EPIDEMIOLOGY

 OF  
COMMUNICABLE  
DISEASES  
EDUARDO  V.  SORIANO,  JR.,  RPh,  MHA,  MPH  
College  of  Pharmacy,  UPH-­‐DJGTMU  
Global  Burden  of  Infectious  Disease  
(WHO  1999)  

Ê  Communicable  or  infectious  diseases  continue  to  remain  a  

leading  cause  of  morbidity,  disability  and  mortality  
worldwide  

Ê  13.3  million  deaths  out  of  a  total  of  53.9  million  deaths  (25%)  
in  1998  were  due  to  infectious  diseases  

Ê  Most  of  these  deaths  occurred  in  the  economically  

developing  countries,  contributing  1  in  2  deaths.  
Epidemiology  of  Infectious  Diseases  

Ê  Epidemiologic  triangle  as  a  model  for  disease  causation  is  

usually  invoked  to  explain  occurrence  of  infectious  diseases  

Ê  Agent,  host  and  environment  relate  to  key  topics  of  
infectious  disease  epidemiology  

Ê  Infectious  diseases  are  usually  categorized  according  to  

mode  of  transmission,  whether  or  not  they  are  vaccine-­‐
preventable,  etc.  
 Epidemiologically  significant  infectious  
diseases  
Foodborne   Person  to  Person  
     Botulism        Aseptic  meningitis  
     Clostridium  perfringens   Sexually  Transmitted        Viral  hepatitis  
     Salmonellosis        AIDS        Respiratory  infections  
     Shigellosis        Gonorrhea        Herpes  simplex  
     Staphylococcal  disease        Syphilis        Streptococcal  disease  
     Traveler’s  disease        Chlamydia  trachomatis        Tuberculosis  
     Leprosy  
Water  and  Foodborne  
     Amebiasis  
     Cholera  
Opportunistic  fungal  
     Giardiasis   Arthropod  borne   infection  
     Legionellosis        Encephalitis        Coccidomycosis  
     Lyme  disease        Candidiasis  
Vaccine  Preventable        Malaria  
     Chickenpox        Plague  
     Diphtheria        Rocky  Mountain                       Zoonotic  
     Measles   spotted  fever        Psittacosis  
     Mumps        Q  fever  
     Poliomyelitis        Rabies  
     Tetanus  
Definitions  (1)  
Ê  INFECTION  –  the  entry,  development  or  multiplication  of  an  
infectious  agent  in  the  body  tissues  of  man  or  animals  
Ê  INFECTIOUS  DISEASE  –  a  clinically  manifest  disease  of  man/animal  
resulting  from  an  infection  
Ê  COMMUNICABLE  DISEASE  –  an  illness  due  to  a  specific  infectious  
agent  or  its  toxic  products  that  arises  through  transmission  from  a  
reservoir  to  a  susceptible  host  either  directly  or  indirectly.  
Ê  Note:  some  communicable  diseases  may  not  be  infectious  BUT  all  
infectious  diseases  are  communicable.  
 Communicable  but  not  infectious:  tetanus,  botulism,  
 staphylococcal  food  poisoning  
Definitions  (2)  

Ê  INCUBATION  PERIOD  –  time  interval  between  initial  contact  

with  an  infectious  agent  and  the  first  appearance  of  
symptoms  associated  with  the  infection  

Ê  COMMUNICABLE  PERIOD  –  time  during  which  an  infectious  

agent  may  be  transferred  from  an  infected  host/reservoir  to  
another  susceptible  host  
Gradient  of  Infection  
Ê  Ranges  from  inapparent  infection  to  severe  clinical  disease  or  even  
death  

Ê  Inapparent  infection  –  infection  in  a  host  without  recognizable  

clinical  signs  or  symptoms;  identifiable  only  by  laboratory  means.  

Ê  Severe  disease  

 -­‐  high  rate  of  severe  clinical  manifestations  
 -­‐  high  case  fatality  rate  (CFR)  
 -­‐  high  proportion  of  surviving  patients  with  sequelae  
 -­‐  serious  problem  from  a  PH  standpoint  where  disease  causes  
   excess  mortality  
 A.  The  ENVIRONMENT  

Ê  Domain  that  is  external  to  the  host  and  in  which  the  agent  
may  exist,  survive,  or  originate  

Ê  Some  total  of  influences  that  are  not  part  of  the  host  and  
comprises  physical,  climatologic,  biologic,  social  and  
economic  components  

Ê  Physical:  water,  humidity,  geologic  formations,  etc.  

Ê  Social:  totality  of  the  behavioral,  personality,  attitudinal,  and  

cultural  characteristics  of  a  group  of  people    
Role  of  environmental  in  infectious  
transmission  

Ê  May  enhance  or  diminish  the  survival  of  the  agent  and  may  
serve  to  bring  agent  and  host  into  contact  

Ê  May  act  as  a  reservoir  that  fosters  the  survival  of  infectious  
disease  agent  
Reservoir  
Ê  Living  organisms  or  inanimate  matter  in  which  an  infectious  agent  
normally  lives  and  multiplies  on  which  the  agent  depends  primarily  
for  survival  and  reproduced  itself  in  such  manner  that  it  can  be  
transmitted  to  a  susceptible  host  
Ê  The  reservoir  may  be:  

•  Part  of  the  physical  environment  (e.g.  contaminated  water  

supply  of  food  for  cholera  and  typhoid)  
•  Animals  or  insect  (vector)  
•  Zoonoses  
•  Main  reservoir:  cases  and  carriers  
 B.  Infectious  Agents  

Ê  The  types  of  infectious  agents:  

•  Bacteria:  TB,  shigellosis  

•  Viruses  and  rickettsia:  AIDS,  hepatitis  

•  Fungi:  candidiasis,  athlete’s  foot  

•  Protozoans:  amoebiasis,  giardiasis  

•  Helminthes:  schistosomiasis,  ascariasis  

 
 B.  Infectious  Agents  

Ê  Intrinsic  properties  

 -­‐  properties  of  infectious  agents  that  do  not  need  any  
 interaction  with  host  
 B.  Infectious  Agents  

Ê  Properties  relating  to  host-­‐agent  interactions:  

•  Infectivity  

•  Immunogenicity  

•  Pathogenicity  

•  Virulence  

•  Toxigenicity  

•  Resistance  
Infectivity  
Ê  Ability  of  an  agent  to  enter  and  multiply  in  a  susceptible  host  and  
produce  infection  

Ê  Basic  measure  is  infective  dose  

Ê  High  infectivity:  polio  and  measles  

Ê  Measured  by:    

•  secondary  attack  rate  (SAR)  –  proportion  of  close  contacts  

who  become  infected.  

•  serologic  surveys  after  epidemics  to  determine  the  infection  

rate  (IR)  
Immunogenicity  

Ê  Infection’s  ability  to  produce  specific  immunity  in  the  host  
e.g.  measles  

Ê  Immunity  –  resistance  associated  with  the  presence  of  

antibodies  or  cells  having  a  specific  action  on  the  
microorganisms  or  on  its  toxin  

Ê  Measured  by  serologic  surveys  

 
Pathogenicity  

Ê  Ability  to  produce  clinically  apparent  illness  in  an  infected  
population  

Ê  Measles  has  high  pathogenicity  (few  subclinical  disease)  

Ê  Polio  has  low  pathogenicity  (most  cases  are  subclinical)  

Ê  Measured  by  proportion  of  infection  which  results  in  disease  
Virulence  

Ê  Extent  to  which  severe  disease  is  produced  in  a  population  
with  clinically  manifested  disease  

Ê  Rabies  is  very  virulent  

Ê  Measured  by:  

•  Case  fatality  ratio  (CFR)  

•  Proportion  of  severe  cases  

Toxigenicity    

Ê  Capacity  of  the  agent  to  produce  a  toxin  or  poison  

Ê  Disease  results  from  the  toxin  produced  by  the  agent  rather  
than  from  the  agent  itself  
Resistance    

Ê  Ability  of  the  agent  to  survive  adverse    environmental  

conditions  

Ê  Agents  of  coccidomycoses  and  hepatitis  are  highly  resistant  

Ê  Gonococci  and  influenza  virus  are  fragile  

 C.  The  Host  

Ê  The  host  after  exposure  to  the  agent  may  progress  through  a  
chain  of  events  leading  from  subclinical  (inapparent)  
infection  to  a  clinical  case  of  the  disease  

Ê  The  end  result  may  be  complete  recovery,  permanent  

disability,  or  death  

Ê  Degree  of  infection  and  disease  severity  depends  on  the  
defense  mechanisms  (immunity)  of  the  host  

Ê  Immunity  refers  to  the  resistance  of  the  host  to  a  disease  
agent  
Mechanisms  of  Transmission  
Ê  Direct  

•  Immediate  and  direct  contact:  person  to  person  

•  Droplet  spray  

Ê  Indirect  

•  Vector-­‐borne  –  mechanical  or  biological  transmission  by  an  

arthropod  

•  Vehicle-­‐borne  –  infected  blood  on  used  needles,  fomites  

•  Airborne  –  droplet  nuclei,  dusts  

 Community  Reactions  to  Agent  
(sum  total  of  the  reactions  of  individuals  comprising  the  group)  

1.  Sporadic  

•  Intermittent    presence  of  a  disease;  occurrence  of  a  few  cases  every  now  and  then  often  without  
relationship  to  each  other  

2.  Endemic  

•  Constant  presence  of  a  disease  within  a  geographical  area;  hyperendemic  –  indicates  persistent  
and  intense  transmission  

3.  Epidemic  

•  Occurrence  in  a  community  of  cases  of  an  illness  clearly  in  excess  of  normal  expectancy  

4.  Pandemic  

•  An  outbreak  of  exceptional  proportion  spreading  quickly  from  one  area  to  another;  epidemic  of  
worldwide  proportion  

 
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