Dynamics of disease transmission

Dr S kar
Associate Professor Community
Medicine
SMIMS
Incubation period

The time interval between invasion by an

infectious agent and appearance of the first
sign or symptom of the disease in question

Factors affecting the incubation period

•Dose of inoculum
•Site of multiplication
•Rate of multiplication
•Host defence mechanism
Factors to determine the incubation period

• GENERATION TIME
• INFECTIVE DOSE
• PORTAL OF ENTRY
• INDIVIDUAL SUCEPTIBILITY
 Generation time

It is defined as the interval of time between

receipt of infection by a host and maximal
infectivity of that host
 Importance of incubation period

• Tracing the source of infection and contact

• Period of surveillance
• Immunization
• Identification of point source or propagated
epidemics
• Prognosis
 Median incubation period

• It is defined as the time required for 50% of

the cases to occur following exposure
Secondary attack rate

It is defined as the number of exposed persons

developing the disease within the range of the
incubation period, following exposure to the
primary case
 Herd immunity
• It is the level of resistance of a community or group of
people to a particular disease
 Disease transmission
• Direct or indirect transfer of Infectious agent
from an infected or diseased host to others
• The route through which this transfer is
effected is called channel of transmission.
• The living or nonliving object from which the
infectious agent are shed is labelled as
reservoir or source of infection
 Modes of transmission
Direct transmission
-Direct contact
-Droplet infection
-Contact with soil
-Inoculation into skin or mucosa
-Transplacental (Vertical)
 Direct Transmission
Direct Contact
• Mucosal level – e.g. Sexually transmitted diseases
• Skin to Skin Contact - Scabies

Droplet infection
• Considered as direct contact transmission even though
there does not exist any sort of actual contact.
• The infected reservoir and the susceptible host are in
close proximity.
• The size of the droplet is large about 100 micron and
can travel a distance of about 100 cms.
E.g. Pulmonary Tuberculosis, Chicken pox.
 Contd.
Percutaneous transmission
• Organism enters through the skin
• Rabies by dog bite
• Hookworm larvae penetrating bare skin of feet
Transplacental transmission
• Fetus in utero getting infected.
• E.g. syphilis, rubella
 Indirect Transmission
• Agent is transmitted to the susceptible host
through some agency or channel so that there
is no proximity between the reservoir and
susceptible host
• The infective agent may just remain viable,
may multiply or undergo development
 Contd.
• Indirect transmission may be

• Vehicle borne transmission

• Air borne transmission
• Vector borne transmission
 Vehicle borne transmission
• Agency of vehicle which holds the infectious agent for
certain length of time and spreads the agent over long
distances depending upon the degree of contamination.
• The common vehicle of transmission are
– Water – Enteric fever, cholera, hepatitis A
– Milk – Staphylococcal poisoning, brucellosis
– Food- Botulism
– Fomites - Gastroenteritis, Diphtheria
• Vehicular transmission is commonly encountered with
poor community health
 Air borne transmission
• The disease agent present in oropharyngeal
and respiratory secretions makes an exit
during the act of sneezing spitting, breathing.
• The large droplet constitute direct contact
transmission
• Smaller droplets with size less than 5 micron
remain airborne for long periods and carried
long distances.
 Contd.
• The droplets may dry up depending upon
higher ambient temperature, lower relative
humidity and carried away depending upon
wind velocity. This leaves behind a trace of
salt, vapour and few microorganisms
embedded in a trace of mucous. These are the
droplet nuclei. E.g. Measles
• Dust reduction measures and wet mopping of
floor can reduce this type of transmission
 Vector borne transmission
• Through a vector which transmits the infection
into or through the skin or mucous
membrane, by biting or by deposits.
• A vector is an arthropod or other invertebrate.
• The infectious agent undergoes some
developmental changes inside the vector
• Both biological and mechanical transmissions
are encountered
 Contd.
• Mechanical transmission

– Through contamination of body surface the fly can

deposit the organism in food matters.
– The transmission can take place as passive
intestinal harbourage - by vomiting or defecation
by housefly
 Contd.
• Biological transmission
–Propagative
–Cyclopropagative
–Cyclodevelopmental
 Contd.
Propagative
• The microbes are consumed by the vector during a
blood meal. They reach proventricularis, stomach
and multiply over time. There is only increase in
number without in developmental life cycle
• During the next blood meal , the organism is
injected to the susceptible host
• This is seen in yersnia pestis ( plague) in vector flea
 Contd.
Cyclopropagative transmission
• Organism undergoes change in form,
completes a part of life cycle along with
multiplication inside the vector
• Malarial parasite in body of vector female
anopheles mosquito. The sexual cycle takes
place inside the vector and is called definitive
host.
 Contd.
Cyclodevelopmental
• Only a cycle of development is completed
inside the vector without any developmental
changes.
• Seen with microfilaria inside culex mosquito.