INTRODUCTION TO

EPIDEMIOLOGY
 LEARNING OBJECTIVES

At the end of this topic, students are able to:

• Define Epidemiology
• Describe theories of disease causation
• Identify components of infectious disease
epidemiology
• Discuss levels of diseases occurrence
 DEFINITION
• The study of the frequency, distribution and
determinants of health-related states or events in
specified human populations and its application to the
control of health problems

Key words:
Frequency: quantifies occurrence of diseases and health
related events
Distribution: refers to how disease is distributed within the
population
• Person, time and place
 Defn…

Determinants: refers to the ‘why’ and ‘how’ of disease

occurrence
• Causes, risk factors, mechanisms

Health-related states / events:

• Physiological/psychological dysfunction of the body
• Vital events, individual behavior, Socioeconomic

Population: it focuses on populations than individuals.

Application: Design effective prevention and control)

 HISTORY OF EPIDEMIOLOGY
Hippocrates (460 B.C): disease are related to personal and env’tal factors.

John Graunt (1662): first to quantify patterns of morbidity and mortality.

Lind (1747): proved the cause of scurvy and its treatment with fresh fruit.

John Snow (1854): used a "natural experiment" to test his hypothesis

linking Cholera to drinking contaminated water.

Austin B. Hill (1937): application of statistics for establishing causation.

1950's-1970's: Major epidemiology successes in the area of – tobacco, BP

and stroke, CHD risk factors, endometrial cancer and exogenous
estrogens.
 BASIC EPIDEMIOLOGIC
ASSUMPTIONS

1. Human diseases do not occur at random

• Some behavioral and environmental factors increase the
risk of acquiring a particular disease.

2. Human diseases have causal and preventive factors

• They can be identified through systematic investigation of
populations or group of individuals.
 SCOPE OF EPIDEMIOLOGY
• Describe the health status of the population.
• Establish natural history of disease.
• Provide understanding of what causes or sustains
disease in populations.
• Define standards and ranges for normal values of
biological and social measures.
• Guide health and healthcare policy and planning.
• Assist in the management and care of health and
disease in individuals.
Scope
 Step Clinician
  Epidemiologist
 
   

History, physical Surveillance,

Data base
exam descriptive epid.
     
Assessment Differential dx Inference

Hypothesis    
testing Diagnostic Analytical
studies epidemiology
  Community
Action Treatment intervention
 BRANCHES OF
EPIDEMIOLOGY
1. Descriptive Epidemiology
• Defines the amount and distribution of health problems
in relation to person, place and time.
• It answers the questions who, where and when.

2. Analytic Epidemiology
• involves explicit comparison of groups of individuals to
identify determinants of health and diseases.
• It answers the questions why and how.
INFECTIOUS DISEASE
EPIDEMIOLOGY
A. NATURAL HISTORY OF DISEASE

Refers to the progression of a disease process in an

individual over time, in the absence of intervention.

Figure 2.1. Natural History of Disease

Figure 2.2 Natural History of Tuberculosis
 B. CAUSAL CONCEPTS OF
DISEASE
Cause of disease: is an event, condition, characteristic or
a combination of these factors which plays an important
role in producing the disease.
•  The causes of disease can be classified in to two:
i. Primary causes
• These are the factors which are necessary for a disease
to occur, in whose absence the disease will not occur.
 ii. Risk factors (contributing, predisposing, or
aggravating factors).
• These are not the necessary causes of disease but they
are important for a disease to occur.

• Not all associations between exposure and disease

are causal.

• If disease does not develop without the factor being present,

then we term the causative factor "necessary".

• If the disease always results in the presence of a factor, then

we term the causative factor "sufficient"
Quiz: Identify the necessary and sufficient factors
• The etiology of a disease is the sum total of all the
factors (primary causes and risk factors) which
contribute to the occurrence of the disease.

• The epidemiologic triad is the traditional model of

infectious disease causation.

• It has three components: an external agent, a

susceptible host, and an environment that brings the
host and agent together.
 Figure. EPIDEMIOLOGIC TRIANGLE AND TRIAD (BALANCE BEAM)

Agent

Host factors Agent factors Environmental factors

• Age, sex, weight, • Virulence, Serotype • Overcrowding
• Personal Behavior • Antibiotic resistance • Air pollution
• Genetic inheritance • Cigarette-tar content • Animal contact
 C. CHAIN OF INFECTION
Infection implies entry and multiplication of the agent,
whether or not the process leads to disease.
• A model used to understand the infection process is
called the chain of infection.
• Each link must be present and in sequential order for
an infection to occur.
• Understanding the characteristics of each link provides
with methods to prevent the spread of infection.
Components of Chain of Infection
1. Causative Agent
2. Reservoir host
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host.
Figure 2.8. Chain of infection
1. Causative agent: is an infectious micro-organism-virus,
bacteria, parasite, or other microbe

2. Reservoir host: is the habitat in which an infectious agent

normally lives, grows, and multiplies.

• Reservoirs for infectious agents may be humans, animals,

plants or other inanimate objects.

• Agents with a human reservoir include measles, mumps,

and most respiratory pathogens.
• Human reservoirs may be persons with symptomatic
illness, or carriers.

• A carrier is a person who does not have apparent

clinical disease, but potentially capable of transmitting
the infection to other people.
Asymptomatic carriers
Incubatory carriers
Convalescent carriers
Chronic carriers
• Some diseases are transmitted to human beings from
animals. These diseases are called zoonosis.
e.g. Rabies, anthrax

3. Portal of exit: is the way the infectious agent leaves

the reservoir.
• Possible portals of exit include all body secretions and
discharges.
─ Mucus, saliva, tears, breast milk, blood,
─ Vaginal and cervical discharges,
─ Excretions (feces and urine).
4. Modes of Transmission:
The mechanism by which an infective agent is transferred
from a reservoir to a susceptible host.
I. Direct Transmission:
• Direct contact – STIs, Rabies
• Direct Projection – Common cold
• Transplacental – Syphilis, HIV/AIDS

II. Indirect Transmission:

• Vehicle-borne – Cholera
• Vector-borne – Malaria
• Airborne – TB
• Parenteral injections – HBV
5. Portal of entry: is the site where an infectious agent
enters a susceptible host.
• Nasal mucosa – common cold
• Conjunctiva – trachoma)
• Injury site – tetanus)

6. Susceptible human host: the final link in the infectious

process.
• The chain of infection may be interrupted if the agent does
not find a susceptible host.
• Host resistance at the community (population) level is called
herd immunity.
 E. LEVELS OF DISEASE
OCCURRENCE
• Diseases occur in a community at different levels at a
particular point in time.
• Some diseases are usually present in a community at a
certain expected level.

I. Expected levels
a. Endemic: a persistent level of low to moderate occurrence
b. Hyper-endemic: a persistently high level of occurrence
c. Sporadic: occasional cases occurring at irregular intervals
At times disease may occur in excess of what is expected
II. Excess of what is expected
a. Epidemic: occurrence of disease in excess of what is
expected in a limited period.
b. Outbreak: same as epidemic, often used by public health
officials for it is less provocative to the public.
c. Pandemic: an epidemic spread over several countries or
continents, affecting a large number of people.
Number of cases

Figure. Levels of disease occurrence.