Epidemiology &

Biostatistics
Lesson 1: Introduction to Epidemiology

Learning Objectives
At the end of the lesson, you should be able to:

• define epidemiology & understand its significance

• learn the history
• describe the basic epidemiologic concepts & principles
• give the roles & function of epidemiology in public health
What is epidemiology?

• comes from the Greek, in which epi means “upon” &

demos means “the population”

• study of something that affects a population

• study of factors that determine the occurrence & distribution of

disease in a population

• study of the frequency, distribution & determinants of health-related

states among specified population/s & the application of that study to
the control of health problems.
Frequency
 How common is the disease?

Distribution
 How are diseases distributed in different groups? Like age, gender,
occupation, social status, etc
 Is there a time pattern (annual, seasonal, etc), place pattern
(geographic variation, rural vs urban, etc), behaviour pattern

Determinants
 What is/are the causative agent/s?
 any factor, event or characteristic or others that brings about a change
in health condition

Population
 This is the main concern of epidemiology, the effect of the disease to the
population rather than individuals.
Brief History of Epidemiology

circa 400 BC

Hippocrates

- attempted to explain disease occurrence from a

rational viewpoint than a supernatural one

- suggested that environmental & host factors might

influence the development of disease in his essay
“On Airs, Waters & Places.”

source: google images

 1662

John Graunt

- published an analysis of mortality in London

- quantified patterns of birth, death & disease

occurrence, noting disparities between
sexes, high infant mortality, urban v. rural
differences & seasonal variation

source: google images

 1800

William Farr

- considered to be the one of the founders of medical

statistics

- developed many basic practices in vital statistics &

disease classification, assembling & evaluating those data
& reporting to health authorities & general public in
Britain
 1854

John Snow

- British physician best known for his work in tracing the

source of the cholera outbreak in London

- considered to be the father of modern or field

epidemiology

- conducted studies both to discover the cause of

cholera & to prevent its recurrence

source: google images

• He believed that the illness was spreading by way of a contaminated water
supply because sewage was routinely dumped into the Thames River and
cesspools near town wells.

• Snow conducted public health surveillance by looking at where those with

cholera lived in London. He saw that larger clusters of the cases were occurring in
specific areas.

• Snow was assisted by a local clergyman, Rev Henry Whitehead, in tracking down
and interviewing cholera victims and their families and geographically mapping
the outbreak.

• Since he believed that water was the source of infection for cholera, he marked
the location of water pumps on his spot map,
then looked for a relationship between the distribution of cases &
the location of pumps.
 Fig. 1. Spot Map of Deaths from Cholera in Golden Square Area London, 1854

source: google
image
 WATER COMPANY NUMBER OF HOUSES NUMBER OF DEATHS CHOLERA DEATH RATE
FROM CHOLERA PER 10000 HOUSES

SOUTHWARK & 40,046 1263 315

VAUXHALL
LAMBETH 26,107 98 37

BOTH COMPANIES 256,423 1422 59

Table 1. Mortality rate from cholera by company supplying water to the household
• He noticed that more cases were getting water from pump A, than
around pump B or C. Thus concluding that pump A was the primary
source of water & the most likely source of infection.

• After he presented his report to the municipal officials, then handle of the pump
was removed & the outbreak ended.

source: google image

Epidemiologic Studies in the 20th Century

1930s-1940s
• Doll & Hill studies
• Framingham studies
1960s
• Smallpox eradication methods
1980s
• studies related to injuries & violence
• HIV/AIDS
1990s
• emergence of new infectious agents Ebola, SARS, drug-
resistant strains of bacteria
Roles of Epidemiology in Public Health:

• Discover the agent, host & environmental factors that affect health

• Determine the relative importance of causes of illness, disability &

death

• Identify those segments of the population that have the greatest risk
from specific causes of ill health

• Evaluate the effectiveness of health programs & services in improving

population health
 Core Epidemiologic Functions:

1. Public health surveillance

• it is the ongoing, systematic collection, analysis, interpretation
& dissemination of health data to help guide public heath
decision making & action

2. Field investigation

3. Analytic studies
• it is the more rigorous methods of studying/investigating in
epidemiology

4. Evaluation
• is the process of determining the relevance, effectiveness,
efficiency & impact of activities
5. Linkages
• epidemiology is a multidisciplinary study, thus working together
with other members of the team such as clinicians, laboratory
workers, nurses, other agencies of the government, etc
6. Policy development
• provide input, testimony & recommendations regarding
disease control strategies, regulations & health-care policies
Lesson 2: Natural History Etiology,
Risk Factors for Disease &
Spectrum of Disease
Fig. 1. Timeline of Natural History of Disease

source: google image

Process of Disease Progression:

1. Exposure- can be due to infectious agents

- can be due to chemicals, drugs, etc
- can be the accumulation of factors enough for the disease
process to begin

2. Latency or subclinical period- pathological changes occur after exposure but

no signs or symptoms of the disease appear or become apparent
- for infectious disease it is known as the incubation period
- maybe detected by laboratory, radiographic or screening methods

3. Clinical or symptomatic stage- marks the onset of signs & symptoms & the
stage where most diagnoses are made
- The spectrum of disease can be mild to severe or fatal.
- 3 outcomes of disease process can either be: recovery, disability or death
 Secondary Prevention Tertiary Prevention
Primary Prevention
Etiology of Diseases:

1. Host factors- Can the host resist the disease?

Can the host adapt to stressors or agents?
- influenced by genetics, nutritional status, body mass index, immunity,
social behaviour such as physical exercise

2. Agents of disease
a. Biologic agents include microorganisms, biologic toxins/venoms,
unhealthy foods
b. Chemicals include nicotine, alcohol, lead, poison
c. Physical agents include guns, knives, radiation, extreme
temperatures
3. Environment- What are the chances that the host & agent will have
contact?
- factors include sanitation, working conditions, housing conditions, etc
- political, social & economic structures greatly influence the
environment etiology of disease
Risk Factors for Disease: BEINGS

1. “B”- Biologic or Behavior factors

- age, weight, gender, etc
- smoking, drinking, drug use, unsafe sexual practices, etc

2. “E”- Environmental factors

- contaminated water, food, poor or unsanitary conditions, etc

3. “I”- Immunologic factors

- immune-related conditions, immunocompetent or immunodeficient
4. “N”- Nutritional factors
- dietary intake, malnourished

5. “G”- Genetic factors

- genetic inheritance of disease conditions

6. “S”- Services, Social & Spiritual factors

- health care services or medical services
- social support by family, friends, others
- spirituality is finding the purpose or meaning in life, access to
forgiveness have influences in health
Chain of Infection:

1. Reservoir- habitat of infectious agent where it lives, grows & multiplies

a. Human reservoir
b. Animal reservoir- ex. plague, parasites
c. Environmental reservoir- ex. plant, water, soil

2. Portal of Exit- path by which the infectious agent leaves its host
- ex. via the respiratory tract, intestinal, urinary, etc
3. Modes of Transmission- from reservoir to host
a. Direct
a.1. Direct contact- skin to skin, sexual intercourse
a.2. Droplet- spray of relatively large, short-range aerosols by
sneezing, coughing or even talking

b. Indirect
b.1. Airborne- when infectious agents are carried by dust or
droplet nuclei suspended in air
b.2. Vehicles- ex. food, blood, water, fomites
b.3. Vectors- ex. insects
4. Portal of Entry- refers to the manner in which a pathogen enters a
susceptible host
- ex. inhalation, fecal-oral, skin, mucous membranes, blood

5. Host- the final link in the chain

- the susceptibility of the host is influenced by genetic, constitutional,
immunity, nutritional & environmental
factors
For infectious diseases interventions are directed at:

1. Controlling or eliminating agent at source of transmission

- ex. treating the infected persons, isolation of infected persons,
proper sanitation & hygiene, decontamination of materials,
proper ventilation, air pressure & filtration systems, control of
vector population

2. Protecting portals of entry- proper use of PPE, use of long sleeves &
pants in infested areas, use of mosquito nets, use of condoms, etc

3. Increasing host’s defenses- use of prophylaxis & most importantly

vaccinations