Title of lecture: General epidemiology of communicable diseases (2)

Number of Lecture: (2)

Instructor: Asmaa El-Sayed Awaad.
Department: Public Health & Community Medicine.

Definitions
 Infection: Entry, development &/or multiplication of the infectious agent in the
body of man or animal
Depending on factors in both host and organism; infection results into either:
1. A clinically manifest disease (Infectious disease).
Or
2. The presence of infection without recognizable clinical signs or
symptoms and identifiable only by laboratory means (Inapparent
infection-subclinical infection).
 Infestation: The lodgment, development, and reproduction of a parasite on the
body surface or inside body tissues.
 Contamination: The presence of an infectious agent on a body surface, in
clothes, bedding, toys, surgical instruments or dressings, or other inanimate
articles or substances including water and food.
 Communicable disease: An illness due to a specific infectious agent or its toxins
that arises through transmission from an infected person, animal or inanimate
reservoir to a susceptible host; either directly or indirectly.
 Latent infection: Infectious agent lies “dormant” within the host without clinical
manifestations.
It reactivates under certain conditions causing the disease.
Ex: herpes zoster, Pulmonary tuberculosis
 Opportunistic infection: Nonpathogenic agents, cause disease when host
immunity decreased
Ex: Pneumocystis carinii, Toxoplasma, and CMV.
 Zoonotic infection: An infection or infectious disease transmissible under natural
conditions from vertebrate animals to humans.
Important international terms related to communicable
diseases
 World Health Organization (WHO): A part of the United Nations that deals
with major health issues around the world. The World Health Organization sets
standards for disease control, health care, and medicines; conducts education and
research programs; and publishes scientific papers and reports. The headquarters
are located in Geneva, Switzerland.
 WHO regions: The Member States of the WHO are grouped into six regions
based on geographical terms.

African (47 countries)

European (53 countries)
Eastern Mediterranean (22countries)
Pan American (35 countries)
South East Asia (11 countries)
Western Pacific (26 countries)

International Health Regulations (IHR): instrument of international law that is legally-

binding on 196 countries including 194 member states of WHO. They create rights and
obligations for countries, including the requirement to report public health events. The
Regulations also outline the criteria to determine whether or not a particular event
constitutes a “public health emergency of international concern” and address the required
health documents for international travel and transport.
Public health Emergency of International Concern (PHEIC): is a formal declaration
by WHO of ‘an extraordinary event which is determined to constitute a public health risk
to other States through the international spread of disease and to potentially require a
coordinated international response’, The IHR decision algorithm assists in deciding
whether a potential PHEIC exists and the WHO should be notified. The WHO should be
notified if any two of the four following questions are affirmed:
 Is the public health impact of the event serious?
 Is the event unusual or unexpected?
 Is there a significant risk for international spread?
 Is there a significant risk for international travel or trade restrictions?
Types of occurrence and spread (distribution) of infectious
diseases in communities
 Sporadic: The infrequent and irregular occurrence of a disease (without common
source of infection).
 Cluster: The aggregation of cases grouped in place and time.
 Endemic: The constant presence of an infectious disease within a given
geographic area; it may also refer to the usual prevalence (baseline level) of a
given disease within such area.
Endemicity of a disease is determined by the existence of its ecological factors
(agent, host and environment).
 Epidemic: An increase in the number of cases of a disease above what is
normally expected in that population in that area.
The number of cases indicating epidemic varies according to the infectious agent,
size and type of population and time and place of occurrence.
 Epidemic threshold: The critical number or incidence above which an urgent
measures is required to control the emerging epidemic. Each disease has a
specific threshold that depends on its infectivity, transmissibility and the degree of
endemicity in a locality.
 Outbreak: Epidemic in limited geographic area or confined group.
 Pandemic: Epidemic that spreads over several countries or continents (Epidemic
that crosses international borders).
Epidemics, outbreaks or pandemics occur when an agent and susceptible hosts are
present in adequate numbers, and the agent can be effectively conveyed from a
source to the susceptible hosts.
More specifically, an epidemic may result from:
Agent factors: recent introduction, increase in number, virulence, enhanced mode
of transmission
Host susceptibility: no or low immunity to the agent, new portals of entry.

Time trends of occurrence of infectious diseases

The occurrence of disease changes over time. Some of these changes occur
regularly, while others are unpredictable.
  Secular (long-term) trends: Some diseases show changes in the occurrence of
disease over a long period of time (long-term variation in the occurrence) e.g.,
measles.

 Seasonal trend: Some diseases such as influenza and West Nile infection are
known to have characteristic seasonal distributions. Seasonal patterns may
suggest hypotheses about how the infection is transmitted, what behavioral
factors increase risk, and other possible contributors to the disease or condition.

 Day of week and time of day: in conditions related to occupational or

environmental exposures that tend to occur at regularly scheduled intervals.
Epidemiologic weeks:
 Commonly referred as EPI week is a standardized method of counting weeks to
allow for the comparison of data year after year in the same locality and between
countries in the same year.
 A typical week starts on Sunday and ends on Saturday.
 The first EPI week of the year ends on the first Saturday of January as long as it
falls at least four days into the month.
 The division of the 365 days of the year in 52 or 53 Epi weeks is known as the
epidemiological calendar which describes the epidemiological year.
Natural History of Disease
It is the progress of a disease in an individual over time in absence of intervention
The outcome of any infection depends on two opposing forces:
1. Invading organism: Dose, pathogenicity, and virulence.
2. The host: Body resistance and immunity.

Chain of infection (infectious cycle)

 A chain of factors necessary for the Development & maintenance of any
infectious disease in the community.
 Knowledge of this cycle is essential to understand how infection can occur.
 All precautions and measures taken in order to prevent and control infection are
based on the interruption of this cycle.
Components of infectious cycle
(1) Causative agent
(2) Reservoir:
 Types.
 Portal of exit.
 Period of infectivity.
(3) Mode of transmission
(4) Host:
 Portal of entry.
 Incubation period.
 Susceptibility & resistance.
Causative agent
Infectious agent: An organism (virus, bacteria, fungus, protozoa or helminth) that is
capable of producing infection or infectious disease.

Agent factors that affect disease behavior:

Infectivity:
 Ability of agent to produce infection (invade, survive and multiply) in a
susceptible host
 Measured by the secondary attack rate (Proportion of exposed susceptible who
become infected)
 Secondary attack rate = (Number of secondary cases ÷ Number of exposed
susceptible) X100

Pathogenicity:
 Ability of the organism to produce overt clinical reaction after infection.
 Measured by the ratio of clinical to subclinical case

Virulence:
 The degree of pathogenicity of an infectious agent
 The ability of organism to produce severe pathological reaction (death or
irreversible damage).
 It is measured by case fatality rates.
 Case fatality rate= (Total number of deaths from a disease/Total number of cases
of that diseases) X100

Antigenicity (Immunogenicity):
 The ability of organism to produce specific immunity (antibodies).
 It is measured by rate of occurrence of a second attack (Re-infection).

Resistance:
 The ability of the agent to survive adverse environmental conditions.