BIOEPI (LEC)

WEEK 10
Circa 400 BC attempted to explain
disease
Epidemiology: an overview Hippocrates occurrence from a rational
rather than a supernatural
viewpoint. In his essay
Etymology of “Epidemiology” entitled
Epidemiology comes from the Greek
“On Airs, Waters, and
word Places”
● epi- on or upon,
● demos- people Hippocrates suggested
● logos- study of that environmental and host
factors such as behaviors
might influence the
development of disease.
Definition of Epidemiology
1. The current definition of “Epidemiology Used epidemiology
is the study of the distribution (who has principles to understand
the problem) and determinants (things disease occurrence
that influence the problem) of
health-related states or events in specified
“Father of Medicine"
populations, and the application of this
“First Epidemiologist"
study to the control of health problems
contributed to the idea of
2. Epidemiology is concerned with the observation and the term
distribution and determinants of health epidemic and endemic
and diseases, morbidity, injuries, disability,
and mortality in populations. ● Epidemic- a
disease or condition
3. The study of a scientific method of that affects a greater
problem solving that helps “disease than expected
detectives” understand how people get number of
sick and die, who gets sick and dies, and individuals within the
how to avoid getting sick. populations,
community or region
Historical Milestones in Epidemiology at the same time.

Although epidemiology as a discipline has ● Endemic- the

blossomed since World War II, normal occurrence
epidemiologic thinking has been traced of disease in a
from Hippocrates through John Graunt, population
William Farr, John Snow, and others.
Epidemiology’s roots are nearly 2500 ● Pandemic –
years old. geographically
widespread, an
epidemic that occurs
in more than one
continent.

1662 published a landmark

John Graunt analysis
of mortality data in 1662.

There were many examples
of how diseases
were controlled using
research methods even
before science had caught
up with identifying
the responsible agent.
1749- He developed a vaccine
1823 against smallpox using cow
pox 160 years before the
Edward virus was identified.
Jenner
“Father of Immunology"
1813- described the association
1865 between dirty water and
cholera 44 years before the
John Snow suspect bacterium, Vibrio
cholera, was identified.
conducted a series of
investigations in London
that warrant his being
considered the “father of
field epidemiology.”
Snow conducted one of his
now famous studies in
1854 when an epidemic of
cholera erupted in the
Golden Square of
London. He began his
investigation by determining
where in this area with
cholera lived and worked.
He marked each residence
on a map of the area.Today,
this type of map, showing
the geographic the
distribution of cases is
called a spot map.
1818- described the association
1865 between childbed fever, a
Iganz life-threatening infection
Semmelweis contracted by a woman
during or shortly after
childbirth, and physicians’
unclean hands 32 years
before a causal agent was
discovered.
1716- conducted an experiment
1794 showing that scurvy, a
disease common among
James Lind sailors on long voyages
with no access to fresh
fruits or
vegetables, could be
treated and prevented with
limes, lemons, and oranges
175 years before ascorbic
acid was discovered.
1874- proved that pellagra, a
1927 disease characterized by
Joseph diarrhea, dermatitis,
Goldberger dementia and death was
not infectious but nutritional
in origin and could be
prevented by increasing the
amount of animal products
in the diet and by
substituting oatmeal for
corn grits. This
finding occurred 10 years
before the cause of
pellagra, a deficiency of
Vitamin B3 or niacin, was
discovered
1930s and Epidemiologist extended
1940s their methods to
non-infectious diseases
1948 studies by linking lung
Doll and Hill cancer to smoking and the
study of cardiovascular
disease among residents of
Framingham
Massachusetts.
1976 Legionnaire’s disease
Pneumonia outbreak
among attendees of a
convention of the American
legion at a Philadelphia
hotel
1980 Toxic Shock Syndrome
New highly absorbent
tampons introduced in
1978
Role of Epidemiology in Public Health
Practice ● to obtain relative frequencies of
the disease within subgroups, and
What can epidemiology be used for? ● to discover important trends in
1.Identifying risk for disease the occurrence of disease.
Causation – to study disease in terms of
traditional risk factors that result in illness
to estimate the actual number of cases
that will develop, and to identify the
distribution within populations.

Risk factors can be nonmodifiable

(such as age or sex) and modifiable
(such as quitting to smoke). Identifying
modifiable risk factors that can be 4.Evaluating health service
changed can lead to prevention programs
designed to control the disease. to be used for planning of future
interventions (programs and projects)

2.Determining the natural history of

disease

Natural history – to describe what

happens to people with an illness
Epidemiology is used to describe the
extent of disease in a population and the
natural history (the course of disease if left
=untreated) and characteristics of a
disease.
3.Describing the health status of
populations and undertaking surveillance
of diseases
● to enumerate the cases of
disease,
Aims of Epidemiology
The implication of these aims is that
Epidemiology has two different goals
1. The first is improved understanding of
the natural history of disease and the
factors that influence its distribution.
2. With the knowledge that is obtained
from such efforts, one can then proceed to
accomplish the second goal –
intervention.
SOURCES OF EPIDEMIOLOGIC
DATA
Epidemiologists use primary and
secondary data sources to calculate rates
and conduct studies.

Primary data
● is the original data collected for a
specific purpose or for an
investigator.
● For example, an epidemiologist
may collect primary data by
interviewing people who became ill
after eating at a restaurant in order
to identify which specific foods
were consumed.
● Collecting primary data is
expensive and time- consuming,
and it usually is undertaken only
when secondary data is not
available.
Secondary data
● is data collected for another
purpose by other individuals or
organizations.
● Examples of sources of
secondary data that are commonly
used in epidemiological studies
include birth and death certificates,
population census records, patient
medical records, disease
registries, insurance claim forms
and billing records, public health
department case reports, and
surveys of individuals and
households.
SOURCES OF EPIDEMIOLOGIC DATA
1. Vital records The purpose of vital
records is to monitor key
indicators of the health of a population.
All developed countries have
record-keeping systems to track vital
events, including births, deaths and fetal
deaths
2. Reportable diseases and conditions
One goal of public health is to protect
people
from diseases and conditions that are
preventable and to alert officials of an
emerging problem that needs to be
addressed. Because of the need to
rapidly assess potential health problems,
the national government developed a list
of reportable or notifiable
diseases/conditions (anthrax, botulism,
dengue, diphtheria, giardiasis, etc.)
3. Health surveys
Population-based health surveys
4.Registries
Listing of information. CDC defines a
registry as “an organized system for
collection, storage, retrieval, analysis, and
dissemination of information on individual
persons who have either a particular
disease, a condition
that predisposes to the occurrence of a
health-related event, or prior exposure to
substances known or suspected to cause
adverse health effects.”
STRATEGIES OF EPIDEMIOLOGY
1. examine existing facts- study
2. generate new hypothesis-
descriptive epidemiology
3. test hypothesis- analytic
epidemiology
4. conclude: generate new facts-
application
Four Phases of Epidemiologic
Approach
1. Descriptive Epidemiology
2. Analytical Epidemiology
3. Interventional/Experimental
Epidemiology
4. Evaluation Epidemiology

BIOEPI (LEC)
WEEK 11
DISEASE CAUSATION
Cause refers to something that brings
about an effect or result.
Theories of Disease Causation
● Disease was due to evil spirits
● Recovery was attributed to good
spirits
● Disease as a form of punishment
● Control measures include offering
sacrifices and “casting-out
demons”
Filth Theory
associates disease with the physical
environment
disease change with seasons, climate,
temperature, overcrowding and filth
diseases were due to poisonous
substances and gasses from the earth
“Bad air” or Miasmatic Theory
It is the notion of bad air.
Bad air was the cause of the fever.
Breathing in certain areas was proposed
to cause disease, such as air around
swamps, marshes and air at night times
was thought to cause an array of
diseases.
Building huge fires can purify the air
Programs to remove filth were put up to
advance community sanitation
Germ or Bacteriological Theory
The germ theory implies the causal effect
is one to one
i.e. a single microorganism is the culprit
behind a specific disease.
Koch confirmed Pasteur’s previous claim
that disease is due to microscopic forms
of life
Opened the concepts of isolation and
quarantine as disease control
Measures to destroy and remove the
bacteriological cause (e.g., disinfection ,
fumigation and general cleanliness) were
employed
Bacteriology – explained the origins and
spread of communicable disease
Concept of Multiple Causation Disease
results from the interaction of multiple
ecological factors within a dynamic
system made up of an agent of
disease, host and the environment
Causality on Infectious Diseases: Koch’s
Postulates
The ground work for public health
advancement
started with the work of Koch who
postulated that:
1.the suspected microorganisms should
always
be found in cases of the disease
2.microorganisms recovered from the
patient
who has the disease can be grown in the
laboratory
3.when re-introduced from the lab, the
organism should always cause disease
Causality of Noninfectious Diseases:
Bradford Hill For noninfectious diseases,
the process of establishing causality is
more complicated due to long latency
period and the possibility that there
may be multiple causes for the same
disease.
Sir Austin Bradford Hill, a British medical Characteristics of hosts that may affect
statistician, developed a list of elements to disease susceptibility:
consider. These guidelines were originally
presented as a way of determining the ● Age
causal link between a specific factor and a ● Gender
disease. ● Race or ethnicity
● Occupation
Causality based on Hill’s Aspect ● Immune status
● Behaviors such as alcohol or drug
● Temporal relationship use
● Strength
● Dose-response relationship
● Consistency - To break this leg of the triangle: prevent
● Plausibility exposure to agents and encourage
● Consideration of alternative immunization.
explanation
● Experiment End result of infection:
● Specificity 1.complete recovery
● coherence 2.permanent disability/ disfigurement
3.death
4.chronicity

Epidemiologic lever Non-specific Defense Mechanisms

● skin
Epidemiologic triangle ● mucosal surface
● tears
Agents ● saliva
Key component of the triangle acid pH of gastric juice
phagocytes & macrophages
Biological organism capable of age, nutrition
causing disease

Types
Bacteria: TB, shigellosis
Viruses and rickettsia: AIDS, hepatitis
Fungi: candidiasis, athlete’s foot
Protozoans: amoebiasis, giardiasis
Helminths: schistosomiasis, ascariasis
- To break the leg of the triangle involves
avoiding or limiting exposure to agents.
Hosts
Organisms, usually humans or animals
that are exposed to and harbor a disease.
The host can be the organism that gets
sick, or an organism that transmits an
infection, but may or may not get sick.
Goes through chain of events leading
from inapparent infection to a clinical case
of the disease
Disease-Specific Defense Mechanisms
Immune response - formation of
antibodies that are
reactive with foreign antigens
Natural, active - an infection induces an
immunologic response (host produces
antibody
against the agent)
Artificial, active - vaccination stimulates
antibody production against the agent 25
Natural, passive - maternal antibodies are
acquired by the fetus transplacentally that
confers
short-term immunity to the newborn
Artificial, passive - pre-formed antibodies
against a specific disease are
administered to an
exposed individual as a means of
prophylaxis
against the disease
26
PREVENTION AND
Environment refers to favorable CONTROL
surroundings and conditions
external to the host that cause or allow the Levels of Prevention Theory --- disease
disease evolves over time and as this
to be transmitted. Some diseases live occurs pathologic changes may become
best in dirty water whereas fixed and
others survive in human blood. Still others irreversible The aim, therefore, is to push
thrive in back the level of
warm temperatures but are killed by high detection and intervention to the
heat. External to the host, and in which precursors and
the agent may risk factors of disease This lays the
exist, survive, or originate emphasis on preventive rather than
curative medicine
27
34
Environment can be physical,
climatologic, biologic, social or Four levels of prevention can be identified,
economic in nature enhances or corresponding to different phases in the
diminishes the survival of the agent development of disease:
serves to bring agent and host into 1. Primordial prevention
contact reservoir that fosters the survival 2. Primary prevention
of infectious 3. Secondary prevention
disease agents 28 4. Tertiary Prevention

Reservoir living organism or inanimate 35

matter in which an
infectious agent normally lives and 1.Primordial prevention latest phase to be
multiplies on recognized as a result of the
which the agent depends primarily for increasing knowledge of the epidemiology
survival and of
reproduces itself in such manner that it specific diseases, e.g., cardiovascular
can be disease • the aim of this level of
transmitted to a susceptible host 29 prevention is to avoid
the emergence and establishment of the
Reservoir of infection social,
o physical environment economic and cultural patterns of living
o animals or insects that are
o human beings (main reservoirs) known to contribute to elevated risk of
disease • e.g. problems needing
primordial prevention:
urban air pollution its global effects (the
greenhouse effect, acid rain, ozone layer
Human Reservoirs depletion)
Cases
(+) infection and (+) disease
Carriers 2.Primary prevention Preventing diseases
(+) infection but (-) disease from occurring at all the prevention of the
disease by altering
31 susceptibility or reducing exposure for
susceptible
Animal Reservoirs infectious diseases of individuals these are measures which can
animals that can cause be accomplished
disease when transmitted to humans. during the pre-pathogenesis stage. 37
rabies Plague
2.Primary prevention consists of
32 measures that fall into two major
categories: a. General Health Promotion
includes provision of conditions at home,
work and
school that favor healthy living ; e.g., good
nutrition,
adequate clothing, shelter, rest and
recreation also encompasses health
education
b. Specific Protective Measures includes
immunization, environmental sanitation
and
protection against accidents and
occupational hazards 38

3.Secondary prevention To diagnose

diseases in an early stage where
treatment
or lifestyle modifications can divert the
natural course of the disease This is most
easily done by screening for early disease
and treating it in the nonclinical stage
before symptoms
are present. Refers to early detection and
prompt treatment of
disease; possible to either cure disease or
slow its
progression, prevent complications, limit
disability, and
reverse communicability of infectious
diseases 39

4.Tertiary prevention Prevent further

complications and disability Because of
our inability to prevent certain diseases,
efforts at control of many chronic diseases
center
primarily around secondary prevention
Health departments and other community
agencies
often conduct screening surveys designed
to uncover
asymptomatic disease and to alter the
natural history of the condition detected
BIOEPI (LEC)
WEEK 12

Descriptive Epidemiology