Epidemiology

Aranas, Cuizon, De Jose, Divinagracia, Famoso,

Jalandoni, Rabago, Robleza, Tamesis
 Definition of Epidemiology

● The study of the distribution and determinants of health-related states

and events in populations, and the application of this study to control
health problems (John Last-1988).
● It is the basic science of preventive and social medicine.
● It is derived from the word epidemic (epi = among; demos = people;
logos = study).
● John Snow has been called the “Father of Modern Epidemiology”
Three components of the definition are:
1. Disease frequency - basic measures are ratio and rate.
2. Distribution of disease - occurs in patterns
3. Determinants of disease - underlying causes of
disease
Aims
1. To describe the distribution and size of disease
problems in human populations.
2. To identify aetiological factors.
3. To provide the data essential to the planning,
implementation, evaluation of services for the prevention,
control, treatment, and to the setting up priorities among
those services.
To eliminate or reduce
health problems or its
consequences and
promote health and
wellbeing.
Objectives
1. To collect, collate and analyze all data relating to the roles of agent, host and
environment to effectively describe the complete epidemiological situation
2. To further analyze and describe the occurrence, distribution and nature of
diseases according to variables such as age, sex, occupation, places, habits and
customs
3. To probe into, in order to fill gaps in our knowledge of the casual factors of disease
4. To help administrators to channel their public health policies to serve the various
groups of population, age, sex, occupation, rural or urban
Principles
1. Exact observation
2. Correct interpretation
3. Rationale explanation
4. Scientific construction
Epidemiology and Clinical Medicine
EPIDEMIOLOGY CLINICAL MEDICINE

● The unit of study is a defined ● The unit of study is case

population

● Study the disease pattern in the entire ● Study the disease in the individual
population patient

● Identify the source of infection, mode ● Diagnosis, prognosis, specific

of spread, future trend, and control treatment
measures

● The investigator goes into the ● The patient comes to the doctor
community

● Subject matter is ‘conceptual’ ● Easily perceived

Epidemiological study design

Experimental Non-experimental

- Clinical trial
- Community interventional trial Analytic Descriptive
- Other experimental designs

- Cohort
- Simple
- Case control
- Case series
- Analytic
- Case reports
survey
Epidemiological Approach
● Asking questions
○ Related to health events
○ Related to health action
● Making comparison - basic approach is to make
comparisons and draw inferences.
EPIDEMIOLOGIC TRIAD
FACTORS INFLUENCING HEALTH EQUILIBRIUM
Balance
Biologic, depends on
Nutrient, age,race sex
Chemical, habits,customs.
Physical, genetic factors,
and personality
Mechanical
AT EQUILIBRIUM LEVER defense
mechanism.

The balance is determined Changes upset balance

by nature and characteristics
of these agents in relation to Social,
host and environmental Economic,
Biologic,
Physiological

The aggregate of all external conditions

and influence affecting the life and
development of an organism, human
behavior
or society.
THE AGENT FACTOR OF DISEASE
Types of Agents
● NON LIVING
● LIVING
● BORDER LINE
● PHYSICAL
● MECHANICAL
● CHEMICAL
● EXOGENOUS
● ENDOGENOUS
● NUTRIENTS
CHARACTERISTICS OF AGENTS OF DISEASES
● Inherent characteristics - the physical features, biologic requirements,
chemical makeup, viability, and resistance
● Characteristics directly related to man - includes infectivity,
pathogenicity, virulence, and antigenicity

1. INFECTIVITY: ability to gain access and adapt to the human host to the
extent of finding lodgement and multiplying.
2. PATHOGENICITY: the ability of an agent when lodged in the body to set up
a specific reaction, local or general, clinical or subclinical.
CHARACTERISTICS OF AGENTS OF DISEASES
3. VIRULENCE: the severity of the reaction produced and is usually

measured in terms of fatality.

4. ANTIGENICITY: ability to stimulate the host to produce antibodies.

ex. immunizing effects of smallpox, dengue, measles, etc.

● Characteristics in relation to the environment- refers to the reservoir

(man, animals, plants, soil, or inanimate organic matter) and sources of
infection and modes of transmission.
CHARACTERISTICS OF AGENTS OF DISEASES
1. SOURCE OF INFECTION : the thing, person, object or substance, from
which an infectious agent passes immediately to a host
2. MODES OF TRANSMISSION: the mechanisms by which an infectious agent
is transported from reservoir to susceptible human host,
● Direct transmission-could be by direct contact such as kissing, touching, or
sexual intercourse.
● Indirect transmission- include vehicle, vector and air.
CHARACTERISTICS OF AGENTS OF DISEASES
Vehicle of Infection: refers to inanimate objects soiled. or contaminated by
an infectious agent. Ex: water, food, milk, blood, utensils, etc

Vectors: are arthropods or other invertebrates which transmit infection by

inoculation or by depositing infective materials on the skin or objects.

Airborne Spread: could be through the respiratory inhalation of residue of

droplets from humans (e.g. chickenpox virus) or from sources such as the
laboratory (e.g. Brucella abortus).
Host factor of a disease
Age- certain diseases have a predilection for specific groups. ( whooping
cough and measles occur mostly in children because of low immunity among
them)

Sex- certain diseases are sex-linked. ( buerger’s disease is common in males)

Race- there are diseases peculiar to certain races. ( sickle cell anemia is
peculiar in black races.)

Habits, custom and religion- example is among Moslem, it would be quite

hard to find cases of pork tapeworm because Moslems don’t eat pork.
Exposure to the agent- most important factor to consider is occupation because of the nature of
work or the conditions of work.

Defense mechanism- these include natural and acquired protective mechanisms.

specific anatomical defenses- these refer to the structure of the body. (secretion of tears and
body fluids for lubrication and cleansing with their antiseptic property)
immunity- defined as the resistance usually associated with the possession of antibodies having
a specific action on the microorganism concerned with a specific infectious disease.
inherent susceptibility- is an ability to resist disease independently of antibodies or specifically
developed tissue response.
resistance- is the sum total body mechanisms which interpose barriers to progress of invasion
of infective agents.
tolerance- term applied to the condition whereby the infectious agent can be demonstrated
from the individual, and yet the person does not show clinical manifestation as should be expected.
premunition- term applied to the condition of refractoriness to further infection in an individual
already sic or harboring already the infectious agent due to a previous infection.
allergy- untoward reaction of the body towards certain specific substance (allergen).
state of nutrition-condition that is commonly agreed by all to influence the occurence of most
diseases.
THE ENVIRONMENTAL FACTORS OF DISEASE
Environment - is the sum total of an organism’s external surrounding
conditions and influences that affect its life and development.

Physical Environment - includes climate and geography

Climate - includes temperature, altitude, humidity, rainfall and wind.

Humidity - very important for the life of mosquitos. The higher the humidity,
the better the chances of survival.

Geography - this mean location, the character of the terrain etc. The
geography of a place affects the habits of the people and the custom.
THE ENVIRONMENTAL FACTORS OF DISEASE
Biologic Environment - the living environment of man consists of plants,
animals and fellow human beings.

Socio-economic Environment - it is not necessary to enter into a lengthy

discussion trying to distinguish purely social factors from those that are purely
economic factors because these two are independent and intricately
connected with each other.
 1. Public Health
Core Epidemiologic Surveillance
2. Field Investigation
Functions 3. Analytic Studies
4. Evaluation
5. Linkages
6. Policy Development
Tools of Measurement
Rate Measures the occurrence of some
particular events in a population
during a given time period.
 It is a ratio which indicates the

Proportion relation in magnitude of a part of

the whole. Numerator is included
in the denominator. It is usually
expressed as percentage.
 It expresses a relation in size
Ratio between two random quantities.
Numerator is not a component of
the denominator.
Concept of Numerator and Denominator
Numerator Denominator

● Refers to the number of ● Related to the population and

times an event has
occurred. In case of rate,
the numerator is a
component of the
denominator.
● Related to the total events and
would comprise of (i) mid-year
population, (ii) population at
risk, (iii) person-time, (iv)
person distance, (v) subgroup
of the population.
comprise of number of
accidents “per 1000 vehicles.”
Measurements in Epidemiology
1. Measurements of morbidity

2. Measurements of mortality

3. Measurements of disability

4. Measurements of natality

5. Measurements of presence, absence or distribution of the characteristics of the

disease

6. Measurements of medical needs, health care facilities, utilization of health services

and other health-related events

7. Measurements of environmental and other factors suspected of causing the

disease
Measurement of Morbidity
Morbidity is defined as a state of having a specific illness
or condition.
Uses

Three aspects of morbidity are 1. They describe the extent and nature of disease in
commonly measured by morbidity the community.
rates or morbidity ratios, namely 2. They usually provide more accurate and clinically
frequency, duration, and severity. relevant information on patient characteristics.

3. They serve as starting point for aetiological studies

and play crucial role in prevention.

4. They are needed for monitoring and evaluation of

disease control activities.
Prevalence - refers specifically to all current cases (old +
new) existing at a given point in time, or over a period of
time in a given population.
Two types of Prevalence
Two types:

1. Point prevalence - defined as the number of all current cases (old + new)
of a disease at one point in time in relation to a defined population.

2. Period prevalence - measures the frequency of all current cases existing

during a period of time expressed in relation to a defined population.
Incidence - The number of new cases occurring in a
defined population during a specified period of time.
Measurement of Mortality - provide the starting point for
many epidemiologic studies. The basis of mortality data is
the death certificate
Limitations of Mortality Data Use of Mortality Data

1. Incomplete reporting 1. Explaining trends

2. Lack of accuracy 2. Indicating priorities for health

action
3. Lack of uniformity
3. Designing intervention programs.
4. Choosing a single cause of death

5. Diseases with low fatality

Mortality Rates and Ratios
Measurement of Disability - impairments, activity
limitations, and participation restrictions.
Measures of Disability

1. Barthel’s index of activities of daily living

2. WHO quality of life brief scale

3. Environment impact scale

4. Disability adjusted life years

5. International classification of functioning

 Measure Numerator Denominator 10^n

Measurements of Natality Crude birth rate Number of live births

during a specified
Mid-interval
population
1,000

time interval

Natality measures Crude fertility rate Number of live births

during a specified
Number of women
ages 15-44 years at
1,000

time interval mid-interval

are
population-based Crude rate of
natural increase
Number of live births
minus number of
Mid-interval
population
1,000

measures of birth. deaths during a

specified time
interval

Low birth weight Number of live births Number of live births 100
ratio <2,500 grams during during the same time
a specified time interval
interval
Terminologies in Epidemiology
Communicable disease: An illness due to a specific infectious agent or its
toxic products capable of being directly or indirectly transmitted from man to
man, animal to animal, or from the environment to man.

Epidemic: The unusual occurrence in a community or region of disease.

Contamination: The presence of an infectious agent on a body surface, also
on or in clothes, beddings, toys, surgical instruments or dressings, or other
inanimate articles or substances including water, milk and food.

Infectious disease: A clinically manifest disease of man or animals resulting

from an infection.

Contagious disease: A disease that is transmitted through contact, e.g.

trachoma, STD, flu, colds and etc.
Endemic: It refers to the constant presence of a disease or infectious agent
within a given geographic area or population group

Sporadic: means scattered about. The cases occur irregularly, haphazardly

from time to time, and generally infrequently.

Infection: The entry and development or multiplication of an infectious agent

in the body of man or animal.
Pandemic: Pandemic usually affecting a large proportion of the population,
occurring over a wide geographic area such as a section of a nation, the entire
nation, a continent or the world, e.g. influenza pandemics of 1918 and 1957.

Nosocomial infection: an infection originating in a patient while in a hospital

or other health care facility.

Opportunistic infection: This is infection by an organism that takes the

opportunity provided by a defect in host defence to infect the host and hence
cause disease.
Iatrogenic disease: Any untoward or adverse consequence of a preventive,
diagnostic or therapeutic regimen or procedure, that causes impairment,
handicap, disability or death resulting from a physician’s professional activity
or from the professional activity of other health professionals.
Investigation of epidemic: The “unusual” occurrence in a community or
region of disease, specific health-related behaviour (e.g. smoking) or other
health-related events (e.g. traffic accidents) clearly in excess of “expected
occurrence”.
The amount of disease occurring in the past, in the absence of an epidemic is
called expected frequency.
Outbreak is term used for a small usually localized epidemic in the interest of
minimizing public alarm, unless the number of cases is indeed very large.