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Slid CH01
Slid CH01
Epidemiology
Eighth Edition
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Chapter 1
Foundations of
Epidemiology
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Objectives
Define epidemiology.
Define descriptive epidemiology.
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Define analytic epidemiology.
Identify selected activities performed in epidemiology.
Explain the role of epidemiology in public health practice and individual decision making.
Define epidemic, endemic, and pandemic.
Describe common-source, propagated, and mixed epidemics.
Describe why a standard case definition and adequate levels of reporting are important in epidemiologic
investigations.
Describe disease transmission concepts.
Describe the epidemiology triangle for infectious disease.
Describe selected models for chronic diseases and behavioral disorders.
Define the three levels of prevention used in public health and epidemiology.
Understand the basic vocabulary used in epidemiology.
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To understand epidemiology, let’s first describe the meaning of health.
Let’s Get Started
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What is Health?
Physical Ability of the human body to function properly; includes physical fitness and activities of daily living.
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Social Ability to have satisfying relationships; interaction with social institutions and societal mores.
Spiritual Feeling as if part of a greater spectrum of existence; personal beliefs and choices.
Environmental Comprises external factors (i.e., one’s surroundings such as habitat or occupation) and internal factors (i.e.,
Public health is the science and art of promoting health and extending life on
the population level.
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Public health is concerned with threats to health in the population (a group of
people sharing one or more characteristics).
The mission of public health is to ensure conditions that promote the six
dimensions of health in the population as a whole.
What is the Meaning of Population?
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collected and evaluated.
Social
Economic
Family (marriage and divorce)
Work and labor force
Geographic factors
How does Public Health Relate to Epidemiology?
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Because of its central role in public health, epidemiology is commonly referred
to as the foundation of public health.
What is Epidemiology?
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prevent and control health problems.
Key Terms in the Definition
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cholera, influenza, pneumonia, mental illness
Conditions associated with health
physical activity, nutrition, environmental poisoning, seat belt use, and provision and use
of health services
Events
injury, drug abuse, and suicide
Why is Epidemiology the Foundation of Public Health?
Because of its central role in carrying out the three core public health functions:
1. The assessment and monitoring of the health of communities and populations at
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risk to identify health problems and priorities
2. The formulation of public policies designed to solve identified local and national
health problems and priorities
3. To assure that all populations have access to appropriate and cost-effective care,
including health promotion and disease prevention services, and evaluation of the
effectiveness of that care
Epidemiology and the Scientific Method
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What is the Scientific Method?
The scientific method involves using appropriate study designs and statistical
techniques for investigating an observable occurrence and acquiring new
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knowledge.
The health problem
Hypotheses
Statistical testing
Interpretation
Dissemination
Study Designs in Epidemiology
Descriptive epidemiology
Involves study designs used to answer: Who? What? When? Where?
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Analytic epidemiology
Involves study designs used to answer: Why? How?
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Place – where?
Time – when?
Clinical criteria – what?
The Importance of Analytic Epidemiology
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Explains why and how health-related states or events occur
Selected Activities Performed in Epidemiology
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Describing the natural history of disease
Identifying individuals and populations at greatest risk for disease
Identifying where the public health problem is greatest
Monitoring diseases and other health-related events over time
Evaluating the efficacy and effectiveness of prevention and treatment programs
Providing information useful in health planning and decision making for
establishing health programs with appropriate priorities
Assisting in carrying out public health programs
Being a resource person
Communicating public health information
Selected Types of Epidemiologic Information
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Causes of disease
Completing the clinical picture
Program evaluation
Efficacy
Effectiveness
Questions that Need Epidemiology (1 of 2)
Diagnosis
Is there such a problem as myalgic encephalitis?
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Is prostate-specific antigen a good test for prostate cancer?
Causes
Why did this patient suffer a stroke?
Is obesity the cause of metabolic syndrome?
Treatment
Is this the best treatment for Parkinson's disease?
Is my surgery as good as that of everyone else?
Prognosis
What are the chances of a recurrent heart attack?
How long will this knee joint prosthesis last?
Questions that Need Epidemiology (2 of 2)
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Will the Irish smoking ban in public places work better than the English policy?
Health inequalities
Why should life expectancy be nearly 5 years lower in unskilled manual workers?
Do health services reduce or increase health inequalities?
Epidemic, Endemic, and Pandemic
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Endemic – Persistent, usual, expected health-related state or event in a
defined population over a given period of time
Pandemic – Epidemic affecting a large number of people in many countries,
continents, or regions
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Prevalence of Self-Reported Obesity Among U.S.
2017
Adults by State and Territory, BRFSS
2011
Disease Transmission
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fomite-borne; objects (e.g., hepatitis A spread by a contaminated eating utensil)
vehicle-borne; inanimate intermediate (e.g., HIV/AIDS spread through needle-
sharing drug users)
vector-borne; invertebrate animal (e.g., malaria spread through mosquitoes)
Common Source, Propagated, and Mixed Epidemics
Common source
Point
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Intermittent/Continuous
Propagated
Spread from person to person
Mixed
A mixture of common source and mixed
Common Source (1 of 2)
Tend to result in more cases occurring more rapidly and sooner than host-to-
host epidemics
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Identifying and removing exposure to the common source typically causes the
epidemic to rapidly decrease.
Common Source (2 of 2)
Examples
Anthrax, traced to milk or meat from infected animals
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Botulism, traced to soil-contaminated food
Cholera, traced to fecal contamination of food and water
Propagated (1 of 2)
Arise from infections being transmitted from one infected person to another
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Transmission can be through direct or indirect routes.
Host-to-host epidemics rise and fall more slowly than common source epidemics.
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Propagated (2 of 2)
Whooping cough
Tuberculosis
Influenza
Measles
Examples
Mixed
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Example – Shigellosis occurred among a group of 3,000 women attending a
music festival. Over the next few weeks, subsequent generations of shigella
cases spread by person-to-person transmission from festival attendees.
Accurate Assessment Requires a Standard Case
Definition
A standard set of criteria, or a case definition, assures that cases are
consistently diagnosed, regardless of where or when they were identified and
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who diagnosed the case.
Concepts and Principles of Case as Used in
Epidemiology
A case is a person who has been diagnosed as having a disease, disorder,
injury, or condition.
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Primary Case, Index Case
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The first disease case brought to the attention of the epidemiologist is the index
case.
The index case is not always the primary case.
Secondary Case
Those persons who become infected and ill after a disease has been
introduced into a population and who become infected from contact with the
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primary case
Different Levels of Diagnosis
Suspect
An individual who has all of the signs and symptoms of a disease or condition, yet
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not diagnosed
Confirmed
All criteria met
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Epidemiology Triangle for Infectious Disease
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Agent is the cause of the disease.
Host is an organism, usually a human or an animal, that harbors a disease.
Environment includes those surroundings and conditions external to the human or
animal that cause or allow disease transmission.
Time accounts for incubation periods, life expectancy of the host or the pathogen,
and duration of the course of the illness or condition.
Stopping an Epidemic
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disease no longer continues along its mode of transmission and routes of
infection.
Some Disease Transmission Concepts
Fomites
Objects such as clothing, towels, and utensils that may harbor a disease agent and
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are capable of transmitting it; usually used in the plural
Example – transmission of cutaneous anthrax from drums to an individual
Vector
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Can spread an infectious agent from an infected animal or human to other
susceptible animals or humans through its waste products, bite, or body fluids,
or indirectly through food contamination
Plague
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occasionally in other wild animals, such as prairie dogs. Plague
transmission from these infected animals generally occurs in one of three
ways:
Bites from infected rodent fleas (85%)
Direct contact with infected tissue or bodily fluids
For example, people can become directly infected with plague by handling infected
rodents, rabbits, or wild carnivores that prey on these animals when plague bacteria
enter through the person's skin.
Inhaling infected droplets
Reservoir
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Humans often serve as both reservoir and host
Zoonosis
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Examples – rabies, Rocky Mountain spotted fever, shigellosis
Carrier
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Example – Typhoid Mary
Modes of Disease Transmission
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Indirect transmission – occurs when pathogens or agents are transferred or
carried by some intermediate item, organism, means, or process to a
susceptible host, resulting in disease
Advanced Epidemiology Triangle for Chronic
Diseases and Behavioral Disorders
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FIGURE 1-3 Advanced Model of the Triangle of Epidemiology
Three Levels of Prevention Used in Public
Health and Epidemiology
Primary prevention (occurs prior to exposure)
Immunization
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Sanitation
Education
Media campaigns
Warning labels
Active Primary Prevention
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Health promotion
Lifestyle changes
Community health education
Ensuring healthy conditions at home, school and workplace
Passive Primary Prevention
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Fluoridation of public water supplies
Secondary Prevention
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The disease already exists in the person.
Cancer screening – cancer already present. The goal is to detect the cancer before
clinical symptoms arise in order to improve prognosis and prevent conditions from
progressing and from spreading
Tertiary Prevention
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The disease has already occurred.
Physical therapy for stroke victims
Halfway houses for recovering alcoholics
Shelter homes for the developmentally disabled
Fitness programs for heart attack patients