Introduction to

Veterinary
Epidemiology

Lear
ning
obje
ctive
s:
At the end of
this topic, the
student

Introduction 1
Definitions

1. Epidemiology - from Greek words: epi + demos + logos

epi, meaning on or upon
demos, meaning people
logos, meaning the study of
epi + demos + logos= the study of disease in a population

2. Epidemiology is the study of diseases in populations[ CITATION Ste05 \l 1033 ].

3. Epidemiology is the study of the distribution and determinants of health-related

states or events in specified populations, and the application of this study to the
control of health problems (Last, 1995).

4. Epidemiology is the study of the distribution and determinants of disease

frequency in man (MacMahon & Pugh, 1970).

5. Epidemiology is the study of disease in populations and of factors that determine

its occurrence; the key word being populations (Thrusfield, 1986).

6. Epidemiology may be defined as the study of the patterns of disease that evist
under field conditions. More specifically, epidemiology is the study of the frequency,
distribution and determinants of health and disease in populations (Martin, Meek,
& Willeberg, 1987)

7. Epidemiology is concerned with the distribution and determinants of health and

diseases, morbidity, injuries, disability, and mortality in populations. Epidemiologic
studies are applied to the control of health problems in populations. The key aspects
of this definition are determinants, distribution, population, and health phenomena
(Friis & Sellers, 2009).

Epi
demos
logos
Introduction 2
Key words in understanding
epidemiology

1. Study. Epidemiology is a systematic and ordered approach to solve health or

productivity problems. It may involve various methods such as observation, surveys,
hypothesis formulation, and experimentation to find the answers.

2. Disease. Epidemiology seeks to understand disease or productivity issues affecting

the host population in order to create appropriate control measures.

3. Distribution. In epidemiology, the disease picture is clearly described according to

animal, time and place (From now one remember ATP: animal, time and place).

4. Determinants. Determinants- refer to factors or events that are capable of bringing

about a change in health. Epidemiologists also attempt to search for causes or
factors that are associated with increased risk or probability of disease. This type of
epidemiology, where we move from questions of "who," "what," "where," and "when"
and start trying to answer "how" and "why," is referred to as analytical epidemiology.

5. Health-related states. Although infectious diseases were clearly the focus of much
of the early epidemiological work, this is no longer true. Epidemiology as it is
practiced today is applied to the whole spectrum of health-related events, which
includes chronic disease, environmental problems, behavioral problems, and
injuries in addition to infectious disease.

What do we mean by health? Back in 1948, the world health organization (who,
1948) defined it as ...a state of physical, mental and social well-being.

6. Populations. One of the most important distinguishing characteristics of

epidemiology is that it deals with groups of people rather than with individual
patients.

7. Control. Finally, although epidemiology can be used simply as an analytical tool for
studying diseases and their determinants, it serves a more active role.
Epidemiological data steers public health decision making and aids in developing
and evaluating interventions to control and prevent health problems. This is the
primary function of applied, or field, epidemiology.

Introduction 3
Six Striking Features Which
Differentiate Epidemiology From
Other Sciences

The Epidemiology Monitor obtained a preview of a chapter in a new book being written
under contract by Alex Broadbent on the Philosophy of Epidemiology. According to
Broadbent, there are six striking features of epidemiology as a science which differentiate it
from other sciences. Here they are:

1. Epidemiology is centrally concerned with finding out about causation, either for its own
sake or to make a prediction. It is not at all concerned with discovering laws of nature,
developing grand theoretical frameworks, measuring constants, or anything else.

2. Theory does not feature prominently in epidemiology. Epidemiology does not have a
proper domain of theory, where theory is understood as making claims about the nature of
the world. Instead, epidemiology develops methods. The expertise of an epidemiologist is
methodological.

3. Experiment does not feature prominently.

4. The methods of epidemiology are domain insensitive. Epidemiologists count things, and
then draw conclusions by comparing the results of different counting exercises. The limits
of what we can count and compare are well outside the limits of what is medically
significant.

5. The centrality of population thinking. Populations (and not just the individuals making
up those populations) are thought of as bearing health-related properties.

6. The stakes are high. The cost of failing to make a correct inference may be as high as the
cost of making an incorrect inference. This is in contrast to many other sciences where the
cost of failing to make a correct inference is merely slow progress.

Source http://www.epimonitor.net/Six_Striking_Features.htm

Introduction 4
Historical perspective
The historical background related to the development of epidemiology demonstrates the
severity of epidemics and pandemics compelling mankind to create a discipline that could
guide health officials in implementing appropriate responses.

The desire of the medical professionals to explain the occurrence of diseases and the efforts
of public officials to control the spreading health problem paralleled the early beginnings of
epidemiology.

Scientific understanding of disease and the factors that affect it is largely a product of the
last 150 years, with very rapid advances in the last half-century.

The history of epidemiology imitates a building under construction. It can be viewed from
different perspectives with several structures undergoing assembly at the same time.
History of disease agents
History of theories about diseases
History of methods for disease investigation
History of influential thinkers
History of organizations
3500B.C. Biblical guidelines on disease control and prevention
Sanitation. The Israelites were commanded to use running water for washing bodies,
hands and clothing when one is exposed to disease (Numbers 19:1419 ). They were
also taught to bury their human waste outside of camp, and to burn the waste of
their animals (See Numbers 19:3-22 , Lev. 11:1-47 ; 15:1-33 , Deut 23:12 ).

Quarantine. In Leviticus 13, God provided instruction concerning lepers: they were
to be quarantined. Before the era of commercialization of drugs, quarantine was one
of the few available means for arresting the spread of infectious diseases.

Disinfection. Hyssop- the first antiseptic. (Purge me with hyssop, and I shall be
clean: wash me, and I shall be whiter than snow. Psalms 51:7; see also Numbers
19:18). Studies have shown that Hyssop possesses a very strong antifungal activity.
The most abundant components in oil are isopinocamphone (43%), pinocamphoe
(16%) and b-pinene (16%). The essential oil was fungistatic on Aspergillus
fumigatus. Studies also identified pinocamphone and isopinocamphone. All yeasts
were strongly inhibited, seven strains of C albicans, C krusei and C tropicalis.
Limonene may be responsible for the antimycotic action.

Introduction 5
460-377 B.C. Hippocrates - the Father of medicine
Personal background Contribution to Epidemiology

1620-1674 John Graunt - The Columbus of biostatistics.

Personal background Contribution to Epidemiology

1624-1689 Thomas Sydenham - the English Hippocrates

Personal background Contribution to Epidemiology

1700s James Lind Experimental Epidemiology on scurvy

Personal background Contribution to Epidemiology

1749-1823 Edward Jenner

Personal background Contribution to Epidemiology
Pioneer in Disease control
through vaccination

Introduction 6
 "In science, credit goes to the man who convinces the world, not the man
to whom the idea first occurs."Francis Galton .History of Medicine
Panyia

1766 Dr. Daniel Bernoulli

Personal background Contribution to Epidemiology

1818-1865 Ignc Flp Semmelweis Father of infection control

and the "Savior of mothers"
Personal background Contribution to Epidemiology

1813-1858 John Snow Father of epidemiology

Personal background Contribution to Epidemiology

18071883 William Farr - The father of modern vital records

Personal background Contribution to Epidemiology

Introduction 7
18201910 Florence Nightingale- Hospital-based disease
monitoring
Personal background Contribution to Epidemiology

18221895 Louis Pasteur

Personal background Contribution to Epidemiology

1843-1910 Robert Koch

Personal background Contribution to Epidemiology

1888- 1908 Rinderpest Outbreak Investigation in the Philippines

In 1888 Don Benigno Quiroga y Ballesteros, the Director General de Administracion
Civil de Filipinas organized a team to investigate the rinderpest epidemic in the
Philippines. The disease introduced to the country by animals imported from Indo
China and Hong Kong [ CITATION Car07 \l 1033 ].
The American colonial government, being dependent on veterinarians coming from
the United States, decided to establish the College of Veterinary Science of the
University of the Philippines

Introduction 8
1900- 1938 Role of carriers in transmission: George Soper &
Typhoid Mary
Personal background Contribution to Epidemiology

1912 Janet Elizabeth Lane-Claypon and her retrospective cohort

study
Personal background Contribution to Epidemiology

1919 Wade Hampton Frost First professor of epidemiology.

Personal background Contribution to Epidemiology

1930s Publication of Epidemiology Textbooks

Hamer W. Epidemiology, old and new. London, United Kingdom: Paul, Trench,
Trubner and Company, 1928.
Vaughan VC. Epidemiology and public health: a text and reference book for
physicians, medical students and health workers. St. Louis, MO: CV Mosby, 1922
Stallybrass CO. The principles of epidemiology and the process of infection. London,
United Kingdom: G Routledge and Son Ltd, 1931.
Greenwood M. Epidemics and crowd-diseases: an introduction to the study of
epidemiology. London, United Kingdom: Williams and Norgate Ltd, 1935.
Greenwood M. Epidemiology, historical and experimental. London, United
Kingdom: Oxford University Press, 1932; Baltimore, MD: Johns Hopkins University
Press, 1932.

Introduction 9
1946 Establishment of CDC
Named as Communicable Disease Center in 1946
The Center adopted the methods and concepts from Florence Nightingales applied
statistics, William Farr's use of statistical induction to analyze death rates, Karl
Pearson's creation of goodness-of-fit tests and correlation methods, and Bradford
Hill's protocol for establishing causal relationships
In 1970, CDC was renamed Center for Disease Control.

1948 Doll and Hills case-control studies for chronic diseases

Personal background Contribution to Epidemiology

1947 The Framingham Study- the prototype and model of the cohort
study
In the late 1940s, Framingham was a self-contained community of about 28,000
residents who obtained their medical care from local physicians and two hospitals
near the center of town. Framingham residents were considered an excellent
population for a community-based prospective study because (1) the town's
population was stable, (2) the investigators could identify a sufficient number of
people with and with-out risk factors for heart disease, and (3) local medical doctors
were eager to help recruit study subjects.
For the past 50 years Framingham Study participants have undergone interviews,
physical exams, laboratory tests, and other tests every 2 years.
The interviews have gathered information on each subject's medical history and
history of cigarette smoking, alcohol use, physical activity, dietary intake, and
emotional stress. The physical exams and laboratory tests have measured
characteristics such as height and weight, blood pressure, vital signs and symptoms,
cholesterol levels, glucose levels, and bone mineral density. These data-gathering
efforts have left an immeasurable legacy of research findings on numerous topics.
1970s Invention and continuing evolution of microcomputer
technologies
Allowing linkage and analysis of large databases
It enabled epidemiologists to explore new public health questions and to assess the
effects of multiple risk factors simultaneously

Introduction 10
1980 CDC develops software packages for epidemiology
Examples of software systems developed by CDC in the 1980s and 1990s

Software system Primary use Reference

name
IDEAS (Interactive Support hospitals' Horan TC, White JW, Jarvis WR, et al. Nosocomial infection
Data Entry and participation in CDC's surveillance, 1984. MMWR 1986;35(No. SS-1).
Analysis System) nosocomial infection
surveillance activities

SAMEC (Smoking- Allow states and local areas CDC. State-specific estimates of smoking-attributable
Attributable to estimate the impact of mortality and years of potential life lost---United States, 1985.
Mortality and smoking-attributable illness MMWR 1988;37:689--93.
Economic Costs) and mortality

Software for Assist states in reporting Dunn RA, Webster LA, Nakashima AK, Sylvester GC,
Congenital Syphilis cases of congenital syphilis Surveillance for geographic and secular trends in congenital
Surveillance syphilis---United States, 1983--1991, MMWR 1993;42(No.
SS-6).
ARDI (Alcohol- Estimate the impact of CDC. Deaths and hospitalizations from chronic liver disease
Related Disease alcohol consumption and cirrhosis---United States, 1980--1989. MMWR
Impact) 1993;41:969--73.
CDC. Alcohol-Related Disease Impact (ARDI). Available at
http://apps.nccd.cdc.gov/ardi/homepage.aspx.
SURVTB Support state health CDC. Expanded tuberculosis surveillance and tuberculosis
departments in TB case morbidity---United States, 1993. MMWR 1994;43:361--6.
surveillance and prevention

STELLAR Support state activities in CDC. State activities for prevention of lead. MMWR
(Systematic prevention of elevated 1993;42:165,171--2.
Tracking of blood lead levels
Elevated Lead
Levels &
Remediation)
PHLIS (Public Support reporting from Bean NH, Martin SM, Bradford H, Jr. PHLIS: an electronic
Health Laboratory state public health system for reporting public health data from remote sites. Am
Surveillance laboratories J Public Health 1992;82:1273--6.
System)
Epi Info Support data collection and Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info: a
analysis from field general-purpose microcomputer program for public health
investigations; to support information systems. Am J Prev Med 1991;7:178--82.
state surveillance activities
Source: [ CITATION Str11 \l 1033 ]

Introduction 11
Introduction 12
Additional Names

Sir R.A. Ross on malaria

Joseph Lister

Joseph Goldberger

Dr Margaret Chan

T.K. Takaki
In 1887 eradicated beriberi from the Japanese Navy by adding vegetables, meat, and fish to
their diet, which was mostly rice
Kwashiorkor Disease

Lemuel Shattuck (1793-1859)

- In 1850, published the first report on sanitation and public health problems
- Shattucks report set forth the importance of
establishing state and local boards of health and
recommended an organized effort to collect and analyze vital statistics
- Recommended the exchange of health information, sanitary inspections, research on
tuberculosis, and the teaching of sanitation and prevention in medical schools

Edgar Sydenstricker (1881-1936)

Suggested that morbidity statistics be classified into five general groups in order to be of
value

1. Reports of communicable diseases

2. Hospital and clinical records
3. Insurance and industrial establishment of school illness records
4. Illness surveys
5. Records of the incidence of illness in a population continuously or frequently observed

Introduction 13
Objectives of epidemiology
There are several objectives (or uses) of epidemiology.

(Note acronym: CDC PROPOSE)

1. CONTROL. To plan, monitor and evaluate disease control programs (Thrusfield,

2007; and Terris, 1992)
2. DETERMINATNS. To determine the agent, host, and environmental factors that affect
health or disease occurrence[ CITATION Ter921 \l 1033 ];
3. COST. To assess the economic effects of a disease and analysis of the costs and
economic benefits of proposed disease control programs (Thrusfield,2007)
4. PREDICT. To predict the occurrence of disease. (Friis & Sellers, 2009)
5. RANK. To measure the extent and relative importance of the disease in order to
establish priorities for research and action (Gordis, 2008; and Terris, 1992). ; The
epidemiologic data will provide the foundation for developing public policy relating
to environmental problems, genetic issues, and other considerations regarding
disease prevention and health promotion (Gordis, 2008).
6. OVERVIEW. To describe the health status of populations. (Friis & Sellers, 2009);
7. POPULATION AT RISK. Identify those sections of the population which have the
greatest risk in order that the indicated action may be directed appropriately
[ CITATION Ter921 \l 1033 ];
8. OUTBREAK. To investigate and control disease outbreaks;
9. SURVEILLANCE. To conduct surveillance of disease and injury occurrence in
populations;
10. ECOLOGY. To acquire information on the ecology and natural history of a disease
(Gordis, 2008; Thrusfield, 2007; and Schoenbach, 2001);

Introduction 14
Introduction 15
Approaches (Types) of
Epidemiological Investigations
1. Descriptive Epidemiology- this is usually considered as the first level in an
epidemiologic study. A disease which has occurred is described according to animal,
temporal and spatial patterns. Tentative theories regarding the cause of the disease
are advanced and a hypothesis is formulated.

2. Analytical epidemiology- the second level in an epidemiologic study where the

hypotheses generated in the descriptive stage are tested using appropriate
epidemiologic studies. These studies seek to identify specific factors that increase or
decrease the risk of disease and to quantify the associated risk.

3. Theoretical Epidemiology- The development of mathematical and statistical

models to explain different aspects of the occurrence of a variety of diseases. With
some infectious diseases, for instance, models have been generated to elucidate the
reasons for epidemics and to predict the behavior of the disease as a reaction to
given control measures [ CITATION Por08 \l 1033 ].

4. Experimental Epidemiology- This approach, similar Analytical Epidemiology, aims

to test a hypothesis. However, in this method, the epidemiologist can select the
group and alter the factors associated with the groups. An example is the efficacy
study of new drug on a certain disease. A group of animals with the disease is
identified, and some samples are randomly selected to receive the drug.

DATE
Introduction 16
Shoe-leather Epidemiology
Synonyms:
Field epidemiology
Intervention epidemiology

Definitions
investigations initiated in response to urgent public health problems and for which
the investigative team does much of its work in the field (i.e., outside the office or
laboratory)- [CITATION kho10 \l 1033 ]
basic, direct, or old-fashioned methods of investigation
Hunting down primary data sources and confirming authenticity.
Collection of epidemiological and other pertinent data relevant to an
epidemiological investigation by painstaking direct inquiry among all or a
representative sample of the affected people, for example by walking door to door
(wearing out shoe leather in the process, hence the term) to ask direct questions.

The urgency of disease control

Comparison of the date of discovery of a measure to prevent a disease with the date of
identification of its true causative or preventive agent

Disease Discoverer of Year of Year of Discoverer of

preventive discovery discovery of agent
measure preventive agent
measure
Scurvy J. Lind 1753 1928 A. Szent-Gyorgi
Pellagra J. Goldberger 1755 1924 G. Casal et al.
Scrotal cancer P. Pott 1775 1933 J.W. Cook et al.
Smallpox E. Jenner 1798 1958 F. Fenner
Puerperal fever I. Semmelweis 1847 1879 L. Pasteur
Cholera J. Snow 1849 1893 R. Koch
Bladder cancera L. Rehn 1895 1938 W.C. Hueper et al.
Yellow fever W. Reed et al. 1901 1928 A. Stokes et al.
Oral cancerb R. Abbe 1915 1974 D. Hoffmann et al.

Source: Wynder EL. Invited commentary: studies of mechanism and prevention. Am J

Epidemiol 1994:547-549, Table 1.

Introduction 17
Skills acquired through training in epidemiology
1. Use of the interdisciplinary approach
2. Use of the scientific method- The scientific method employs a systematic approach
and objectivity in evaluating the results of research.
3. Enhancement of critical thinking ability
a. Reasoning by analogy and deduction
b. Problem solving
4. Use of quantitative and computer methods ex. biostatistics
5. Communication skills
6. Inculcation of aesthetic values

Introduction 18
Comparison of Epidemiology with
other disciplines

Clinician Pathologist Epidemiologist

Patient Sick Individual Dead individual Population
Usual Setting Hospital or clinic Laboratory Field
Primary objective Treat the individual Pinpoint Control the disease
abnormal forms
or functions
Diagnostic Clinical Utilization of Analysis of disease
procedure (organoleptic) laboratory tools patterns or frequencies
examination or reagents
Questions asked What is it? Whats abnormal How is the disease
How do I treat it? with the sample? distributed in terms of
Whats the time, animal and place?
possible What are the disease
pathogenesis? determinants?
How can this disease
be controlled
effectively?

Modified from Schwabe, Riemann, & Franti (1977).

Introduction 19
The Interdisciplinary Approach
Epidemiology is an interdisciplinary science. It employs principles and practices from other
disciplines.

Biostatistics
Biostatistics is application of statistical methods in biology, medicine and public health.
Statistics
Statistics is the science and art of dealing with variation of data in order to obtain reliable
results and conclusions
Public health
Public health is the Science and Art of
(1) preventing disease,
(2) prolonging life, and
(3) promoting health and efficiency
through organized community effort for:
(a) the sanitation of the environment,
(b) the control of communicable infections,
(c) the education of the individual in personal hygiene,
(d) the organization of medical and nursing services for the early diagnosis and
preventive treatment of disease, and
(e) the development of social machinery to ensure everyone a standard of living
adequate for the maintenance of health, so organizing these benefits as to enable
every citizen to enjoy his birthright of health and longevity. (As quoted in Institute of
Medicine. 1988. The Future of Public Health. Washington, DC: National Academy
Press.)

Introduction 20
Subdisciplines of Epidemiology

By physiology/disease By methodological approach

Infectious disease epidemiology Environmental epidemiology
Occupational Injury & Illness epidemiology Economic epidemiology
Cardiovascular disease epidemiology Clinical epidemiology
Cancer epidemiology Conflict epidemiology
Neuroepidemiology Cognitive epidemiology
Epidemiology of Aging Genetic epidemiology
Oral/Dental epidemiology Molecular epidemiology
Reproductive epidemiology Nutritional epidemiology
Obesity/diabetes epidemiology Social epidemiology
Renal epidemiology Lifecourse epidemiology
Intestinal epidemiology Epi methods development / Biostatistics
Psychiatric epidemiology Meta-analysis
Veterinary epidemiology Spatial epidemiology
Epidemiology of zoonosis Tele-epidemiology
Respiratory Epidemiology Biomarker epidemiology
Pediatric Epidemiology Pharmacoepidemiology
Quantitative parasitology Primary care epidemiology
Infection control and hospital epidemiology
Public Health practice epidemiology
Surveillance epidemiology (Clinical
surveillance)
Disease Informatics

Source: [ CITATION Wik11 \l 1124 ]

Strictly speaking, there is no life science, where epidemiological approach

and principles cannot be applied.
From womb to tomb, epidemiology is applicable

Introduction 21
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Introduction 22
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Introduction 23