EPIDEMICS

Epidemics
Ma. Lucila M. Perez, MD, MSc

PREVENTIVE & COMMUNITY MEDICINE 2 YL 2

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Definitions

John Hopkins School of Public Health

• Hyperendemic – persistent high levels of disease occurrence
• Outbreak - an epidemic in relatively limited geographic or focal area

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Epidemics in the 21st century

Faster and further with greater impact:

• Spread widely, more quickly, affecting more people
• Produce ruinous impact on economy (global), disrupt
travel, trade, livelihoods
PREVENTIVE & COMMUNITY MEDICINE 2 YL 2
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WHICH IS AN OUTBREAK / EPIDEMIC?

✔ 1. 10 members of the swim team
️ vomiting after eating at
Restaurant A
X 2. 30 Dengue cases every month for
the past year
✔ 3. 196 Measles cases in NCR from
️ January 1-19, 2019

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Coronavirus COVID-19, Philippines
January – March 2020
200 187
180
160
140 142
140
120 111
100 89
80 64
60 52
40 33
20 5 6 10
3
0
30-Jan 5-Mar 6-Mar 8-Mar 9-Mar 11-Mar 12-Mar 13-Mar 14-Mar 15-Mar 16-Mar 17-Mar

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EPIDEMIC PHASES

Introduction Localized Amplification Reduced

or emergence transmission Transmission

1st Phase: Emergence in a community

2nd Phase: Localized transmission or sporadic infections occur
3rd Phase: Human to human transmission causes a sustained outbreak
4th Phase: Reduced transmission because population acquires
immunity or effective interventions control the spread
WHO, 2018
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Why do Epidemics Occur?

1. New disease
A. Introduction of a new disease
B. Recognition for the first time of an already existing
disease known by another name

C. Diseases previously affecting only lower animals

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Why do Epidemics Occur?

2. Flare up of an old or existing disease, implying
changes in :
a. Environment – favorable conditions for survival of
vectors & enhanced mode of transmission
ex. calamities
b. Agent – inc. virulence, new strain, inc. capacity to
multiply
c. Host – inc. susceptibility : lowering of general
resistance, decrease herd immunity

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Herd Immunity Threshold

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Epidemic Patterns
• According to manner of spread
1. Common – source: exposed to same source
a) Point source – cases all exposed to same source during brief period of time,
cases occur within one incubation period

b) Continuous source – same source during more than a brief period

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Epidemic Curves
Exposure

Salmonella outbreak at wedding reception

POINT SOURCE EPIDEMIC CURVE

Explosive exposure (steep upslope) and a more gradual downslope
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Epidemic Curves

CONTINUOUS SOURCE CURVE

Range of exposures and incubation periods tend to flatten and widen the peaks
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Epidemic Patterns
2. Propagated: Infectious agent passes from one host to
another, cases occur over >1 incubation period
a) directly from person to person (ex. handshaking or kissing), or
b) indirectly via vectors (ex. malaria ) or vehicles (ex. HIV )

3. Mixed

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PROPAGATED (PROGRESSIVE) EPIDEMIC CURVE

Peaks occur consistent with incubation period of the disease

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Epidemic Curves

E. Coli 0157 in Nursery

E.Coli 0157 in nursery

MIXED EPIDEMIC CURVE

Characteristics of both common and propagated
epidemics Ex. Often in food-borne infectious agents
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USES OF EPIDEMIC CURVES

1) Type of exposure from its shape

2) Suggest possible agents - if time of exposure is known

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USES OF EPIDEMIC CURVES

3) ID time of onset - if agent is known

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Control and Preventive measures

1. Eradication/elimination of disease agents at source

2. Interrupt / closure of transmission
3. Exhaustion or protection of susceptibles

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Control and Preventive measures

___
1 1. Remove source of contamination
___
1 2. Treat the infected person
___
2 3. Physical distancing

1. Eradication / elimination of disease agents at source

2. Interrupt / closure of transmission
3. Exhaustion of susceptibles

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Physical Distancing and COVID-19 infection

Unlike other diseases, there is no known effective drug or vaccine against this novel virus.
Drastic mitigation measures such as social distancing and lockdowns could delay the
epidemic and flatten the curve thus, reducing the burden on hospitals and infrastructure.

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5 Stages of Response Interventions

Response Anticipation Early Containment. Control & Elimination or

Interventions detection Mitigation Eradication

EPIDEMIC Introduction Localized Amplification Reduced

PHASES or emergence transmission Transmission

The phases of epidemics, as described before, will dictate

the response and the sequence of interventions

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Stay safe everyone! STAY HOME

PREVENTIVE & COMMUNITY MEDICINE 2 YL 2