Althea Joyce C.

Corro
Coverage: iv.
8. Chain of Infection
2.1 Epidemiology: Disease Transmission
a. Agent
and Chain of Infection
b. Reservoir
c. Point of Exit
Types of Tests: d. Mode of transmission
● e. Point of Entry
f. Susceptible Host
Glossary (Terms I think are important)
1. Spanish Flu
2. H1N1
3. Epidemiology
a. Scientific discipline
b. Scientific inquiry
c. Data driven
d. Systematic and unbiased
e. Basic science
f. Scientific methods of descriptive and
analytic epidemiology
g. Experience
h. epidemiologic judgment
i. understanding of local conditions
4. Communicable diseases
5. Non-communicable diseases
6. Direct contact
a. Skin to skin
b. Kissing
c. Sexual intercourse
d. Contact of infected soil/vegetation
e. Droplet Spread
7. Indirect Transmission
a. Airborne
i. Dust
ii. Droplet Nuclei
b. Vehicles and Fomites
i. Food
ii. Water
iii. Biological Products
1. blood
iv. Fomites
1. Objects that hold
infectious particles
2. Beddings, surgical
instruments, etc.
c. Vectors
i. Mosquitoes
ii. Flies
iii. Fleas
Althea Joyce C. Corro
2.1 Epidemiology: Disease Transmission and
Chain of Infection
Spanish Flu
● Caused by the H1N1 virus
● AKA great influenza pandemic in 1918
● One of the survivors of the flu
○ Franklin Delano Roosevelt
○ Walt Disney
Why is Cov-19 compared to Spanish Flu
● Staggering number of deaths caused by the
virus
● Both diseases are compared because both
viruses are “novel.”
● In the era when they infected people, no one
had immunity to them.
● Contrast
○ Spanish Flu
■ Most affected groups were relatively
young adults between 20 to 40 years
old.
○ Cov-19
■ Affected adults over the age of 65 with
underlying health conditions
■ Most children have much milder
symptoms.
Epidemiology
What is it?
● Study of the distribution and determinants of
health-related states or events in specified
populations.
● A scientific discipline that employs sound
methods of scientific inquiry
● Data-driven
○ relies on a systematic and unbiased
approach to the (CAI)
■ Collection
■ Analysis; and
■ Interpretation of data.
● Basic science of public health because it is
applied in the control of health problems.
● The following are used in “diagnosing” the
health of a community and proposing
appropriate, practical, and acceptable
interventions to control and prevent disease.
○ Scientific methods of descriptive and
analytic epidemiology
○ Experience
○ epidemiologic judgment
○ understanding of local conditions
FUN FACT:
“Contagion”
● One of the most popular movies which featured
the science of epidemiology is
Types of Diseases
Two general types of diseases:
1. Communicable diseases
a. Comprise infectious diseases such
as tuberculosis and measles
2. Non-communicable diseases
a. mostly chronic diseases such as
cardiovascular diseases, cancers,
and diabetes.
Infectious diseases are transmitted from person to
person by direct or indirect contact.
Direct Contact
● Occurs through
○ skin-to-skin contact
○ Kissing
○ Sexual intercourse
○ Contact with infected soil or vegetation;
○ Contact via droplet spread.
● Droplet spread refers to
○ spray with relatively large, shortrange
aerosols
○ Produced by sneezing, coughing, or even
talking.
○ classified as direct because transmission is
by direct spray over a few feet, before the
droplets fall to the ground.
Indirect Transmission
● Refers to the transfer of an infectious agent
from a reservoir to a host by
○ suspended air particles (airborne)
○ inanimate objects (vehicles or fomites)
Althea Joyce C. Corro
○ Animate intermediaries (vectors) ■ Fleas carry Yersinia pestis in their gut.
○ Ticks
Airborne transmission ● In the case of biologic transmission, the
● Infectious agents are carried by dust or droplet causative agent of malaria or guinea worm
nuclei suspended in air. disease undergoes maturation in an
○ Dust particles intermediate host before it is transmitted to
■ The dust includes material that settles humans.
on surfaces and are suspended again
through air currents, as well as Chain of Infection (ARPMPS)
infectious particles blown from the soil 1. Agent
by the wind. 2. Reservoir
○ Droplet nuclei 3. Portal of Exit
■ dried residue of less than 5 microns in 4. Mode of transmission
size. 5. Portal of entry
■ Droplet nuclei may remain suspended in 6. Susceptible host
the air for long periods of time and may
be blown over great distances. Traditional epidemiologic triad model
■ For instance, measles can occur in ● infectious diseases result from the interaction of
children who come into a physician's agent, host, and environment.
office after a child with that disease ● Transmission
leaves because the virus remained ○ agent leaves its reservoir or host through a
suspended in the air. portal of exit

Vehicles or Fomites Agent

● Includes ● Infectious microorganism or pathogen:
○ Food ○ Virus
○ Water ○ Bacteria
○ biologic products (i.e. blood) ○ Parasite
○ fomites (inanimate objects such as ○ Other microbes
handkerchiefs, bedding, or surgical ● Presence of agent is necessary for disease
scalpels). ● BUT, agent alone is not enough
● A vehicle may
○ passively carry a pathogen A variety of factors influence whether
■ Ex: hepatitis A. exposure to an organism will result in disease,
○ provide an environment in which the agent including the organism's pathogenicity and dose.
grows, multiplies, or produces toxins
■ Ex: improperly canned foods that Reservoir
support production of botulinum toxin by ● habitat in which it lives, grows, and multiplies.
Clostridium botulinum. ● Examples
○ humans, animals, and the environment
Vectors ● May or may not be the source from which an
● Vectors may carry an infectious agent through agent is transferred to a host.
mechanical means or they may support growth ● For example
or changes in the agent. ○ Reservoir of Clostridium botulinum = soil
○ Mosquitoes ○ Source of most botulism infections =
○ Flies improperly canned food containing its
■ flies carry Shigella on their appendages spores.
○ Fleas
Althea Joyce C. Corro
● Many common infectious diseases have human
reservoirs.
● Person-to-person diseases w/o intermediaries
○ sexually transmitted diseases
○ Measles
○ mumps
○ streptococcal infection
○ many respiratory diseases.
● Incubatory carriers
○ can transmit the agent during the incubation
period before clinical illness begins
● Convalescent carriers
○ have recovered from their illness but remain
capable of transmitting to others.
● Chronic carriers
○ continue to harbor a pathogen (such as
hepatitis B virus or Salmonella typhi) for
months or even years after their initial
infection.
● Symptomatic persons
○ aware of their illness, and may be less likely
to transmit infection because
■ they are either too sick to be out and
about.
■ They take precautions to reduce
transmission
■ Receive treatment that limits the
disease.
Animal Reservoirs
● Mostly animal-to-animal
○ Sometimes humans become incidental
hosts
● Zoonotic diseases
○ brucellosis (cows and pigs)
○ anthrax (cows)
○ plague (rodents)
○ trichinellosis/trichinosis (swine)
○ Tularemia (rabbits)
○ rabies (bats, cats, dogs, and other
mammals)
○ encephalitis (birds).
● Many newly recognized infectious diseases in
humans, including HIV/AIDS, Ebola infection,
SARS, and CoVid-19 are thought to have
emerged from animal hosts.
Plants, soil, and water reservoirs
● Many fungal agents (i.e. histoplasmosis
agents), live and multiply in the soil.
● Outbreaks of Legionnaire’s disease are often
traced to water supplies in cooling towers and
evaporative condensers.
Portal of Exit
● Path by which a pathogen leaves its host
● Usually corresponds to the site where the
pathogen is localized.
● Examples
○ influenza viruses and Mycobacterium
tuberculosis : respiratory tract
○ schistosomes exit : urine
○ Vibrio cholera : feces
○ Sarcoptes scabiei : skin lesions
○ enterovirus 70 : conjunctival secretions
○ Bloodborne agents : placenta (rubella,
syphilis, toxoplasmosis), cuts or needles in
the skin (hepatitis B) or blood-sucking
arthropods (malaria).
Portal of Entry
● manner in which a pathogen enters a
susceptible host.
● It provides access to tissues in which the
pathogen can multiply or a toxin can act.
● Often agents use same portal to enter and exit
○ influenza virus exits the respiratory tract of
the source host and enters the respiratory
tract of the new host.
○ Those that cause gastroenteritis follow a
so-called “fecal-oral” route because they
exit the source host in feces, are carried on
inadequately washed hands to a vehicle
such as food, water, or utensil, and enter a
new host through the mouth.
● Other portals of entry include
○ skin (hookworm)
○ mucous membranes (syphilis)
○ blood (hepatitis B, human immunodeficiency
virus).
Susceptible Host
● Susceptibility depends on
○ genetic or constitutional factors
○ specific immunity
Althea Joyce C. Corro
■ refers to protective antibodies that are
directed against a specific agent.
■ Antibodies may develop in response to
infection, vaccine, or toxoid.
■ They may also be acquired by
trans-placental transfer from mother to
fetus, or by injection of antitoxin or
immune globulin.
○ nonspecific factors
■ include the
● Skin
● mucous membranes
● Gastric acidity
● cilia in the respiratory tract
● the cough reflex
● other nonspecific immune
responses.
○ genetic makeup
● For example, persons with sickle cell trait is at
least partially protected from a type of malaria
● Factors that increase susceptibility to infection:
○ Malnutrition
○ Alcoholism
○ Disease/therapy that impairs the nonspecific
immune response.

Knowledge of the portals of exit and entry and

modes of transmission provides a basis for
determining appropriate control measures. These
measures are directed against the segment in the
infection chain that is most susceptible to
intervention.

Interventions are directed at:

(a) controlling or eliminating an agent at its
source of transmission
(b) protecting portals of entry
(c) increasing a host 's defenses