Introduction to epidemiology

Dr. Md. Mobarak Hossain Khan

Professor and Chairperson
Department of Social Relations
East West University
Dhaka, Bangladesh

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 Learning objectives
• After this lecture, students will be able to:
• Definition of epidemiology
• Activities of epidemiologists
• Types of epidemiology
• Understand epidemiologic triangle
• Chain of infection
• Important terminologies of epidemiology
• Questions and discussion

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 Definitions of epidemiology
• Epidemiology is the study of the distribution and determinants of
health-related states or events in specified (human) populations and the
application of this study to the prevention and control of health
problems (Last, 1995; Merrill, 2017))

Last JM, ed. A dictionary of epidemiology. 3rd ed. Oxford: Oxford University Press; 1995.
Merrill RM. Introduction to epidemiology. Sudbury, MA: Jones and Bartlett Publishers, 2017

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 Activities of Epidemiologists
• Identifying risk groups for disease
• Identifying where/when the public health problems are greatest
• Identifying primary agents/risk factors for disease, injury, and death
• Describing the natural history of disease
• Monitoring diseases and other health-related events/exposures over time
• Identifying the mode of transmission
• Evaluating efficacy/effectiveness of prevention and treatment programs
• Providing useful information for health planning and decision making
• Assisting in carrying out public health programs/interventions
• Being a resource person
• Communicating public health information

Merrill RM. Introduction to epidemiology. Sudbury, MA: Jones and Bartlett Publishers, 2017 4
 Types of epidemiology (I)
Questions addressed:
Descriptive • When?
epidemiology • Where?
• Who?
Epidemiology

Questions addressed:
Analytic
• How?
epidemiology
• Why?
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 Types of epidemiology (II)
• Descriptive epidemiology is used to:
• Describe the distribution of diseases in a specified population by time, place
and person
• Generate hypotheses, allocate resources, plan programs and compare groups

• Analytic epidemiology is used to:

• Study the aspect of epidemiology concerned with why and how a health
problem occurs.
• Quantify the association between exposures and outcomes (disease)
• Test causal hypothesis (cause-effect relationship)
• Provide sufficient evidence to design control/prevention measures
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 Questions addressed in epidemiology:
Descriptive and analytic

Descriptive epidemiology Analytic epidemiology

(1) When was the population affected? (1) How was the population affected?

(2) Where was the population affected? (2) Why was the population affected?

(3) Who was affected?

 The Epidemiology Triangle
• The simplest model to study disease causation
• Consists of four essential components:
• Host
• Agent Host
• Environment
• Time

• In this model, disease happens from the interaction Time

between the agent and the host in an environment
that supports transmission of the agent from a Agent Environment
source to the host.

Merrill RM. Introduction to epidemiology. Sudbury, MA: Jones and Bartlett Publishers, 2017 8
 Epidemiology Triangle: Agents
Agent: the cause of disease/disease-causing organism (Biological, physical & chemical)
• Bacteria
• Viruses
• Parasites For infectious diseases
• Fungi
• Molds
• Chemicals from dietary foods
• Substances/tobacco smoke
• Solvents (chemical, poison) For noninfectious disease, disability,
• Nutritional deficiencies injury or deaths
• Heat or radiation (Physical)

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• Necessary for disease to occur
Merrill RM. Introduction to epidemiology. Sudbury, MA: Jones and Bartlett Publishers, 2017
 Epidemiology Triangle: Host
Host: an organism, usually a human or an animal, that harbors the disease
• Personal characteristics
• Lifestyles/behaviors
• Overall fitness of the host
• Level of exposure
• State of health
• Genetic predisposition/makeup
• Level of immunity

These factors influence the chance for disease or its severity

Merrill RM. Introduction to epidemiology. Sudbury, MA: Jones and Bartlett Publishers, 2017 10
 Epidemiology Triangle: Environment
Environment: Surroundings and conditions external to the human or animal that cause
or allow the disease transmission
• External conditions and surroundings
• Physical stresses (e.g. heat, cold, noise, radiation, ozone depletion, housing)
• Biological (bacteria, viruses, fungi, parasites)
• Chemical (e.g. drugs, acids, alkali, poisons like arsenic)
• Psychosocial (e.g. neighborhoods, SES, social support, social networking, access to
healthcare)

• Contribute to the disease process

Merrill RM. Introduction to epidemiology. Sudbury, MA: Jones and Bartlett Publishers, 2017 11
 Epidemiology Triangle: Time
• Time-related includes:
• Incubation periods (delays in time from infection to when symptoms develop)
• Life expectancy of the host or the agents (pathogen)
• Duration of illness or condition

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 Important terms of epidemiology
• Epidemic: The occurrence of cases of health-related states/events,
which is more than normal expectation in a community or region (e.g.
Corona virus in China)
• Endemic: The usual occurrence of a disease in a given population or
geographic area (e.g. Ebola virus in Africa)
• Pandemic: Refers to a extensive region/worldwide epidemic (e.g.,
HIV/AIDS)
• Outbreak: Carries the same definition of epidemic but is often used for a
more limited geographical area

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 When can endemic becomes epidemic?
• When host, agent, and environmental factors are changed or
imbalanced

• Particularly, endemic becomes epidemic due to:

• New agent or change in existing agent (infectivity, pathogenicity) (Agent)
• Change in susceptible (at risk) hosts (Host)
• Environmental changes that affect transmission or growth of the agent
(Environment)

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 What is an epidemic curve?
• An epidemic curve (epi
curve) is a graphical
depiction of the number of
cases of illness by the date
of illness onset

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 Infection and Chain of Infection
• Infection is the invasion and multiplication of an organism in the tissue
of a host
• Types of infection:
§ Primary infection: Initial infection with organism in host
§ Secondary infection: Infection by a new organism due to lower resistance of
host by a preexisting infection
§ Reinfection: Subsequent infection by same organism in a host (after recovery)
§ Superinfection: Infection by same organism in a host before recovery
§ Nosocomial infection: Cross infection occurring in hospital.
§ Subclinical infection: It is one where clinical affects are not apparent
 The chain of infection

• Chain of infection and epidemiology triangle is closely linked.

• Disease transmission occurs when the causative agent (pathogen) leaves the
reservoir/host through a portal of exist, is spread by one of several modes
of transmission, and enters through an appropriate portal of entry to infect
a susceptible host. This sequence is called the chain of infection. .

CDC. Principles of epidemiology in public health practice.

Chain of Infection

CDC. Principles of epidemiology in

public health practice.

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 Chain of infection
• Six links in the chain of infection

Causative agent
Reservoir

Susceptible host

Portal of exit

Portal of entry
Mode of
transmission

Thomas and Weber (2001): Epidemiologic methods for the Study of Infectious Diseases. Oxford University Press.
 Causative agent (pathogen)
• Definition: The cause of disease. It disrupts the normal
physiology of the infected host

• Cellular agent (living)

• Parasites (e.g., Tapeworm)
• Protozoa (e.g., Malaria)
• Bacteria (e.g., Leprosy)
• Fungi (e.g., Athlete’s foot) Athlete’s foot

• Acellular agent (non-living)

• Virus (e.g., HIV/AIDS)
• Prion (e.g., CJD - Creutzfeldt-Jakob disease (CJD) - a
rare disease of brain disorder
 Reservoir
• Definition: The place for a pathogen to live, grow and multiply

• Three potential reservoirs of pathogens are:

§ Living:
• Humans
• Animals
§ Nonliving:
• Environment (such as water, food, soil)
 Portal of exit
• Definition: a pathway by which an agent can leave its host
• Examples:
• Mouth
• Nose
• Broken skin
• Respiratory secretions
• Blood exposure

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 Mode of transmission
• Definition: A way to get to a new host
• Direct transmission (person-to-person contact)
• Direct and immediate transfer of an agent from a
host/reservoir to a susceptible host
§ Body fluids (i.e. blood, secretions)
• Indirect transmission
§ Occurs when an agent is transferred by some
intermediate item, organism, means, or process to a
susceptible host
§ Examples:
§ Fomites (cloths, towel, utensils, toothbrushes,)
§ Vectors (e.g., mosquito, tick)
§ Water, food,
§ Dust particles

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 Portal of entry
• Definition: A pathway into the host that gives an agent access to
tissue that will allow it to multiply or act

• Broken skin
• Respiratory tract (nose, mouth)
• Gastrointestinal tract (mouth, anus)
• Genitals
• Insect bites
 Susceptible host
• Concept of susceptibility: It is based on level of immunity.
• Definition of susceptible host: The host who has no immunity to the
pathogen.

• How can a host reduce susceptibility to the pathogen?

• Following methods are useful:
• Get immunizations (create antibodies)
• Physical exercise
• Eat well-balanced diet
 How to break the chain of infection?
• Target: If you can break even ONE link, an infection will not occur!
• How to break?
§ Kill the pathogen
§ Prevent contact
§ Prevent its escape
§ Prevent transmission
§ Block the entry ports
§ Resistant host

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Thank you

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