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Session Two ID Epi
Session Two ID Epi
Communicable/Infectious Disease
Epidemiology
BY:
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• Learning objectives
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• Infectious disease epidemiology
• The study of circumstances under which both
infection and disease occur in a population and the
factors which influence their frequency, spread and
distribution of infectious diseases.
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Natural History of Diseases
• It refers to the progression of a disease process in an
individual over time, in the absence of intervention.
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• Natural…
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• Stage of susceptibility
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• Stage of Pre-symptomatic (sub-clinical) disease;
• No manifestations of the disease but pathologic
changes (damages) have started to occur in the body.
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• The Clinical stage
• The person has developed signs and symptoms of the
disease.
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• Stage of disability or death
• Some diseases run their course and then resolve
completely either spontaneously or by treatment.
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• Eventually the host becomes non-infectious by,
• Clearing the infection, possibly by developing
immunity
• Therapeutic intervention, or
• Death.
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Time Course of a Disease in Relation to Its Clinical
Expression and Communicability
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• The natural history of infectiousness includes:
Pre patent period: the time interval from infection to
becoming infectious (shedding of the agent).
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Natural History of Disease …
• Reading assignment
• What is carriers?
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• Natural History of Disease …
• Models of disease Causation
• Cause of disease: is an event, condition,
characteristic or a combination of these factors
which plays an important role in producing the
disease.
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Natural History of Disease …
Natural History of Disease …
2. The epidemiologic triad or triangle
• Is the traditional model of infectious disease causation.
• Infectious diseases result from the interaction between
the infectious agent, host/reservoir and environment.
Host
Agent Environment
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Natural History of Disease …
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• Epidemiologic triad or triangle…
• The epidemiologic triangle, depicts the relationship
among three key factors in the occurrence of disease
or injury: agent, environment, and host.
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Sisay S. (Bsc., MPH in Epidemiology)
Natural History of Disease …
Natural History of Disease …
Natural History of Disease …
Necessary/primary and sufficient cause model
• Necessary cause/primary cause: A causal factor
whose presence is required for the occurrence of the
disease.
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– Rabies virus is sufficient for developing clinical rabies.
Components of Infectious Disease Process
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• Reservoirs
• Habitat, in which an infectious agent normally lives, transforms,
develops and/or multiplies.
• Reservoirs for infectious agents may be humans, animals, plants or
other inanimate objects.
• All infected humans, whether showing signs and symptoms of the
disease or not, are potential sources of infection to others.
• A person who does not have apparent clinical disease, but is a
potential source of infection to other people is called a Carrier.
• An example of carrier is a person infected with HIV.
• Some diseases are transmitted to human beings from animals. These
diseases are called zoonoses.
• E.g. Rabies, anthrax, etc.
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• Portal of Exit
• Portal of exit is the way the infectious agent leaves
the reservoir
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• Direct transmission • Indirect transmission
Direct contact
Airborne
Touching
Vehicle-borne
Kissing
Biting Vector-borne
Sexual intercourse Non-vector
Blood transfusion
intermediate host
Direct projection
Coughing,
Sneezing,
Singing
Trans-placental
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• Secondary Attack Rate
• A secondary attack rate is a measure of frequency of
new cases of a disease among the contacts of known
cases.
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• Portal of entry
• Is the site where an infectious agent enters a
susceptible host.
• Examples:
– Nasal mucosa is portal of entry for common cold
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• Susceptible human host:
• The susceptible human host is the final link in the infectious
process.
• Host susceptibility or resistance can be seen at the individual and at
the community level.
• Host resistance at the community (population) level is called herd
immunity.
• It the resistance of a population to the introduction and spread of
an infectious agent, based on the immunity of a high proportion of
individual members of the population, thereby lessening the
likelihood of a person with a disease coming into contact with
susceptible.
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• Example –
• If 90% of the children are vaccinated for measles,
the remaining 10 % of the children who are not
vaccinated might not become infected with measles
because most of the children (90 %) are vaccinated.
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Infection and Disease Outcome
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2. From infection to disease
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Cont….
3. From disease to disease outcome
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• Case study
• One hundred people attend a wedding feast, and eighty
of them ate a piece of the wedding cake. Ten of the
participant were later hospitalized with sever
gastroenteritis but fortunately none of them died. When
the incident was later investigated the infections agent
(IgM antibodies) were found in 60 of the 80 participants
who had eaten cake, including the ten hospitalized ones.
Another 20 of the 60 participants with antibodies had
reported having experience diarrhea but not serious
enough to report to health services.
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• Question
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Levels of Disease Prevention
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• Levels of Disease Prevention
• It is important for implementing interventions
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• There are several stages during the course of a disease at
which we can intervene in order to control the disease.
I. Primary prevention
• The objectives here are to promote health,
prevent exposure, and prevent occurrence of
disease.
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A. Health promotion (Primordial):
– Education,
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C. Prevention of disease:
• This is when the intervention aims to prevent
initiation of disease, in persons who may already
be exposed to agent
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III. Tertiary prevention
• Intervention that acts after permanent damage has
set in,