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‫جامعة ام درمان االسالمية‬

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‫)‪Lecture notes on Epidemiology (1‬‬

‫‪Introduction to epidemiology‬‬
 Epidemiology:
• Is the study of the determinants, occurrence,
distribution, and control of health and disease
in a defined population.
• Epidemiology can accurately describe a
disease and many factors concerning its
occurrence before the cause of the disease is
identified.
• Epidemiology is a descriptive science that
uses rates, to quantify disease occurrence
within a specific population.
• Incidence and prevalence rates provide
information on the importance of a disease in
a defined population.
• Epidemiology today is applied to the whole
spectrum of health-related events, which
includes:
• chronic disease,
• environmental problems,
• behavioral problems,
• and injuries
• in addition to infectious disease.
 Purposes Of Epidemiology
• 1-Identify causes and risk factors for disease.
• 2-Determine the extent of disease in the
community.
• 3-Study natural history and prognosis of
disease.
• 4-Evaluate preventive and therapeutic
measures
• 5-Provide foundation for public policy
 Components of Epidemiology
• 1-Measure disease frequency
• 2-Quantify disease
• 3-Assess distribution of disease
• -Who is getting disease?
• -Where is disease occurring?
• -When is disease occurring?
• 4-Formulation of hypotheses concerning causal and
preventive factors. Hypotheses are tested using
epidemiologic studies
• 5-Identify determinants of disease
 Levels of Disease Occurrence
• 1-Sporadic level: occasional cases occurring at
irregular intervals
• 2-Endemic level: persistent occurrence with a low to
moderate level
• 3-Hyperendemic level: persistently high level of
occurrence
• 4-Epidemic or outbreak: occurrence clearly in excess
of the expected level for a given time period
• 5-Pandemic: epidemic spread over several countries or
continents, affecting a large number of people
• Epidemiologic Triad of Disease (Host, Agent&
Environment)
Epidemiologists must frequently overcome many
problems to determine the agent causing the
disease and where the exposure occurred.
• In some situations, the signs and symptoms of
the disease are specific to one or two agents and
the diagnosis will be straight forward,
• however in many situations, the agent will not
be known or might be a combination of agents.
 Agents
• The agent is component in the triad that are
responsible for the postulated cause of a disease..
• Agent can be:
• -biological, Microbes
• chemical,
• -Nutrients
• -Poisons
• -Allergens
• -Radiation , nuclear, or explosive
• -Physical trauma
• -Psychological experiences
 Microorganism
• The microorganism etiologic agent may be any
that can cause infection. It is characherized by:-
• A-Pathogenicity of an agent is its ability to
cause disease;
• pathogenicity is further characterized by
describing the organism's virulence and
invasiveness.
• B-Virulence refers to the severity of infection,
which can be expressed by describing the
morbidity (incidence of disease) and mortality
(death rate) of the infection.
• An example of a highly virulent organism is
Yersinia pestis, the agent of plague, which
almost always causes severe disease in the
susceptible host.
• No microorganism is assuredly avirulent. An
organism may have very low virulence, but if
the host is highly susceptible, as when
therapeutically immunosuppressed, infection
with that organism may cause disease.
• For example, the poliomyelitis virus used in
oral polio vaccine is highly attenuated and
thus has low virulence, but in some highly
susceptible individuals it may cause paralytic
disease.
• C-The invasiveness of an organism refers to its
ability to invade tissue.
• Vibrio cholerae organisms are noninvasive,
causing symptoms by releasing into the
intestinal canal an exotoxin that acts on the
tissues.
• In contrast, Shigella organisms in the intestinal
canal are invasive and migrate into the tissue.
 Host:
• A person or other living animal, including birds and
arthropods, that affords lodgment to an infectious
agent under natural (as opposed to experimental)
conditions.
• Hosts in which the parasite attains maturity or
passes its sexual stage are primary or definitive
hosts;
• Hosts in which the parasite is in a larval or asexual
state are secondary or intermediate hosts.
• A transport host is a carrier in which the organism
remains alive but does not undergo development
• Susceptible host:
• is The final link in the chain of infection.
Susceptibility of a host depends on:
• genetic factors,
• specified acquired immunity,
• and other general factors.
• General factors which defend against infection
include :
• the skin, mucous membranes, gastric acidity,
the cough reflex, and nonspecific immune
response.
• Host Characteristics That May Be Associated
With Disease
• -Age –Sex
• –Race –
• -Genetic profile
• Religion –Customs
• –Occupation
• -Marital status
• -Immune status -Vaccination status
 Environment
Environmental Factors That May Be Associated With Disease:-
• a-- Temperature
• b – Humidity
• c-- Altitude
• d– Wind
• e- Crowding
• f --Atmosphere
• g-environmental exposure (water, food supply, etc)
• h-Modes of communication ie phenomena in the environment that
bring host and agent together, such as:
• *Vector
• *Vehicle
• *Reservoir
•
 Types of epidemiology
• A-Descriptive epidemiology :
• identifying associations of disease in relation
to Triad of Disease :-Time-Place-Persons
• B-Analytic epidemiology:
• Identify associations of disease with possible
etiologic factors (chemical release, biological
agent)
• Further refine and test hypotheses regarding
etiology
 Triad of Disease descriptive epidemiology
• The three essential characteristics of disease
in descriptive epidemiology are:
• person, place &time
• A-Personal Characteristics (whom):
• e.g. Age/Gender /Socio-economic status
 :B-Place (where)
• It may be found useful to analyze data according
to place categories such as:-
• -Geographically restricted or widespread
(outbreak, epidemic, pandemic)
• -climate effects (temperature, humidity, and
combined effects.)
• - urban , sub-urban &rural
• -domestic or foreign
• -institutional or non institutional
• -Multiple clusters or one
 Time (when):
• It may be found useful to analyze data according to
time categories such as:-
• 1-Clustered (epidemic) or evenly distributed
(endemic)
• 2-Point source, propagated
• 3- seasonal, secular, combinations
• Depending on what event to describe,& the number
of cases reported, is to look at the occurrence of the
condition by:-
• A-: years, season, months, weeks, days or even time
of a day
 B-Secular (long-term) trends:
• For some conditions (e.g. chronic diseases)
long-term changes in the number of cases or
rate of the condition is interested in.
• The rate of a disease over a period of years
shows long-term or secular trends in the
occurrence of the disease.
• These trends are to used to suggest or predict
the future incidence of such a disease.
 :C-Seasonality

• When a disease show its occurrence by a week or

month over the course of a year or more, show its
seasonal pattern
• Some diseases are known to have characteristic
seasonal distributions; e.g., influenza typically
increases in winter.
• Seasonal patterns may suggest hypotheses about
how the infection is transmitted, what behavioral
factors increase risk, and other possible
contributors to the disease or condition.
 D-Epidemic period:
• To show the time course of a disease outbreak
or epidemic, is by using a specialized graph
called :an epidemic curve.
• A histogram: is used for epidemic curves.
• The shape and other features of an epidemic
curve can suggest hypotheses about the time
and source of exposure, the mode of
transmission, and the causative agent
•
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