Lecture 2:

Epidemiology
 LECTURE 2: EPIDEMIOLOGY
After studying this chapter, you should be able to:
• Define epidemiology and understand the common
tools used in its study
• Classify diseases according to transmissibility and
occurrence.
• Understand the concepts of chain of infection and
reservoirs of infection
Introduction
Epidemiology is the study of factors that determine the
frequency, distribution, and determinants of diseases in
human populations, and ways to prevent, control, or
eradicate diseases in populations.
Epidemiologist – are scientists who specialize in the study of
disease and injury patterns (incidence and distribution patterns)
in populations, and ways to prevent or control diseases and
injuries.
EPIDEMIOLOGY TOOLS
Basic Epidemiology Tools:
• Incidence
• Morbidity rate
• Period prevalence
• Point prevalence
• Mortality rate
• Case fatality rate
EPIDEMIOLOGY TOOLS
• Incidence – is defined as the number
of new cases of that disease in a
defined population during a specific
time period.
Example: the number of new cases
of Dengue in the Philippines in
2019.
 EPIDEMIOLOGY TOOLS
• Morbidity rate – is the number of new cases of a
particular disease that occurred during a
specified time period per a specifically defined
population (usually per 1,000, 10,000, or
100,000 population).
Example: the number of new cases of a
particular disease in 2009 per 100,000 U.S.
population.

ICU patients infected of COVID-19

EPIDEMIOLOGY TOOLS
• Period prevalence – is the number of
cases of the disease existing in a
given population during a specific
time period.
Example: the total number of cases
of malaria that existed in the U.S.
population during 2009.
EPIDEMIOLOGY TOOLS

• Point prevalence – is the number of cases

of the disease existing in a given population
at a particular moment in time.
Example: the number of cases of
malaria in the U.S. population at this
moment.
EPIDEMIOLOGY TOOLS
• Mortality refers to death.
• Mortality rate – is the ratio of the number of
people who died of a particular disease
during a specified time period per a
specified population (usually per 1,000,
10,000, or 100,000 population).
Example: the number of people who died
of a particular disease in 2009 per 100,000
U.S. population.
EPIDEMIOLOGY TOOLS
• Case fatality rate – is the
proportion of deaths from a
certain disease compared to the
total number of people diagnosed
with the disease for a certain
period of time.
TYPES OF DISEASES ACCORDING TO
TRANSMISSIBILITY

Types of diseases according to

transmissibility:
• Infectious diseases
• Communicable disease
• Contagious disease
• Zoonotic diseases
TYPES OF DISEASES ACCORDING TO
TRANSMISSIBILITY
• Infectious diseases (infections) –
are diseases caused by
pathogens.

• Communicable disease – is an
infectious disease that is
transmissible from one human to
another. Example: HIV
 TYPES OF DISEASES ACCORDING TO
TRANSMISSIBILITY

• Contagious disease – is a
communicable disease that is
easily transmitted from one
person to another. Example:
influenza
• Zoonotic diseases or zoonoses –
are infectious diseases that
humans acquire from animal
sources. Example: malaria
TYPES OF DISEASES ACCORDING TO
OCCURRENCE
The types of diseases according to
occurrence are:
• Sporadic disease
• Endemic diseases
• Epidemic (or outbreak)
• Pandemic
TYPES OF DISEASES ACCORDING TO
OCCURRENCE
• Sporadic disease – is a disease
that occurs only occasionally
(sporadically) within the
population of a particular
geographic area.
Example: tetanus, and typhoid
fever.
TYPES OF DISEASES ACCORDING TO
OCCURRENCE
• Endemic diseases – are diseases that are
always present within the population of a
particular geographic area. The number of
cases of the disease may fluctuate over time,
but the disease never dies out completely.
Example: tuberculosis (TB), common cold,
influenza, chickenpox, and mumps.

Chicken pox rashes

TYPES OF DISEASES ACCORDING TO
OCCURRENCE
• Epidemic (or outbreak)
– is defined as a greater than usual
number of cases of a disease in a
particular region, usually occurring
within a relatively short period of
time.
 TYPES OF DISEASES ACCORDING TO
OCCURRENCE
Some epidemics that happened abroad:
 Legionnaires’ disease or legionellosis in 1976 in Pennsylvania.
 Hamburger poisoning in 1992–1993 in the Pacific Northwest of U.S.
 Hantavirus pulmonary syndrome (HPS) on Native American
reservations in the Four Corners region in 1993.
 Cryptosporidiosis epidemic (a diarrheal disease) in Milwaukee,
Wisconsin in 1993.
 West Nile Virus (WNV) epidemic in U.S.
 Foodborne disease outbreaks.
 Ebola virus in Africa in 1976, 1979, 1994, 1995, 1996, 2001, and
2003.
 TYPES OF DISEASES ACCORDING TO
OCCURRENCE
2019 Epidemics in the
Philippines:
 Dengue – with 414,532 cases
and 1,546 related deaths from
Jan. 1 to Nov. 30, 2019.
Dengue mosquito
 Measels– with 34,950 reported
cases and 477 deaths from
January 1 to May 11
 Polio – 8 cases, after 19 years
of having zero cases.

Measles rashes
TYPES OF DISEASES ACCORDING TO
OCCURRENCE
• Pandemic disease – is a disease
that is occurring in epidemic
proportions in many countries
simultaneously, sometimes
worldwide.
TYPES OF DISEASES ACCORDING TO
OCCURRENCE
Pandemic cases:
 The 1918 Spanish flu pandemic was the
most devastating pandemic of the 20th
century. It infected 500 million and killed
more than 50 million people worldwide.

Spanish flu pandemic

TYPES OF DISEASES ACCORDING TO
OCCURRENCE
Pandemic cases:
 Severe acute respiratory syndrome
coronavirus-2 (SARS-CoV-2), commonly
known as COVID-19 has affected 220
countries and territories around the world
(as of June 20, 2021). It is caused by a virus
with an incubation period of 14 days and
can be transmitted through respiratory
droplets or airborne transmission on
circumstances where aerosols are formed.

For the updated number of cases globally, you can visit

https://www.worldometers.info/coronavirus/?utm_campaign=homeAdv
egas1?
TYPES OF DISEASES ACCORDING TO
OCCURRENCE
Pandemic cases:
 Human immunodeficiency virus (HIV) targets cells
of immune system, which help the body respond
to infection. Acquired immunodeficiency
syndrome (AIDS) is used to refer to the most
advanced stages of HIV infection. There were
approximately 37.9 million people living with HIV
at the end of 2018
TYPES OF DISEASES ACCORDING TO
OCCURRENCE
Pandemic cases:
 Tuberculosis. In 2018, approximately 10
million people fell ill and a total of 1.5 million
died with TB worldwide. It is caused by
Mycobacterium tuberculosis bacteria that
most often affect the lungs. The symptoms of
this disease are: cough, fever, night sweats,
and weight loss.

Tuberculosis infected lung

TYPES OF DISEASES ACCORDING TO
OCCURRENCE
Pandemic Cases:
 Malaria. It is a life-threatening disease caused
by parasites that are transmitted to people
through the bites of infected female
Anopheles mosquitoes. In 2018, there were
an estimated 228 million cases and 405, 000
deaths of malaria worldwide.

Anopheles mosquito
INTERACTIONS AMONG PATHOGENS,
HOSTS, AND ENVIRONMENTS
Factors pertaining to the pathogen:
• Virulence – the measure or degree of
pathogenicity
• Way of entry
• Number of organisms that enter the body
INTERACTIONS AMONG PATHOGENS,
HOSTS, AND ENVIRONMENTS
Factors pertaining to the host:
• The person’s health status
• The person’s nutritional status
• The susceptibility of the host (e.g., age,
lifestyle [behavior], socioeconomic
level, occupation, travel, hygiene,
substance abuse, immune status
[immunizations or previous experience
with the pathogen])
INTERACTIONS AMONG PATHOGENS,
HOSTS, AND ENVIRONMENTS
Factors pertaining to the environment:
• Physical factors such as geographic location, climate, heat,
cold, humidity, and season of the year.
• Availability of appropriate reservoirs, intermediate hosts,
and vectors (discussed later in this chapter)
• Sanitary and housing conditions; adequate waste disposal;
adequate healthcare
• Availability of potable (drinkable) water
CHAIN OF INFECTION
The six components in the chain of
infection are :
1. a pathogen
2. a reservoir of infection
3. a portal of exit
4. a mode of transmission
5. a portal of entry
6. a susceptible host
CHAIN OF INFECTION
Example:
1. pathogen - a cold virus
2. reservoir of infection - Andy has a cold
virus.
3. portal of exit - When Andy blows his nose,
cold viruses get onto his hands.
4. mode of transmission - Andy shook hands
with Bob and transferred the virus to Bob’s
hand
5. portal of entry - Bob rubs his nose, the cold
virus is transferred from his hand to the
mucous membranes of his nose.
6. susceptible host - Since Bob had previously
been infected by that particular cold virus
and had developed immunity to it, he is
not susceptible and will not develop a cold. Figure 1. The six components of the chain of infection
Source: Burton’s Microbiology FTHS 9th ed.page 178
 STRATEGIES FOR BREAKING THE
CHAIN OF INFECTION
 Practice effective hand hygiene procedures.
 Maintain good nutrition and adequate rest and reduce
stress.
 Obtain immunizations against common pathogens.
 Practice insect and rodent control measures.
 Practice proper patient isolation procedures.
 Ensure proper decontamination of surfaces and
instruments.
 Dispose of infectious waste properly.
 Use gloves, gowns, masks, respirators, and other personal
protective equipment, whenever appropriate to do so.
RESERVOIRS OF INFECTION

A reservoir is any site

where the pathogen can
multiply or merely survive until
it is transferred to a host.

Reservoirs may be:

 living hosts
 inanimate objects or
materials.
RESERVOIRS OF INFECTION
A carrier is a person who is colonized with a
particular pathogen, but the pathogen is not
currently causing disease in that person.
Classification of carriers:
• Passive carriers
• Incubatory carrier
• Convalescent carriers
• Active carriers
RESERVOIRS OF INFECTION
Zoonoses
–are infectious diseases
transmissible from animals
to humans.
A tick biting a person
Zoonoses are acquired by:
 direct contact with the animal
 inhalation or ingestion of the
pathogen from animals
 injection of the pathogen by an
arthropod vector.
RESERVOIRS OF INFECTION
Example of zoonotic diseases:
 Rabies from dogs, cats, bats, skunks, & other animals.
 Toxoplasmosis from cats litter
 Salmonellosis, acquired from the feces of turtles, other
reptiles, and poultry.
 Variant Creutzfeldt-Jakob (CJ) disease in humans from
the ingestion of prion-infected beef from cow
 Tularemia from rabbits
 Anthrax from dead animals
 Psittacosis or “parrot fever”
 Arthropods
RESERVOIRS OF INFECTION
Nonliving or inanimate reservoirs of
infection:
 Air
 Soil
 Dust
 Food
 Milk
 Water
 Fomites – are inanimate objects
capable of transmitting
pathogens. Fomites include
clothes, bedding, towels, eating
and drinking utensils, etc.
 RESERVOIRS OF INFECTION
The principal modes of pathogen transmission:
 Direct skin-to-skin contact.
 Direct mucous membrane-to-mucous membrane
contact by kissing or sexual intercourse.
 Indirect contact via airborne droplets of
respiratory secretions
 Indirect contact via food and water
 Indirect contact via arthropod vectors
 Indirect contact via fomites
 Indirect contact via transfusion of contaminated
blood or blood products from an ill person or by
parenteral injection
RESERVOIRS OF INFECTION

Figure 2. Modes of disease transmission

Source: Burton’s Microbiology FTHS 9th ed.page 184
The 1918–1919 Spanish flu pandemic
 also known as the swine flu pandemic
 killed around 20 to 100 million people,
worldwide
 Mortality rate: 2.5% - 5% of the world
population.
 Case fatality rate: 2% - 20% of those infected
compared
 With high fatality rate for healthy young
adults.
 the virus kills by causing an overreaction of
the body’s immune system.
References:
• Burton’s Microbiology for the Health Sciences, 9th Edition
• https://www.cdc.gov/flu/pandemic-resources/1918-
commemoration/1918-pandemic-history.htm
• https://www.who.int/news-room/fact-sheets/detail/tuberculosis
• https://www.who.int/news-room/fact-sheets/detail/malaria
• https://www.who.int/news-room/q-a-detail/hiv-aids
• https://www.google.com/amp/outbreaknewstoday.com/philippines
-dengue-outbreak-414k-cases-through-november-2019/amp/
• https://reliefweb.int/report/philippines/unicef-who-philippines-
measels-outbreak-situation-report-11-27-may-2019
• https://www.who.int/news-room/commentaries/detail/modes-of-
transmission-of-virus-causing-covid-19-implications-for-ipc-
precaution-recommendations
Other References (for pictures):
• atozreasearch.com
• microbenotes.com
• oneill.law.georgetown.edu
• mayo.edu
• healthcareinamerica.us
• phys.org
• dreamstime.com
• nursingtimes.com
• nhs.uk
• brightinstruments.co.uk
• 123rf.com
• evolution.berkeley.edu
• Economictimes.indiatimes.com
• ft.com
• cdc.org
• doh.gov.ph
• bangkokpost.com
• nationaljewish.org
• verywellhealth.com
• thejakartapost.com
• washingtonpost.com
• en.wikipedia.org
• sphweb.bumc.bu.edu
• sitn.hms.harvard.edu
• npr.org
• scienceabc.com