OUR LADY OF FATIMA UNIVERSITY

College of Pharmacy

MODULE 2:
EPIDEMIOLOGY
PART 1 of 2
PHPP 311 – Week 1 (Day 4 of 6)
NOTES

DEFINITION OF
EPIDEMIOLOGY
EPIDEMIOLOGY
• Epidemiology is a SCIENTIFIC DISCIPLINE with around
method of scienDfic inquiry at its foundaDon.

• Basic epidemiologic methods tend to rely on careful

observaDon and use of valid comparison groups to assess
whether what was observed.
•  Such as:
•  Number of cases of disease in parWcular area during a parWcular Wme
period
•  The frequency of an exposure among persons with disease
WHAT IS EPIDEMIOLOGY?
•  The word Epidemiology comes from the Greek word
EPI à Upon
DEMOS à People
LOGOS à Study

•  Epidemiology is the STUDY of the DISTRIBUTION and DETERMINANTS -

cycle I schematic

of HEALTH-RELATED STATES OR EVENTS in SPECIFIED POPULATIONS,

and the APPLICATION of this study to the control of health problems.
 Frequency

DISTRIBUTION Physical appearance

Time , place ,
Pattern
-

•  Epidemiology is concerned with the FREQUENCY and PATTERN of

health events in a populaDon.
DISTRIBUTION
FREQUENCY
Refers to NOT only to the number of
health events such as:
•  The number cases of meningiDs or
diabetes in a populaDon
•  The relaDonship of that number to
the size of the populaDon,
But it compares the disease
occurrence across different
populaDon.

 Rhinovirus -

March to October

DISTRIBUTION ( ONNA RSV , Influenza MPV lnoyp A

Stepp Jan Deo
-
-

I
, ,

Enterovirus -

June Oct
-

PN -
3
-

March to July Piv 2. b -

Aug -
Nov

PATTERN may be:

• TIME PATTERNS may be
ANNUAL, SEASONAL, DAILY,
WEEKLY, DAILY, HOURLY,
WEEKDAY VERSUS WEEKEND or
any other breakdown of Dme
that may influence disease or
injury occurrence.
can predict to avoid or prevent the disease
DISTRIBUTION
PATTERN may be:
•  PLACE PATTERNS such as
Geographic variaDon,
urban/rural differences and
locaDon of work sites or
school.
DISTRIBUTION
PATTERN may be:
•  PHYSICAL CHARACTERISTIC
including DEMOGRAPHIC
FACTORS which may be
related to RISK OF ILLNESS,
INJURY OR DISABILITY such as
AGE, SEX, MARITAL STATUS
and SOCIOECONOMIC STATUS
as well as BEHAVIORS AND
ENVIRONMENTAL
EXPOSURES.
 DETERMINANTS

•  Epidemiology is also used to

search for determinants, which
are the primary causes, and
other factors that influence the
occurrence of disease and other
health-related events. ( to get Tb
High risk
 DETERMINANTS

•  To search for these

determinants, epidemiologist
use analyDcal epidemiology or
epidemiologic studies to provide
the WHY and HOW of such
events.
DETERMINANTS

•  Assess groups with different rates of disease differ in their

demographic characterisDcs, geneDc or immunologic make-up,
behaviors, environmental exposures or other so-called potenDal RISK
FACTORS.

•  Findings will provide sufficient evidence to direct prompt and

effecDve public health control and prevenDon measures.
SPECIFIED POPULATION

•  Epidemiologist are concern with

disease occurrence and control
and the collecDve health of the
people in a community or
populaDon.
SPECIFIED
POPULATION

•  Epidemiologist focuses on
idenDfying exposure or source
that caused the illness, number
of person who have exposed to
similar hazard, potenDal spread Example:
in community and intervenDons
to prevent the addiDonal cases. CHERNOBYL DISASTER
The Chernobyl disaster was a nuclear accident that occurred on Saturday 26 April 1986, at the No. 4 reactor in the
Chernobyl Nuclear Power Plant, near the city of Pripyat in the north of the Ukrainian SSR in the Soviet Union.

Nuclear accidents 9 Abortion i 506 entire population → thyroid cancer

of
-

<
APPLICATION
•  Epidemiology involves applicaDon of
knowledge to the community-based
pracDce.

•  Epidemiologists use scienDfic methods of

descripDve and analyDc epidemiology as
well as experience, epidemiologic
judgement and understanding diagnosis of
health of a community
-
 POP QUIZ
A.  Study B. DistribuDon C. Determinants
D. Specified PopulaDon E. ApplicaDon

_____1.) Compare food histories between persons with Staphylococccus
Study
aureus food poisoning and those without.

Determinants
_____2.) Compare frequency of brain cancer among anatomists with
frequency in general populaDon
population
_____3.) Mark on map the residences of all children born with birth defects
specified
within 2 miles of hazardous waste site.
 POP QUIZ
A.  Study B. DistribuDon C. Determinants
D. Specified PopulaDon E. ApplicaDon

Distribution
_____4.) Graph the number of cases of congenital syphilis by year for the
country.

Application
_____5.) Recommend that close contacts of a child recently reported with
meningococcal meningiDs should receive Rifampin.
population
specified
_____6.) Tabulate the frequency of clinical signs, symptoms and laboratory
findings among children with chickenpox in SiDo Igiban, AnDpolo City
↳ B , op
EPIDEMIOLOGIC FUNCTIONS
EPIDEMIOLOGIC FUNCTIONS
•  During mid – 1980’s, there are 5 MAJOR CORE FUNCTIONS OF
EPIDEMIOLOGY were idenDfied:

•  Public health surveillance

•  Field invesDgaDon
•  AnalyDc studies
•  EvaluaDon
•  Linkages
•  Policy development (Recently added)
PUBLIC HEALTH SURVEILLANCE
•  It is the ONGOING, SYSTEMATIC
COLLECTION, ANALYSIS,
INTERPRETATION and
DISSEMINATION OF HEALTH
DATA to help guide public health
decision-making and acDon.

•  Surveillance is equivalent to
monitoring the pulse of
community.
PUBLIC HEALTH SURVEILLANCE
•  This funcDon is also known as INFORMATION FOR ACTION. It portrays
the ongoing paJerns of disease occurrence and disease potenDal so
that the invesDgaDon, control, and prevenDon measures can be
applied efficiently and effecDvely.
Heart Disease Diabetics Obesity
f
1 ,

•  MORBIDITY and MORTALITY reports are common sources of

surveillance data for local and state health departments.
 -
search Tounder

Date

and Mission

location

-
search Tounder

Date

and Mission

location

CASE SURVEILLANCE
SYSTEM US-CDC
The United States Centers for Disease Control and Prevention is the
national public health agency of the United States. It is a United States
federal agency, under the Department of Health and Human Services, and is
headquartered in Atlanta, Georgia. July 6, 1946

Founder: Joseph Walter Mountin

The World Health Organization is a specialized agency of the United

Nations responsible for international public health. The WHO Constitution,
which establishes the agency's governing structure and principles, states its
main objective as "the attainment by all peoples of the highest possible level
of health".
Founded: 7 April 1948
Headquarters: Geneva, Switzerland
PUBLIC HEALTH •  Other sources of health – related
data that are used for surveillance
SURVEILLANCE include reports from invesDgaDons
of individual cases and disease
clusters, public health program data
such as immunizaDon coverage in a
community, disease registries and
health surveys.
LEADING CAUSES OF DEATH
(psa.gov.ph)

artery
-

narrowing
-

abnormal
growth of all's -
Tumor -

benign 1 malignant
affect blood vessels
-

and supply
inflame air sucks ( mostly children)
-

pus
-

disorder not produce enough

insulin causing sugar
abnormallyhigh

contagious
FIELD
INVESTIGATION
•  The invesDgaDon may be limited as a
phone call to the health – care
provider to confirm or clarify the
circumstances of the reported case,
or it may involve a field invesDgaDon
requiring the coordinated efforts of
dozens of people to characterize the
extent of an epidemic and to idenDfy
its cause.
FIELD
INVESTIGATION
•  InvesDgaDons oqen lead to the
idenDficaDon of addiDonal unreported
or unrecognized ill persons who might
otherwise conDnue to spread
infecDon to others.
 •  For example, one of the hallmarks of
FIELD invesDgaDons of persons with sexually
INVESTIGATION transmiJed disease is the idenDficaDon of sexual
partners or contact of paDents.
Ex : contact Tracing
FIELD INVESTIGATION
•  For some diseases, invesDgaDons may idenDfy a
source or vehicle of infecDon that can be
controlled or eliminated.
•  Example:
•  InvesDgaDon of E.coli O157:H7 case, where it
focuses in idenDfying the vehicle – are oqen are
ground beef but someDmes in fruit juices –
invesDgators able to determine how many people
might have already been exposed and how many
conDnue to be at risk.
FIELD INVESTIGATION
•  Field invesDgaDon of the type
described above are someDmes
referred to as SHOE LEATHER
EPIDEMIOLOGY, conjuring up images
of dedicated epidemiologists
beaDng the pavement to search
addiDonal clues, regarding to the
source and mode of transmissions

•  EIS or Epidemic Intelligence

Service is a CDC’s training
program for disease detecDves.
ANALYTIC STUDIES

•  AnalyDc studies employ more

rigorous methods such as
combinaDon of surveillance and
field invesDgaDon to provide
clues or hypothesis about causes
and modes of transmission and
analyDc studies evaluaDng the
credibility of the hypothesis.
ANALYTIC STUDIES

•  Clusters or outbreaks are

frequently invesDgated iniDally
with descripDve epidemiology.
•  DescripDve epidemiology-
involves the study of disease
incidence and distribuDon by
Dme, place and person.
EVALUATION
•  The evaluaDon may focus on:
POLO
•  Plan – FormaDve evaluaDon
•  OperaDons – Process EvaluaDon
•  Impact – SummaDve EvaluaDon
•  Outcomes

•  For example, assessing the efficiency of the operaDons, the

proporDon of the target populaDon immunized, and the apparent
impact of the program on the incidence of vaccine-preventable
disease.
 EVALUATION
•  A hallmark of an analyDcal epidemiologic study:
1.  DESIGN
-appropriate research strategy and study design
' 2. CONDUCT
put -securing appropriate clearances and approvals
3.  ANALYSIS
-describing the characterisDc of the subjects
4.  INTERPRETATION
-purng the findings into perspecDve
EVALUATION
•  It is the process of determining, as systemaDcally and objecDvely as
possible, the relevance, effecDveness, efficiency an impact of
acDviDes with respect to established goals.

•  WE EVALUATE FOR:
•  EffecWveness – it is the ability to produce results under ideal
condiDons.

•  Efficacy – ability to produce results under minimum expenditure

of Dme and resources.
LINKAGES
•  Epidemiology is a TEAM SPORT.
•  During an invesDgaDon an epidemiologist
usually parDcipates as either a member
or the leader of mulDdisciplinary team.

•  Medical technologists
•  Sanitarians
•  InfecDon Control personnel
•  Nurses
•  Pharmacists
•  Physicians
•  Computer InformaDon specialist
LINKAGES
•  Mechanisms for sustaining such
linkages include:

•  Official memoranda of
understanding
•  Sharing of published or on-
line informaDon for public
health audiences
•  Outside partners and informal
networking that takes place at
professional meeDng.
POLICY
DEVELOPMENT

•  According to the definiDon:

“The applica9on of this study to the
control of health problems”.

•  Epidemiologist who understands a

problem and the populaDon in
which it occurs are oqen in a
uniquely qualified posiDon to
recommend appropriate
intervenDons.
POP QUIZ
p.surua.HN
A.  Public Health B. Field InvesDgaDon C. AnalyDc studies
D. EvaluaDon E. Linkages F. Policy Development

A
_____1.) Reviewing reports of test results for Chlamydia trachoma9s from
public health clinics.

E
_____2.) MeeDng with directors of family clinics and college health clinics to
discuss Chlamydia tesDng and reporDng.

F
_____3.) Developing guidelines/ criteria about which paDents coming to the
clinic should be screened (tested) for Chlamydia infecDon.
POP QUIZ
A.  Public Health B. Field InvesDgaDon C. AnalyDc studies
D. EvaluaDon E. Linkages F. Policy Development

B
_____4.) Interviewing persons infected with Chlamydia to idenDfy their sex
partners

C
_____5.) ConducDng an analysis of paDent flow at the public health clinic to
determine waiDng Dmes for clinic paDents

D
_____6.) Comparing persons with symptomaDc versus asymptomaDc
Chlamydia infecDon to idenDfy predictors
DESCRIPTIVE
AND
ANALYTICAL
EPIDEMIOLOGY
DESCRIPTIVE EPIDEMIOLOGY
-

emphasizes tends and rates of disease in a specific population

•  It covers Dme, place and person. It strives for similar

comprehensiveness in characterizing epidemiologic events.

•  Epidemiologist tend to use synonyms for the 5 W’:

1.  Case DefiniWon
2.  Person
3.  Place
4.  Time
5.  Causes/ Risk Factors/ Modes of Transmission
DESCRIPTIVE EPIDEMIOLOGY
•  Compiling and analyzing data by Dme, place and person is desirable
for several reasons:

1.  FIRST, look at the data carefully.

2.  SECOND, idenDfy the variable, its limitaDon and their eccentriciDes.
3.  THIRD, learn the extent and paJern of public health
4.  FOURTH, detailed descripDon of health of a populaDon that can be easily
communicated with tables, graphs and maps.
5.  FIFTH, idenDfy the area or groups within the populaDon that have high rates
of disease
TIME
•  The occurrence of disease changes over Wme. Some of these changes
occur regularly, while others are unpredictable.
•  WINTER – Influenza
•  AUGUST-SEPTEMBER – West Nile virus infecDon
•  OCCURS ANYTIME – Salmonellosis and HepaDDs B

•  Displaying the pa@erns of disease occurrence by Wme is criDcal for

monitoring disease occurrence in the community and for assessing
whether the public health intervenDons made a difference.
TIME
•  Secular (Long Term) Trends

•  Graphing the annual cases or

rate of a disease over a
period of years shows long-
term or secular trends in the
occurrence of the disease

•  It is used as a predictor for the

future incidence of disease.
TIME
•  Seasonality
•  Disease occurrence can be graphed
by week or month over the course
of a year or more to show its
seasonal paJer, if any.
•  For example, the seasonal paJerns
of Rubella, Influenza and Rotavirus.
•  Rubella – March to June RMJ
•  Influenza – November to March Iwm
•  Rotavirus – February to April RFA

12112
TIME
•  Day of week and 9me of day
•  Analysis at these shorter Dme
periods is parDcularly appropriate
for condiDons related to
occupaDonal or environmental
exposures that tend to occur at
regularly scheduled intervals.
•  Epidemic period
•  Time course of a disease outbreak
or epidemic. It is also known as
Epidemic Curve.
PLACE
•  Describing the occurrence
of disease by the place
provides insight into the
geographic extent of the
problem and it geographic
variaDon.


COVID update as of May 2020

PLACE
•  CharacterizaDon
by place refers not
only to place of
residence but or
any geographic
locaDons include
place of diagnosis
or report,
birthplace, site of
employment,
school district,
hospital unit or
recent travel
desDnaDons
PERSON
•  Personal characterisDcs may affect illness,
organizaDon and analysis of data by
“person” may use inherent characterisDcs
of people, biologic characterisDcs, acquired
characterisDcs, acDviDes, or the condiDons
under which they live.

•  Age and sex are included in almost all data

sets and are the two most commonly
analyzed “person” characterisDcs.
ANALYTICAL EPIDEMIOLOGY
associated
-
deals in recognising causes and prejudicing
risk in disease development

•  Epidemiologist can use

descripDve epidemiology to
generate the hypothesis and
analyDcal epidemiology to test
the hypothesis.
ANALYTICAL EPIDEMIOLOGY

•  The key feature it is a COMPARISON

GROUP. When invesDgators find that
persons with a parDcular characterisDc:

D •  Demographic factor such as age, race

or sex;
C •  ConsDtuDonal factor such as blood
group or immune status;
B •  Behavior or act that contract infecDon
or disease.
C •  Circumstances
 ANALYTICAL
EPIDEMIOLOGY

ANALYTICAL
EPIDEMIOLOGY FALL EXPERIMENTAL OBSERVATIONAL

INTO 2 CATEGORIES:
CLINICAL TRIAL/
COMMUNITY COHORT STUDY
1. Experimental studies TRIAL
- investigator will determine through a
controlled process the exposure for each
individual or community the effect of exposure. frequency disease in community researches assign notions to intervention and control or RETRSOSPECTIVE
-

The study of relationships of various factors determining the and distribution of a

or
comparison groups in attempt to isolate the effects of the intervention

2. Observational studies
-observes the exposure and disease CASE CONTROL
status of each study participant. STUDY

CROSS –
SECTIONAL
STUDY
COHORT STUDY characteristics typically those who experience a common event in a selected
-

group of people who

share a
defining
section at intervals through time
period birth order tuition performing across
-

such as .
-

•  Group of people with something

in common at the start of study.
The cohort is classified according
to exposure status and followed
up over Dme.

•  Incidence of the disease is

compared between groups with
and without risk factor/
intervenDon.
•  It is called follow – up or
prospecDve
RETROSPECTIVE COHORT STUDY
-

enrolls participant who already have a disease or condition in other words all cases happened before the study begins
said to bi directional
at the same time The study be
prospective
is a
-

and methods
both are use
.

retrospective
.

On

•  It is commonly used in invesDgaDons of disease groups. Both

exposure and outcomes have already occurred.
CASE – CONTROL STUDY
-

aka : case Reference study

-

In which two existing rows differing in outcome identified and compared on a basis of some supposed to be causal attributes

•  The invesDgators start with paDents with or without disease.

•  The key in a case – control study is to idenDfy an appropriate control
group, comparable to the case group in most respects, in order to
provide a reasonable esDmate of the baseline or expected exposure.
 CROSS – SECTIONAL STUDY
defined as the observational research that analyzes data variables collected at the one
given point in time across a
sample population for predefined subset the study time
-

a
-

aka: cross sectional analysis transverse study

,
or Valance
pre study

•  It tends to assess the

presence (prevalence)
of the health outcome
at that point of Dme
without regard to
duraDon.

CROSS – SECTIONAL STUDY

•  It uses rouDnely to
document the
prevalence in a
community of health
behaviors, health states
and health outcomes,
parDcularly chronic
condiDons
SUMMARIZED
COMPARISON
POP QUIZ
A.  DescripDve Epidemiology B. AnalyDcal Epidemiology C. None of the Choices
D. Cohort E. Cross – secDonal F. Case - Control

E
_____1.) RepresentaDve sample of residents were telephoned and asked how much they
exercise each week and whether they currently have (have ever been diagnosed) heart
disease.

D
_____2.) Occurrence of cancer was idenDfied between April 1991 and July 2002 for 50,000
troops who served in the First Gulf War (ended April 1991) and 50,000 troops who served
elsewhere during the same period.

F
_____3.) Persons diagnosed with new onset Lyme disease were asked how oqen they walk
through woods, use insect repellant, wear short sleeves and pants etc. twice as many.
POP QUIZ
A.  DescripDve Epidemiology B. AnalyDcal Epidemiology C. None of the Choices
D. Cohort E. Cross – secDonal F. Case - Control

F
_____4.) Persons diagnosed with new onset Lyme disease were asked how oqen
they walk through woods, use insect repellant, wear short sleeves and pants etc.
Twice as many paDents without Lyme disease from the same physicians’ pracDce
were asked the same quesDons, and the response in the two groups were
compared.

c-
Experimental
____5.) Subjects were children enrolled in a health maintenance organizaDon. At 2
months, each child was randomly given one of two of a new vaccine against
rotavirus infecDon. Parents were called by a nurse two weeks whether the children
had experienced any of a list of side – effects.
END of MODULE 2
PART 1