COMMUNICABLE DISEASE HANDOUTS EPIDEMIOLOGY “EPI” Means DSES

study of dse occurrences, distribution and determinants of health-r/t states/ events in specified populations

backbone of the prevention of dse

JOHN SNOW – Anesthesiologist “Father of Epidemiology”

1800's - He studied the epidemic of CHOLERA

erupted in the Golden Square of Soho district London (1854)

Epidemiologic Triad: eg. (spag, food, poisoning, outdoor picnic)

1. HOST– intrinsic factor (man as primary host)
2. AGENT– etiologic factor (cause) ex. virus, bacteria, fungi, parasites etc.
3. ENVIRONMENT – extrinsic factor ex: climate

In Epidemiology:
DISTRIBUTION

refers to descriptive

answer questions When, Where, Who

time (when), place (where), and person (who)

DETERMINANTS

refers to analytic

discovers causes, Rf, mot

answers Why and How

causes (including agents), risk factors (exposure to sources)

Descriptive vs. Analytic epidemiology

DESCRIPTIVE

identify patterns among cases and in populations by time, place and person

Survey used find out nature of population affected by a particular dse noting age, sex & occupation
ANALYTIC

concerned with the search for causes and effects/ why and the how

Patterns of Occurrence and Distribution

SPORADIC Ex: gonorrhea, chlamydia, syphilis, tetanus, plagues, leprosy

intermittent occurrence of a few isolated (scattered/kumakalat) and unrelated cases like Rabies
ENDEMIC

continuous occurrence throughout period of time of usual no# cases given Locality like Malaria

outbreak of various deseases

constant presence and/usual prevalence of dse or infx agent in population w/in a geographic area
EPIDEMIC(Outbreak)

unusual large number of cases in a relatively SHORT period of time usually in weeks
a) Point source – food poisonings canned goods, honey, salmonella, cholera
b) Cyclical pattern – dengue fever (seasonal)
c) Secular trend – influenza & measles
d) Propagated (person to person) - Hiv/Aids
PANDEMIC
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simultaneous occurrence epidemic same dse

Several countries affecting large number popu.

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CHAIN OF INFECTION
1. AGENT

Any micro-organism capable of producing an agent

(Bacteria, virus, fungi, parasites)

Killing the microorganism by:

DISINFECTION: Killing micro-organism but NOT their spores
STERILIZATION: Killing of all micro including spores (0%)
CLEANING METHOD: process of removing dirt by visible means and using vacuum
AUTOCLAVING
 15 pounds pressure
 moist heat method (except glass equipment)
 250 degrees Fahrenheit (121°C)
 Dry cool place and not air condition
 Black strips tape suggests successful autoclave

2. RESERVOIR

natural Habitat in which the agent normally lives, grows, and multiplies.
HUMAN RESERVOIRS: Measles, mumps, HIV and STI
ANIMAL RESERVOIR: anthrax (sheep/tupa) and rabies (dogs)
ENVIRONMENT RESERVOIRS: Histoplasmosis (soil) infx coz fungus

Take Note:
Carrier- person/animal harbors specific infectious agent w/o discernible clinical dse
- serves as potential source of infx

3. PORTAL OF EXIT

path by which a pathogen leaves its host.

Many portals of exit are identical to portals of entry

Influenza and TB exit the respiratory tract

Cholera bacteria exit in feces

4. MOT

Considered as the WEAKEST link

easily break by HAND WASHING (#1 way stop transmission)

TIME: 40-60 sec (wetting to drying)
MINIMUM TIME EACH HAND: 15 secs
AVERAGE TIME: 20 secs
BEST TIME: 30 secs

2 Types: above waist/below waist is considered unsterile

MEDICAL- hands are held lower than elbow
SURGICAL- hands are held higher than elbow

Mode of Transmissions
1)CONTACT TRANSMISSIONS
1) Direct Contact
 skin-to-skin contact, kissing, and sexual intercourse
 Contact with soil/ vegetation harboring infectious organisms.
 infectious mononucleosis (“kissing disease”)
 gonorrhea spread from person to person by direct contact
 Hookworm is spread by direct contact with contaminated soil.
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2) Indirect Transmission
 transfer of an infectious agent from a reservoir to a host by suspended air particles, inanimate objects (vehicles), or animate
intermediaries (vectors)
 5 F’s — Fingers(hands)- Fomites (inanimate object)- Foods- Feces-Flies
 Contact transmission
a) Multidrug resistant organism (methicillin)- staphylococcus aureus most common
b) Respiratory infx
c) Skin infx (leprosy, ringworm, scabies)
d) Wound infx (tetanus) and STI’s (HIV/AIDS)
e) Enteric infx (GI Dse)
f) Eye infections (conjunctivitis) do not share special belongings like towel
 Vehicle Transmission
 Milk and dairy foods carrying LISTERIOSIS (L. Monocytogenes)
 Food carrying salmonella
 water carrying Legionella
 blood borne hepatitis B and C
 drugs can carry bacteria from contaminated infusion supplies.
 Contaminated Blood, food, water, inanimate objects
2) DROPLETS TRANSMISSION

Droplets are body fluids.

pray w/ relatively large, short-range aerosols produced by sneezing, coughing, or even talking.

Droplets DO NOT remain suspended in air for very long & seldom travel > 3 feet around pt/5 microns

Some studies in 2003 suggested that smallpox and SARS could reach persons located 6 feet or more from the source. (Some
examples- flu, rhinovirus, SARS, group a strep, Neisseria meningitis.)

Droplet Precaution:
 Streptococcal infx and scarlet fever
 Pertussis, pneumonia, parvovirus B-19
 Influenza
 Diptheria- mousy pseudo membrane (sakit lalamunan sa bata at pinakamanganib)
 Epiglottitis
 Rubella
 Mumps, measles(rubeola), mycoplasma, meningitis
 Adenovirus infx (Coryza/ sipon) & Novel coronavirus (COVID-19) Sars-Cov-2

3) AIRBORNE TRANSMISSION

Droplet nuclei are dried residue of LESS than 5 microns in size.

Particles are suspended in air for LONG PERIOD OF TIME or when dust particles contain pathogens

MTV- Measles (paglabas sa room pinagsuot ng mask at may o2 sa hallway), TB, Varicella/chickenpox

4) VECTORBORNE TRANSMISSION

Vectors are non human carriers that transmit organisms from 1 host to another and can be biologic or mechanical. (mosquitoes,
animals, fleas, and ticks)
 Deer ticks – lymes disease
 Mosquitos – dengue, malaria, filariasis
 Rat flea – black death/bubonic plague
 Dogs– rabies
 Snail – schistosomiasis
Mode of transmission continuation

5. PORTAL OF ENTRY

refers to the manner in which a pathogen enters a susceptible host.

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For example:
 Respiratory tract (Influenza virus)
 Fecal -oral (gastroenteritis)
 Skin (hookworm)
 Mucous membranes (syphilis)
 Blood (hepatitis B, HIV).

Donning (putting on): from bottom up (shoe cover ni GowMa GoGlo)

 Boot covers
 Gown/Apron
 Mask
 Goggles
 Gloves (when hands raised above head)

Doffing (taking off): alphabetical order

1. Boot covers 2. Gloves 3. Goggles 4. Gown 5. Mask (last to) - Tapon sa loob ng room

6. HOST

FINAL link

Compromised-w/ lowered resistance to infx & dse for any reason (malnu, illness, trauma, immunosupp)

STAGES OF INFECTIOUS DISEASE COMMUNICABILITY PERIOD

1. INCUBATION PERIOD
time dse is Most Contagious & Easily Transmitted to others
time period b/w exposure & appearance of 1st sx

latency, no s/sx) VIRULENCE

degree of pathogenicity of an agent

2. PRODROMAL PERIOD
nonspecific- until specific sx - manifest mild s/sx

3. STAGE OF ILLNESS
Most severe stage
PATHOGENCITY
4. STAGE OF DECLINE ability of an agent to cause a dse
returns to a normal state of health (s/sx subside)
examples:
immune response and antibody titers normally peak
Mumps/parotitis (beke)- 24 hrs before swelling begins
IGM- sick (nakakahawa)
Chickenpox (centripetal rashes)- 24 hrs before rashes
IGG (protected (magaling na)
Measles (cephalocaudal rashes)- 4 days b4 to 4 days after

5. CONVALESCENCE PERIOD
period of recovery
TYPES OF INFECTIOUS DISEASES 3 LINES OF DEFENSE AGAINST INFECTION

ZOONOTIC DISEASES FIRST LINE OF DEFENSE

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transmitted from animals to humans INNATE IMMUNITY (walang buhay)

 Physical (Intact skin)
NOSOCOMIAL  chemical barrier
a)Hospital acquired infection
 Appear symptoms up to 48 – 72 hrs after hospital admission SECOND LINE OF DEFENSE:
 most common:
1. UTI e.coli (CAUTI) Adaptive immunity (nonspecific)
2. followed pneumonia
3. surgical wounds (pseudomonas aeroginusa) inflammatory response: 5 Carinal signs
1. Redness (rubor)
b) Community acquired infection 2. Calor (heat) only applicable to the body extremities
 appear symptoms 24-48 hrs after admission 3. Tumour (swelling)
 most common 4. Dolor (pain)
1. pneumonia (strepto) 5. Funtio laesa (loss of function)

IATROGENIC INFECTION Prostaglandin-universal substance for pain

secondary to tx and procedures Bradykinin- universal stimuli for pain

THIRD LINE OF DEFENSE

Immune response (specific)

TYPES OF ANTIBODIES (HUMORAL IMMUNITY) AB VS AG

NATURAL PASSIVE
IgG GLOBULINS / ANTIBODY
ONLY antibody crossing placenta A protective protein found in the blood

galing kay nanay associated to immune system

tatagal ng 6-12 mons produced in response to foreign substances (eg. Bacteria/ viruses)
IgA invading the body.

Breastmilk

ACTIVE
IgM

FIRST immunoglobulin made following Ag exposure (infection)

largest type/macro ANTIGENS:

IgE Foreign substances (e.g. bacteria or viruses)
Involved in mediating ALLERGIC reactions
capable of causing disease
can result anaphylactic reaction
lahat ng papasok sa katawan
Useful against parasitic infections
IgD

B lymphocyte maturation/memory cell production

TYPES OF IMMUNITY COMMUNICABLE DISEASES
1. NATURAL ACTIVE
- Exposure to the dse organism
- experiencing the actual disease ACUTE ILLNESS
- Long lasting immunity/lifelong (Nagkasakit Ako) - Less than 6 months
covid - Sx often severe & appears suddenly/ abruptly/biglaan , subside
2. ARTIFICIAL ACTIVE quickly
- Good prognosis
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- introduction of a killed/ weakened form of dse organism - Example: Dengue fever, measles
tru vacc (Aray Aray like turok ng EPI vaccines
- hepa b,covid 19,measles, OPV

3. NATURAL PASSIVE
- IgA found in human colostrum and milk and IgG
tranplacental (Nanay Pasuso(breastfeeding) and Nay
Papasa ng IgG from placenta in pregnancy)
- Emmediate/temporary protection CHRONIC ILLNESS
- Natural passive last only for 6 to 12 months - Longer than 6 months
- Slow onset
4. ARTIFICIAL PASSIVE (all anti) - w/periods of remissions/bumabalik & exacerbations/lumalala
- Provides immediate protection, but short-term protection - Example: TB and leprosy, filariasis, HIV
by injection of antibodies, (may last 2 – 3 weeks)
- Injection of gamma globulin, rabies antibodies, anti-
tetanus serum