLher
lnfecLlous dlseases such as malarla as well as
chemlcal agenLs
hanges ln enLerlc flora lnduced by anLlbloLlcs
may produce acuLe dlarrhoea
auses of ularrhoea conL
lnfecLlous agenLs LhaL cause dlarrheal dlsease
are usually spread by Lhe fecaloral rouLe
speclflcally by
a) lngesLlon of conLamlnaLed food or waLer
b) conLacL wlLh conLamlnaLed hands
requency of Cccurrence
Around 730 mllllon chlldren below 3 years of
age ln developlng counLrles suffer from acuLe
dlarrhoea each year
ularrhoea can reach up Lo 24 Lo 49 eplsodes
per chlld per year
1hree Lo slx mllllon dle annually from acuLe
dlarrhoea
Leading Causes of Childhood Deaths
ource WnC est|mates of the causes of death |n ch||dren 3
8ryce Lancet March
requency of Cccurrence conL
I|ra| d|arrhoea
rotavrus
Cne Lhlrd of hosplLallzed cases ln lnfanLs and
chlldren under 3 years
LssenLlally all chlldren are lnfecLed by roLavlrus ln
Lhelr flrsL 23 years of llfe
8esponslble for 600 000 870 000 deaLhs each
year ln developlng counLrles
CuLbreaks may occur
requency of Cccurrence conL
8acter|a| d|arrhoea
scher|ch|a Co|| nterotox|gen|c stra|n (@C)
ntero|nvas|ve stra|ns (C)
13 of dlarrhoeal eplsodes
h|ge||a
600 000 deaLhs per year worldwlde
CuLbreaks may occur
erson dlsLrlbuLlon
I|ra| D|arrhoea
ota v|rus
1 nfants and young ch||dren
1 (under 3 years of age) uncommon below 3 monLhs
2 SuscepLlblllLy ls greaLer beLween 6 24 monLhs
3 8y age 3 mosL lndlvlduals have acqulred lmmunlLy
Adu|ts mmunocomprom|sed |nd|v|dua|s
contacts of |nfected ch||dren e|der|y
erson dlsLrlbuLlon conL
8acter|a| d|arrhoea
scher|ch|a Co|| (@C) (C)
uurlng Lhe flrsL 3 years of llfe
Leads Lo acqulslLlon of lmmunlLy consequenLly
Less frequenL ln older chlldren and adulLs
1ravelers from developed counLrles
erson dlsLrlbuLlon conL
h|ge||a
1wo Lhlrds of cases and mosL of deaLhs
chlldren 10 years
unusual under 6 monLhs of age
Llderly deblllLaLed malnourlshed
lace dlsLrlbuLlon
I|ra| D|arrhoea
ota v|rus
Worldwlde
8acter|a| d|arrhoea
scher|ch|a Co|| (@C) (C)
ueveloplng counLrles
h|ge||a
Lndemlc ln LemperaLe and Lroplcal counLrles
complex emergency seLLlngs (ouLbreaks)
@|me d|str|but|on
I|ra| D|arrhoea
ota v|rus
ln Lroplcal cllmaLes LhroughouL Lhe year
ln LemperaLe cllmaLes seasonal peaks durlng cool
monLhs
h|ge||a
Lpldemlcs ofLen occur durlng hoL humld ralny
seasons
8lsk acLors
8reasL feedlng
vacclnaLlon (measles)
nuLrlLlonal sLaLus
ersonal hyglene
LnvlronmenLal sanlLaLlon human excreLa
dlsposal solld wasLe dlsposal
WaLer supply and sLorage pracLlces
Mode of Lransmlsslon
onLamlnaLed food
onLamlnaLed waLer
ulrecL fecaloral Lransmlsslon
person Lo person (Shlgella dysenLerlae)
8esplraLory spread (roLa vlrus)
onLrol measures
9revent|ve measure
ealLh educaLlon (hand washlng)
Safe dlsposal of human excreLa
roLecL purlfy chlorlnaLe publlc waLer
supply
onLrol flles
use scrupulous cleanllness ln food preparaLlon
and handllng
onLrol measures conL
asLeurlze or boll mllk
Lnforce quallLy conLrol measures ln food and
drlnk lndusLrles
Lncourage breasL feedlng
onLrol measures conL
Contro| of pat|ents contacts |mmed|ate
env|ronment
8eporL Lo local healLh auLhorlLy
oncurrenL dlslnfecLlon of fecal dlscharges and
solled arLlcles
1reaLmenL rehydraLlon anLlbloLlc (lf
appllcable)
Lpldemlc measures
8eporL aL once Lo local healLh auLhorlLy
lnvesLlgaLe waLer food and mllk
ubllclze Lhe lmporLance of hand washlng
vlbtlo cboletoe
vlbtlo cboletoe
Vibrio spp.
V. cholerae Other vibrios
V. cholerae
Non-O1
V. choIerae O1
Biotype
Classical
EI Tor
Serotype
Ogawa
naba
Toxin
Toxigenic
Non-toxigenic
holera ln Lhe world 19602003
0
100000
200000
300000
400000
500000
600000
700000
1
9
6
0
1
9
6
2
1
9
6
4
1
9
6
6
1
9
6
8
1
9
7
0
1
9
7
2
1
9
7
4
1
9
7
6
1
9
7
8
1
9
8
0
1
9
8
2
1
9
8
4
1
9
8
6
1
9
8
8
1
9
9
0
1
9
9
2
1
9
9
4
1
9
9
6
1
9
9
8
2
0
0
0
2
0
0
2
2
0
0
4
ear
N
u
m
b
e
r

o
f

C
a
s
e
s
Latin America
Asia
sub-Saharan Africa
Source WC Weekly Lpl 8ecord
holera 8 19602003
Source WC Weekly Lpl 8ecord
0
5
10
15
20
25
30
35
40
1
9
6
0
1
9
6
2
1
9
6
4
1
9
6
6
1
9
6
8
1
9
7
0
1
9
7
2
1
9
7
4
1
9
7
6
1
9
7
8
1
9
8
0
1
9
8
2
1
9
8
4
1
9
8
6
1
9
8
8
1
9
9
0
1
9
9
2
1
9
9
4
1
9
9
6
1
9
9
8
2
0
0
0
2
0
0
2
2
0
0
4
ear
C
F
R
orld
sub-Saharan Africa
Asia
Latin America