THE SCOPE OF

EPIDEMIOLOGY
Veterinary Public Health and
Epidemiology Unit II
Definition of Epidemiology:

• The word 'epidemiology', based on its Greek roots (epi-) = upon, (demo-) = people, and
(logo-) = discoursing, is 'the study of that which is upon the people' or, in modern
parlance, 'the study of disease in populations.

• Traditionally, 'epidemiology' related to studies of human populations

“Epidemiology is the study of disease in

populations and of factors that determine
its occurrence.”

• Veterinary epidemiology additionally includes investigation and assessment of other

health-related events, notably productivity.

• ‘Epizootiology', from the Greek (zoo-) = animal, to the studies of animal (excluding
human) populations
 The Uses or Objectives of epidemiology

1 . Determination o f the origin o f a disease whose cause is known.

2. Investigation and control of a disease whose cause is either unknown or

poorly understood.

3. Acquisition of information on the ecology and natural history of a disease.

4. Planning, monitoring and assessment of disease control programmes.

5. Assessment of the economic effects of a disease, and analysis of the costs

and economic benefits of alternative control programmes.
Types of epidemiological investigation or Types of Epidemiology

They are of four types.

1. Descriptive epidemiology: Descriptive epidemiology involves observing and

recording diseases and possible causal factors. It is usually the first part of an
investigation. The information recorded may generate hypotheses that can be
tested more rigorously later.

2. Analytical epidemiology: Analytical epidemiology is the analysis of observations

using suitable diagnostic and statistical procedures.

3. Experimental epidemiology: Experimental epidemiologists observe and analyse

data from groups of animals from which they can select, and in which they can
alter, the factors associated with the groups. An important component of the
experimental approach is the control of the groups.

4. Theoretical epidemiology: Theoretical epidemiology consists of the

representation of disease using mathematical 'models' that attempt to simulate
natural patterns of disease occurrence.
Epidemiological subdisciplines
These generally reflect different areas of interest, rather than different techniques.

They all apply the four types of epidemiology described before, and can overlap, but
their separate identities are considered by some to be justifiable.

1. Clinical epidemiology: Clinical epidemiology is the use of epidemiological

principles, methods and findings in the care of individuals, with particular reference
to diagnosis and prognosis

2. Computational epidemiology: involves the application of computer science to

epidemiological studies . This includes the representation of disease by
mathematical models and the use of expert systems.

3. Genetic epidemiology: is the study of the cause, distribution and control of disease
in related individuals, and of inherited defects in populations.

4. Field epidemiology: Field epidemiology is the practice of epidemiology in response

to problems of a magnitude significant enough to require a rapid or immediate
action (shoe-leather epidemiology’ or Intervention epidemiology)
5. Molecular epidemiology: The application of molecular techniques like nuclear acid
fingerprinting and hybridization, restriction enzyme analysis, PCR, monoclonal
antibodies etc. to study small genetic and antigenic differences between micro
organisms

6. Chronic disease epidemiology: is involved with diseases of long duration (e.g.,

cancers),many of which are non-infectious.

7. Environmental epidemiology: is concerned with the relationship between

8. disease and environmental factors such as industrial pollution and, in human
medicine, occupational hazards.

9. Micro-epidemiology: is the study of disease in a small group of individuals with

respect to factors that influence its occurrence in larger segments of the population.
For example, studies of feline acquired immunodeficiency syndrome (FAIOS) in
groups of kittens have provided insights into the widespread human disease, AIDS

10. Macro-epidemiology: is the study of national patterns of disease, and the social,
economic and political factors that influence them
10. Serological epidemiology: It involves application of serological tests for the
investigation of various diseases.

11. Predictive epidemiology: It deals with forecasting of possible diseases on the basis of
ecological and environmental parameters.

12. Nutritional epidemiology

13. Sub clinical epidemiology

Components of epidemiology
The first stage in any investigation is the collection of relevant data.

Investigations (data) can be either qualitative or quantitative or a combination of these two

approaches.

Qualitative investigations
The ecology of diseases, including the distribution, mode of transmission and maintenance
of infectious diseases, is investigated by field observation

Field observations also may reveal information about factors that may directly or indirectly
cause disease.
If field observations suggest that certain factors may be causally associated with a disease,
then the association must be assessed by formulating a causal hypothesis.

Quantitative investigations

Quantitative investigations involve measurement (e.g., Morbidity, Mortality, economic

evaluation of the disease, modelling), and therefore expression and analysis of numerical
values.

The interplay between epidemiology and other sciences

During the first half of the 20th century most epidemiologists were trained initially as
bacteriologists, reflecting epidemiologists' early involvement in the qualitative investigation
of outbreaks of infectious disease.

The epidemiological approach, however, is now practiced by veterinarians from many

disciplines:
• The geneticist concerned with an hereditary defect in a population.
• The nutritionist investigating a deficiency or toxicity.
• The clinician concerned with risk factors for non-infectious diseases such as cancer.
• Statisticians analysing data from groups of animals.
• Mathematicians modelling diseases.
• Economists assessing the economic impact of disease.
• Ecologists studying the natural history of disease.

Each of these sciences is concerned with different facets of epidemiology, ranging

from the purely descriptive, qualitative approach to the quantitative analytical approach.

The relationship between epidemiology and other diagnostic disciplines

The biological sciences form a hierarchy, ranging from the study of non-replicating
molecules to nucleic acids, organelles, cells, tissues, organs, systems, individuals, groups
and, finally, whole communities and ecosystems

The various disciplines in veterinary medicine operate at different levels in this hierarchy.

Histologists and physiologists study the structure and dynamics of the individual.

Pathologists are concerned with disease processes in the individual, pathologists interpret
lesions to produce a diagnosis

Clinicians diagnose disease using signs displayed by the patient

Epidemiologists investigate populations, using the frequency and distribution of disease to
produce a diagnosis (healthy, sick and dead).

These three diagnostic disciplines, operating at different levels in the hierarchy, are
complementary

Epidemiologists, dealing with the higher levels, must have a knowledge of those disciplines
'lower' in the hierarchy

This means that they must adopt a broad rather than a specialist approach, avoiding the
dangers of the specialist

The major attributes required to become a competent veterinary epidemiologist are

• A natural curiosity
• A logical approach
• A general interest in and knowledge of, veterinary medicine
• Experience of the realities of animal disease
Koch's postulates

Robert Koch in the late 19th century, to determine the cause of infectious disease
These state that an organism is causal if:

• It is present in all cases of the disease;

• It does not occur in another disease as a fortuitous and non-pathogenic parasite;
• It is isolated in pure culture from an animal, is repeatedly passaged, and induces the
same disease in other animals.

Few would argue that an organism fulfilling the above criteria does not cause the disease
in question, but is it the sole and complete cause?

Koch provided a rigid framework for testing the causal importance of a microorganism but
ignored the influence of environmental factors

There was dissatisfaction due to these postulates in different groups

Some microbiologists thought that the postulates were too difficult to satisfy because
there can be obstacles to fulfilling Koch's postulates with some infectious agents that are
causes of disease
Others thought that the postulates were insufficient because they did not specify the
environmental conditions that turned vague associations into specific causes of disease.

Furthermore, the postulates were not applicable to non-infectious diseases.

Evans' rules
Alfred Evans (I 976) has produced a set of rules that are consistent with modern concepts of
causality:

• The proportion of individuals with the disease should be significantly higher in those
exposed to the supposed cause than in those who are not;
• Exposure to the supposed cause should be present more commonly in those with than
those without the disease, when all other risk factors are held constant;

•
• The number of new cases of disease should be significantly higher in those exposed to the
supposed cause than in those not so exposed, as shown in prospective studies;

• Temporally, the disease should follow exposure to the supposed cause with a distribution of
incubation periods on a bell-shaped curve

• A spectrum of host responses, from mild to severe, should follow exposure to the supposed
cause along a logical biological gradient;
• A measurable host response (e.g., antibody, cancer cells) should appear regularly following
exposure to the supposed cause in those lacking this response before exposure, or should
increase in magnitude if present before exposure; this pattern should not occur in
individuals not so exposed;

• Experimental reproduction of the disease should occur with greater frequency in animals
or man appropriately exposed to the supposed cause than in those not so exposed; this
exposure may be deliberate in volunteers, experimentally induced in the laboratory, or
demonstrated in a controlled regulation of natural exposure;

• Elimination (e.g., removal of a specific infectious agent) or modification (e.g., alteration of

a deficient diet) of the supposed cause should decrease the frequency of occurrence of the
disease;

• Prevention or modification of the host's response (e.g., by immunization or use of specific

lymphocyte transfer factor in cancer) should decrease or eliminate the disease that
normally occurs on exposure to the supposed cause;

• All relationships and associations should be biologically and epidemiologically credible.

Variables
“A variable is any observable event that can vary”

Examples of variables are the weight and age of an animal and the number of cases of
disease.

Study variable
A study variable is any variable that is being considered in an investigation.

Response and explanatory variables

A response variable is one that is affected by another (explanatory) variable.

In epidemiological investigations, disease is often the response variable.

For example, when studying the effects of dry cat food on the occurrence of urolithiasis,
cat food is the explanatory variable and urolithiasis is the response variable.

Types of association
Association is the degree of dependence or independence between two variables.
There are two main types of association
1 . Non-statistical association;
2. Statistical association.
Non-statistical association
A non-statistical association between a disease and a hypothesized causal factor is an
association that arises by chance

For example, Mycoplasma felis has been isolated from the eyes of some cats with
conjunctivitis. This represents an association between the mycoplasma and conjunctivitis in
these cats.
However, surveys have shown that M. felis also can be recovered from the conjunctivae of
80% of apparently normal Cats.

Analysis revealed that the association between conjunctivitis and the presence of M. felis
arose by chance: the mycoplasma could be present in healthy cats as well in those with
conjunctivitis.

Therefore factor cannot be inferred to be causal

Statistical association
Variables are positively statistically associated when they occur together more frequently
than would be expected by chance.

They are negatively statistically associated when they occur together less frequently
than would be expected by chance.
Positive statistical associations may therefore indicate a causal relationship

However, not all factors that are positively statistically associated with a disease are
necessarily causal.
Explanatory and response variables can be causally associated either directly or indirectly
Confounding
Confounding (Latin: confundere = to mix together) is the effect of an extraneous variable
that can wholly or partly account for an apparent association between variables.

Confounding can produce a spurious association between study variables, or can mask a
real association.

A variable that confounds is called a confounding variable or confounder.

A confounding variable generally must;

• be a risk factor for the disease that is being studied; and

• be associated with the explanatory variable, but not be a consequence of exposure to it.

An e.g. of confounding effect in relation to respiratory disease in pigs

A statistical association was demonstrated between fan ventilation and respiratory

disease. This was not because fan ventilation caused respiratory disease. The association
resulted from the confounding effect of herd size: large herds are more likely to develop
respiratory disease than small herds, and are also more likely to have fan ventilation rather
than natural ventilation.
What is a confounding variable?

Confounding variables (a.k.a. confounders or confounding factors) are a type of

extraneous variable that are related to a study’s independent and dependent variables. A
variable must meet two conditions to be a confounder:

• It must be correlated with the independent variable. This may be a causal relationship,
but it does not have to be.
• It must be causally related to the dependent variable.
Example of a confounding variable

You collect data on sunburns and ice cream consumption. You find that higher ice cream
consumption is associated with a higher probability of sunburn. Does that mean ice cream
consumption causes sunburn?
Here, the confounding variable is temperature: hot temperatures cause people to both eat
more ice cream and spend more time outdoors under the sun, resulting in more sunburns.
The relationship of causes to their effects allows classification of causes into two types

• Sufficient causes
• Necessary causes

A cause is sufficient if it inevitably produces an effect. A sufficient cause virtually always

comprises a range of component causes; disease therefore is multifactorial

For example, distemper virus is referred to as the cause of distemper, although the sufficient
cause actually involves exposure to the virus, lack of immunity and, possibly, other
components.

A particular disease may be produced by different sufficient causes. The different sufficient
causes may have certain component causes in common.

If a cause is a component of every sufficient cause, then it is necessary

Therefore, a necessary cause must always be present to produce an effect.

Component causes therefore include factors that have been classified as:
• Predisposing factors, which increase the level of susceptibility in the host (e.g., age and
immune status);

• Enabling factors, which facilitate manifestation of a disease (e.g., housing and nutrition);

• Precipitating factors, which are associated with the definitive onset of disease (e.g., many
toxic and infectious agents);

• Reinforcing factors, which tend to aggravate the presence of a disease (e.g., repeated
exposure to an infectious agent in the absence of an immune response).

The object of epidemiological investigations of cause is the identification of sufficient

causes and their component causes. Removal of one or more components from a sufficient
cause will then prevent disease produced by that sufficient cause.

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