CHN: Concept 2 (Part 2)

Ms. Pepito

EPIDEMIOLOGY
What is epidemiology?
- Epi: on/upon
- Demos: people
- Logos: study of
o The study of what befalls a population
- It is the study of occurrences and distribution of diseases as well as the distribution and
determinants of health status or events in a specified population, and the application to the
control of health problems.
- Epidemiologists are concerned with more positive health states and the means to improve
health.
- It is the “backbone” of disease prevention.

Two main areas of Investigation

- study of the distribution of disease (demographics)
- search for the determinants (causes) of the disease and its observed distributions

What are the uses of Epidemiology?

- Study the history of the health population and the rise and fall of diseases.
- Diagnose the health of the community and the condition of people to measure the distribution
and dimension of illness in terms of incidence, prevalence, disability and mortality, to set health
problems in perspective. to define their relative importance and identify groups needing special
attention.
- Study the work of health services with a view of improving them.
- Estimate the risk of disease, accident, defects and the chances of avoiding them.
- Identify syndromes by describing the distribution and association of clinical phenomena in the
population.
- Complete the clinical picture of chronic disease and describe their natural history.
- Search for causes of health and disease by comparing the experience of groups that are clearly
defined by their composition, inheritance, experience, behavior and environments.

Models of Disease Causation

1. Epidemiologic Triangle
o Host, or organism harboring the disease (the “who”)
o Environment, or those external factors that cause or allow disease transmission (the
“where”)
o Agent, or microbe that causes the disease (the “what”)

Classification of Agents, Host and Environmental Factors

which determine the occurrence of Disease in the Human Population

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Ms. Pepito

- AGENTS:
o Nutritive elements (excess and
deficiencies)
o Chemical agents (poisons, allergens)
o Physical agents
o Infectious agents
- HOST:
o Genetics
o Age
o Sex
o Ethnic Group
o Physiologic
o Immunologic
o Inter-current or Pre-existing disease
o Human behavior
- ENVIRONMENT:
o Physical
o Biologic (humans, flora)
o Socio-economic (occupation, organization, disruption)

2. The Wheel Model of Disease Causation

o This was proposed by Mausner and Kramer in 1985.
o It eliminates the agent as a sole cause of disease, but
emphasizes the complex interaction of physical, biological,
and social environments.
o It also introduces genetics into the mix. The outer
circumference is divided between environmental factors
comprising of social, biological, and physical factors. The
core depicts the genetic component.

Patterns of Disease Occurrence and Distribution

1. Sporadic - intermittent occurrence of a few isolated and unrelated cases in a given locality.

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2. Endemic - Continuous occurrence throughout a period of time, of the usual number of cases in a
given locality.

3. Epidemic - Unusually large number of cases in a relatively short period of time in a specific
locality.

4. Pandemic - Simultaneous occurrence of epidemic of the same disease in several countries.

Determinants/Epidemiologic Variables
- These determine the individuals and populations at greatest risk of acquiring a particular
disease, and knowledge of these associations may have predictive value.
o Time: The period which the cases of the disease were exposed to the source of infection
and the period during which the illness occurred.
o Person: Refers to the characteristics of individuals who were exposed and who
contacted the infection (ex. Age, sex, occupation, race, etc)
o Place: Features, factor or conditions which existed in or described the environment
where the disease occurred (Ex. Urban/rural areas, socio-economic areas)

Practical Applications of Epidemiology

- Assessment of the health status of the community or community diagnosis.
- Elucidation of the natural history of disease
- Determination of disease causation
- Prevention and control of disease
- Monitoring and evaluation of health interventions
- Provision of evidence for policy formulation
Outline of Plan for Epidemiological Investigation
1. Establish fact of presence of epidemic.

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o Verify the diagnosis- do clinical and laboratory studies to confirm the data
o Ensure complete reporting- Is data complete? Does it represent an accurate picture of
the present situation?
2. Establish time and space relationship of the disease.
o Are the cases limited or concentrated in a particular geographic location?
o Is there a relation of the cases by days of onset, to onset of the first known case by days,
week or months?
3. Analyze the relations to characteristics of the group of community.
o Relation of cases to age, group, sex, race, occupation, past immunizations
o Sanitary facilities e.g. water supply, sewerage disposal, home sanitation, animal or insect
vectors
o Milk and food supply
o Cases of known carriers
4. Correlate all data obtained.
o Summarize the data clearly using tables, charts to give a clear picture of the situation.
o Build up the case for the final conclusion carefully utilizing all available evidence.
o Establish the source of the epidemic and the manner of the spread, if possible.
o Make suggestions as to the control, if the disease is still present in the community and
as to the prevention of future outbreaks.

Basic Steps in an Outbreak Investigation

1. Prepare for fieldwork
o Investigation
o Scientific knowledge
o Supplies and equipment
o Administrative procedures e.g. travel documents, allowance
o Consultation
 Know expected role
 Local contact person/s
2. Establish the existence of an outbreak
o Compare the current number of cases in previous years.
o Surveillance records
o Hospital records, registries, mortalities, statistics
o Data from neighboring areas
o Community survey
3. Verify diagnosis
o Ensure proper diagnosis of reported cases
o Rule out laboratory error as basis for the increase in diagnosed cases.
o Review clinical findings.
o Review laboratory results.
o Summarize clinical findings with frequency distribution
o Visit patients.
4. Define and Identify cases

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o Establish a case definition*

*Standard set of criteria for the health condition
 Clinical criteria (Signs and Symptoms)
 Restrictions by time, place and person
 Apply without bias
o Identify and count cases
 Personal information
 Demographic information
 Clinical information
 Risk factor information
 Reporter information
5. Perform descriptive epidemiology
o Describe and orient the data in terms of time, place and person.
 Characterized by Time
 Maximum and minimum incubation period
 Probable time of exposure
 Incubation period when probable time of exposure is known
o Characterized by Place
 Geographic extent
 Spot map
 Area map
o Characterized by Person
 Demographics (age, race, sex) and medical status
 Exposures (occupation, leisure activities, use of drugs, etc)
6. Develop the hypotheses
o Consider the source of agent
o Mode of transmission
o Vectors of transmission
o Risk factors
*The hypotheses should be testable.
7. Evaluate the hypotheses
o Compare with established facts.
o Use analytical epidemiology (case control studies, retrospective control studies)
8. Refine the hypotheses and execute additional studies.
*Unrevealing analytic studies = POOR HYPOTHESES
*May need more specific exposure histories
*May need more specific control group
9. Implement control and prevention measures.
o Prevent additional cases
o Prevent outbreaks in the future
10. Communicate findings.
o Through writing and disseminating full report
o Meetings and discussions
o Local and mass media

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o LGUs
o Local health workers
o Regional health authorities
o Department of Health
11. Follow-up recommendations.
o What activities have been undertaken?
o Has health status improved?
o Has health problem reduced?

Functions of the Epidemiology Nurse

 Implement public health surveillance.
 Monitor local health personnel conducting the disease surveillance.
 Conduct and/or assist other health personnel in outbreak investigations.
 Assist in the conduct of rapid surveys and surveillance during disasters.
 Assist in the conduct of surveys, program evaluations, and other epidemiologic studies.
 Assist in conducting training courses in epidemiology.
 Assist the epidemiologist in preparing the annual report and financial plan.
 Responsible for inventory and maintenance of epidemiology and surveillance unit (ESU)
equipment.

Specific Role During Epidemiological Investigations

- Maintains surveillance of the occurrence of notifiable diseases.
- Coordinates with other members of the health team during the disease outbreak.
- Participates in case findings and collection of laboratory specimens.
- Isolates cases of communicable diseases.
- Renders nursing care, teaches and supervises delivery of care.
- Performs and teaches household members -method, concurrent and terminal disinfection.
- Gives health teachings to prevent further spread of the disease to individuals and families.
- Follow up cases and contacts.
- Organizes, coordinates and conducts community health education campaigns/ meetings.
- Refers cases when necessary.
- Coordinates with other concerned community agencies.
- Accomplishes and keeps records and reports and submits to the proper office/ agency.