Terminology

Infections:

The entry and development or multiplication of a disease producing agent in the body or
animals is infection. An infection does not always cause illness.

Infectious diseases:

A clinically manifested disease of a man or animals resulting from an infection is infectious

disease. Eg. Polio, Measles, Cholera, ARI etc.

Contamination:

The presence of an infectious agent on a body surface also in clothes, beddings, surgical or
dressing instrument or other inanimate article or substances including water milk and food is
called contamination.

Endemic:

Constant presence of disease or infectious agent within a given geographic area or population
group, without importing from outside may also refer to the usual or expected frequency of the
disease.

Epidemic:

Clinical (excess of expected) occurrence of disease in a certain geographical area. The disease
may be the same endemic disease or new disease. E.g. Typhoid, Cholera etc.

Pandemic:

The epidemic affecting a large proportion in a wide geographical area exceeding the national
boundaries. E.g. HIV/AIDS, influenza, SARS etc.

Sporadic:

Cases occurs haphazardly, infrequently and irregularly eg: tetanus.

Opportunistic Infection:

This is infection by an organism that take the opportunity provided by a defect in host defense
to infect the host and hence cause disease. The organism include M. Tuberculosis, Herpes
simplex. E.g. Opportunistic infections are common in AIOs infection.

Nasocomial Infection:

Hospital acquired infection eg: infection of surgical wound, UTI etc.

Iatrogenic infection:

Physician acquired conditions. May be resulted from preventive diagnostic and therapeutic
procedure.

Screening:

Search for the disease through clinical procedures or tests in apparently healthy people.

Isolation:

Separation or infected persons or animals for the period of communicablity.

Source of Infection:

Source of infection is defined as “ the person, animals, object or substance from which an
infectious agent passes or its disseminated to the host. “ For example measles case if source of
infection of Measles, infected soil is a source of infection for tetanus.

Reservoir for infection:

Reservoir is defined as “Any person, animal, arthropods, plant, soil or substance in which a
infectious agent lives and multiplies on which it depends primarily for survival and where it
reproduces itself in such manner that it can be transmitted to a susceptible host. For eg. Man is
the reservoir for typhoid fever.

Concept of Epidemiology:
Epidemiology is the study of the occurrence, distribution and determinants of health problems
and diseases in human populations or communities and use of this knowledge for the
prevention, control and treatment of disease. The primary unit of study in epidemiology is a
group of person not any single person. The population can be defined in geographical terms or
specific group of hospital patients or factory workers. The population used in epidemiology is
that in a given area or country at a given time

The word “Epidemiology” is derived from the Greek word epidemic

Epi: on, upon, to

Demos: people
Logos: knowledge, doctrine, discourse, science.
Historical Development of Epidemiology:

Epidemiology was first expressed over 2000 years age by Hippocrates. Hippocrates attempted to
explain the occurrence of diseases from rational course instead of supernatural force. In his
essay in title “Air, water and place” suggested that environment and host factors might have
influences in the development of disease.

John Graunt who studied the mortality statistics published mortality data in 1862. He is the first
person to quantify the pattern of birth, death and disease occurrence infant mortality,
urban/rural and seasonal variation of these events.

Then an anesthesiologist John snow conducted several classical investigations in London around
mid 1800 probably 20 years before the development of microscope. He performed
epidemiological investigation of cholera outbreak (1848 - 1854 AD) to discover the cause of
disease and to prevent reoccurrence. He sketched the spot map and pointed out the sources of
drinking water to illustrate the outbreak and the area affected by cholera epidemic. The source
of infection for the cholera was suspected to be polluted water. He made an explanation on the
basis of characteristics in terms of time, place and person.

During mid and late 1800, many other European and United States sphere countries began to
apply the epidemiologic method for the study of chronic diseases and other non-infectious
diseases among human population.

In USA, Winslow and Sedgwict taught epidemiology in the early 1920 although the subject was
not given departmental status.

Then in 1927 WH Frest became the first professor of epidemiology. In USA, then after
epidemiology has been evolved as a subject matter of study in medical college.

Studied by Doll and Hill (1950) linking to smoking and cancer and study of cardiovascular disease
since 2nd world war. Finally the epidemiological methods and principles were applied for the
eradication of smallpox during 1960’s and 1970’s.

Epidemiology has been evolved rapidly during past 3 decades with its many ramifications which
cover the study of diseases and other health and health related events by identifying etiology
(Study of Causes risk features of chronic diseases) formulating and evaluating treatment
modalities.

Definitions of Epidemiology:

“The study of the distribution and determinants of health related states or events in specified
populations and the application of the study to control of health problems” (Last JM, 1988)

“Epidemiology is the study of distribution and determinants of disease frequency in man” (Mac
Mohan 1960)
 Epidemiological Traid:

Diseases result from a complex interaction between agents, host and environment. The
causative factors of a disease may be classified as agent, host and environment. These three
factors are referred as “Epidemiological traid.”

Epidemiological Traid

Agent (Physical, chemical, mechanical, biological factors)

Host Environment

nomic factors, nutritional status, behavior, health status, susceptibility

Environment to disease
(climate,
etc.
topography, rainfall, occupational setting, air quality, f

Fig: Epidemiological Traid and related factors.

The more presence of agents, host and favorable environmental factors in the pre-pathogenesis
period is not sufficient to start the disease in man. What is required is an interaction of these 3
factors to initiate the disease process in man. The agent, host and environment separating in
combination determine not only the onset of diseases which may range from a single case to
epidemics but also the distribution of diseases in the community.
Agent factors

The agent has main role in the chain of disease transmission cycle. The disease agent is defined
as a substance living or non-living, or a force, tangible or intangible the excessive presence
process. The disease agents may be classified into following groups.

1. Biological Agents:
These are living agents, which can cause disease. Eg.
i. Viruses: chickenpox, poliomyelitis, measles etc.
ii. Bacteria: Typhoid, Dysentery, pertusis.
iii. Protoza: A. Dysentery, malaria.
iv. Helmenthes : Ringworm.
2. Physical Agents:
It includes the exposure to excessive heat, cold, humidity, pressure, radiation, sound
etc which may cause illness
i. Heat: Burn, Heat stroke.
ii. Cold: frost bite
iii. Pressure: pressure wound, sore
iv. Radiation: genetic mutation, cancer etc.
3. Chemical Agents:
It can be classified into two groups
i. Endogenous: produced by own body endogenously may result of dis
arrangement of function e.g:
Urea: Uraemia
Bilirubin: Jaundice
Uric acid: gout etc.
ii. Exogenous: Agents arising outside the human host e.g. fumes, dust, gases,
allergens may be acquired by inhalation, ingestion or inoculation.
4. Nutrient Agents:
The essential nutrients are carbohydrates, proteins, fats, vitamins, minerals and
water. Any excess or low intake of nutrient elements may result nutritional disorder
eg PEM, Anaemia, Goitre, scurvy, Rickets etc.
5. Mechanical Agents:
Exposure into mechanical forces or movable machines may result in crushing,
sprains, fractures and even death.
6. Social Agents:
Social factors also promote to cause the disease. It includes poverty, smoking, drug
abuse, unhealthy life style etc.
7. Host factors:
Animal or plant in which disease causing agents live or undergo growth and
development are called host factors.
 The host factor may be classified as:
i. Demographic characteristics e.g. Age, sex etc.
ii. Biological characteristics e.g. Blood pressure, biochemical level of blood and
cholesterol, blood group etc.
iii. Social and economic characteristics e.g. education, occupation, socio-
economic status, marital status, housing etc.
iv. Lifestyle factors e.g. living habit, food habit, exercise, alcohol consumption
etc.

Factors affecting to the host

a. Age
Sometimes disease may depend on the age. For e.g. measles, diphtheria only occur in
children and cancer, heart disease and hypertension occur only in adult.
b. Sex
Some disease occur only in male and some in female e.g. orchitis and BEP in male,
breast cancer and cervical cancer in female.
c. Heredity
Some disease can transmit in generation. If a grandfather or father or mother has
disease then it may appear to their son or daughter. For e.g. Hypertension, Diabetes,
Hemorrhoids etc.
d. Nutrition
Lack of nutrition leads to malnutrition. If someone gets malnutrition may suffer many
disease and act as host to them.
e. Occupation
Human may get many disease due to their occupation e.g. coal tar-anthracosis, cotton
dust-byssinosis, sugar-cane dust-bagassosis etc.
f. Culture, customs and habits
Different life style, habit, cultural practice, trend, norms may effect the causation of
disease e.g. there is low chance of getting tapeworm infestation in muslim, because they
don’t consume pork.
g. Immunity power
The immunity power has major role in causing the disease. If someone has high
immunity power and is early immunized then there is low risk of occuring a disease. For
e.g. immunization against Hepatitis B prevents hepatitis B

Environmental factors

Environment of man has been divided into three components as follows

1. Physical environment
It includes non-living things and physical factors. Physical environmental factors includes
a. Minerals: lack of iodine and iron gives rise to goitre and anemia.
 b. Poor housing: it badly affects in our health e.g. eye and chest.
c. Poor disposal of waste: lack of proper sanitation and proper disposal of waste,
human excreta causes, diseases, such type of eg. Diarrhoea, worm infestation,
typhoid etc.
d. Pollution: air pollution, water pollution, noise pollution, radiation hazards etc.

2. Biological environment
The biological environment indicates the living being including man which surrounds
man. The living being includes virus, bacteria and other organisms, insects, rodents
animals and plants. Sometimes they act as disease producing agent for eg.
i. Virus and bacteria - related disease
ii. Insects - malaria, filaria, trachoma, kalazar
iii. Rodents- plague
iv. Dogs- Rabies
v. Plants- some plants may cause poisonous effect.
3. Psychosocial environment
Psychosocial environment includes:
- values - Moral
- Customs - Religion
- Habits - Life style
- Economic condition - Education
- Population - Social and political organization
- Occupation
- Beliefs
- Attitudes.