Epidemiology of Communicable

(Infectious) Diseases

Dr. Abdullah Muharram

 Infectious
(Communicable) Disease

Any illness due to a specific infectious agents or its

toxic products capable of being directly or
indirectly transmitted from an infected man to
man, animal to man, or from the environment
(through air, dust, soil, water, food, etc.) to man or
.animal Dr. Abdullah Muharram
History of infectious diseases epidemiology
 Ignaz Semmelweiss demonstrated in 1846 the
importance of hand washing using antiseptics in the
prevention of puerperal sepsis.

 The concept of disease transmission and contagion

was well established before microorganisms were
identified. John Snow was one of the first to apply
epidemiologic methodology to infectious diseases
with his classic investigation of cholera epidemic in
1854.

Dr. Abdullah Muharram

 History of infectious diseases epidemiology – cont.

 In the 1860’s, John Lister proved the importance of

aseptic technique and disinfection in reducing the
incidence of infections following surgery.

 In 1890 Robert Koch theorized that certain diseases

were caused by particular pathogens and established
suggests for proving the etiologic role of these
pathogens.

Dr. Abdullah Muharram

 History of infectious diseases epidemiology – cont.
 The Henle-Koch suggests stated that:
1) The bacteria should be identified in the lesions
of the infection.
2) The bacteria could be isolated in pure culture on
artificial media.
3) The disease was reproduced when inoculated
into a susceptible animal,
4) The bacteria was then recoverable from the
infected animal.

Dr. Abdullah Muharram

 History of infectious diseases epidemiology – cont.

 In the mid-1300’s about 23 million people in Europe

died from plague.
– Plague-related deaths represented 10-15% of each
new generation for a period of about 100 years.
 Traditionally, infectious disease was the biggest
health threat to human civilization.
 As medical technology and public health reduced
the threat of infectious diseases, lifespans increased
to the point of making chronic diseases more
prevalent.
Dr. Abdullah Muharram
 History of infectious diseases epidemiology – cont.

Influenza
 By many estimates, major flu outbreaks occur about
every 11 years.
 The 1918 flu pandemic killed more than 50 million
people within about 18 months.
 The 1976 swine flu scare resulted in a national
immunization program.
The fear was that the swine flu was a close
variant of the 1918 virus and would trigger
another pandemic.
Dr. Abdullah Muharram
 History of infectious diseases epidemiology – cont.

Syphilis
 Is thought to have been brought back by Columbus’
group from the New World to Europe.

HIV/AIDS
 Human Immunodeficiency Virus was first detected
in 1980.
COVID 19
 In December 2019 Virus was first detected.

Dr. Abdullah Muharram

 History of infectious diseases epidemiology – cont.

 14th century plague kills 20-45% of the world’

population.
 1831 Cairo – 13% of population succumbs to
cholera.
 1854-56 Crimean war – deaths due to dysentery
were 10 times higher than deaths due to casualties.

Dr. Abdullah Muharram

 History of infectious diseases epidemiology – cont.

Success
 Eradication of Smallpox 1977.
 Elimination of Poliomyelitis from the most
countries.
 Potential elimination of measles in the next 10 to 20
years.
 Vaccine in development for prevention of diarrheal
diseases, cervical cancer (HPV).
 Vaccine in development for COVID 19.

Dr. Abdullah Muharram

Infectious Diseases: A World in Transition

AIDS
UP

?
Avian Influenza DOWN
Ebola
Marburg
Cholera Guinea worm
Rift Valley Fever Smallpox
Typhoid
Tuberculosis Poliomyelitis
Leptospirosis Measles
Malaria
Leprosy
Chikungunya
Dengue Neonatal tetanus
Antimicrobial
resistance
Dr. KANUPRIYA CHATURVEDI
Emerging & Re-emerging infectious diseases

Emerging infectious disease

Newly identified and previously unknown

infectious agents that cause public health problems
either locally or internationally.

Dr. Abdullah Muharram

Re-emerging infectious disease

Infectious agents that have been known for some

time, had fallen to such low levels that they were no
longer considered public health problems and are
now showing upward trends in incidence or
prevalence worldwide.

Dr. Abdullah Muharram

Factors contributing to emergence:
1) Agent:

 Evolution of pathogenic infectious agents

(microbial adaptation and change).
 Development of resistance to drugs.

 Resistance of vectors to pesticides.

Dr. Abdulla A.Muharram

 Factors contributing to emergence – cont.
2) Host:
 Human demographic change (inhabiting new
areas).
 Human behavior (sexual and drug use).
 Human susceptibility to infection
(Immunosuppression).
 Poverty and social inequality.
3) Environment:

Dr. Abdulla A.Muharram

 Factors contributing to emergence – cont.
4) Transmission of infectious agent from animals to
humans:
 >2/3rd emerging infections originate from animals- wild and
domestic.
 Emerging Influenza infections in Humans associated with
Geese, Chickens and Pigs.
 Animal displacement in search of food after deforestation/
climate change.
 Humans themselves penetrate/ modify unpopulated regions-
come closer to animal reservoirs/ vectors (Yellow fever).

Dr. Abdulla A.Muharram

 Factors contributing to emergence – cont.
5) Climate and Environmental Changes
 Deforestation forces animals into closer human
contact- increased possibility for agents to break
species barrier between animals and humans.

 Global warming- spread of Malaria, Dengue,

Leishmaniasis, Filariasis.

Dr. Abdulla A.Muharram

 Factors contributing to emergence – cont.
6) Poverty, Neglect & Weakening of Health
Infrastructure:
 Poor populations- major reservoir and source of continued
transmission.

 Poverty – malnutrition - severe infectious disease cycle.

 Lack of funding, poor prioritization of health funds,

misplaced in curative rather than preventive infrastructure,
failure to develop adequate health delivery systems.

Dr. Abdulla A.Muharram

 Factors contributing to emergence – cont.

7) Uncontrolled urbanization and Population

displacement
 Growth of densely populated cities- substandard housing,
unsafe water, poor sanitation, overcrowding, air pollution.
Problem of refugees and displaced persons.
 Diarrheal and intestinal parasitic diseases, ARI
in ecology, suburban migration of population.
8)Human behavior,
9)Antimicrobial drug resistance.

Dr. Abdulla A.Muharram

Some concepts of infectious diseases
Infection:
Infection is the entry and development or
multiplication of an infectious agent in the body of
man or animals. An infection does not always
cause illness.
Contamination:
The presence of an infectious agent on a body
surface, on or in clothes, beddings, toys, surgical
instruments or dressings, or other articles or
substances including water and food.
Dr. Abdulla A.Muharram
 Some concepts of infectious diseases
Intoxication
Some pathogens can cause disease by the elaboration of a
toxin. This can occur in the absence of viable bacteria.
Example is food poisoning.
Carrier
An individual with asymptomatic colonization or
infection who is capable of transmitting infection to
others.
Example Typhoid Mary” a cook was responsible for
several outbreaks of Salmonella typhi infections in the
Northeast.
Dr. Abdullah Muharram
 Some concepts of infectious diseases – cont.
Infestation
It is the lodgment, development and reproduction of
arthropods on the surface of the body or in the
clothing, e.g. lice, itch mite. This term could be also
used to describe the invasion of the gut by parasitic
worms, e.g. ascariasis.

Agent: usually refers to the biological pathogen that

causes a disease, such as a virus, parasite, fungus ,
or bacterium.

Dr. Abdullah Muharram

 Some concepts of infectious diseases – cont.
Latency
The pathogen remains viable but is dormant within the
host. It however remains capable of causing disease at
a later date.

Epidemic
The occurrence in a community or region cases of an
illness, specific health-related behavior, or other
health-related events clearly in excess of normal
expectancy.

Dr. Abdullah Muharram

 Some concepts of infectious diseases – cont.
Endemic :
The constant presence of a disease or infectious agent
within a given geographic area or population group.
It can be changed into epidemic, under certain
conditions.
Hyper endemic:
The term “hyper endemic” expresses that the disease
is constantly present at high incidence and/or
prevalence rate and affects all age groups equally.

Dr. Abdullah Muharram

 Some concepts of infectious diseases – cont.
Holy endemic:
The term “holy endemic” expresses a high level of
infection beginning early in life and affecting most of
the child population, leading to a state of balance such
that the adult population shows evidence of the disease
much less commonly than do the children (e.g. malaria)

Outbreak:
An epidemic limited localized increase in the incidence of
disease, e.g., in a village, town, or closed institution;
upsurge is sometimes used as a synonym for outbreak.

Dr. Abdullah Muharram

 Some concepts of infectious diseases – cont.

Pandemic
An epidemic occurring worldwide, or over wide area,
crossing international boundaries, and usually
affecting a large number of people.

Incubation period
The time interval between invasion by an infectious
agent and appearance of the first sign or symptoms
of the disease in question.

Dr. Abdullah Muharram

 Some concepts of infectious diseases – cont.

Period of communicability
The time during which an infectious agent or toxic
products that arises through transmission of that
agent or its products from an infected person,
animal, or reservoir to susceptible host, either
directly or indirectly through an intermediate plant
or animal host, vector, or the inanimate
environment.
 Communicability varies in different diseases.

Dr.Abdullah A.Muharram
 Some concepts of infectious diseases – cont.

Elimination
Reduction of case transmission to predetermined very
low level, e.g. elimination of tuberculosis as public
health problem was defined by WHO (1991) as
reduction of prevalence to level below one case per
million population.

Dr.Abdullah A.Muharram
 Some concepts of infectious diseases – cont.

Eradication
Termination of all transmission of infection by
extermination of the infectious agent through
surveillance and containment.

Eradication, as in the instance of smallpox, is based on

the joint activities of control and surveillance.

Dr.Abdullah A.Muharram
Spectrum of disease:

The full range of manifestation of disease; a vague

term, which can mean every thing from mild or
subclinical or precursor states to fulminating, florid
disease, or alternatively, the natural history of a
disease from onset to resolution.

Dr.Abdullah A.Muharram
 Iceberg of disease
According to this concept, disease in a community may be
compared with iceberg. The floating tip of the iceberg
represents what the physician sees in the community, i.e,
clinical cases. The vast submerged portion of the iceberg
represents hidden mass of disease.
1) Latent,
2) In apparent,
3) Presymptomatic,
4) Undiagnosed cases,
5) Carriers in the community.
The water line represents the demarcation between apparent &
inapparet disease.
Dr.Abdullah A.Muharram
Iceberg of disease – cont.

Diagnosed
disease

Undiagnosed or
wrongly diagnosed disease