Dynamics of Disease

Transmission
(In Infectious Diseases)
Chain of Infection

Source of Susceptible
Modes of
Reservoir Host
Transmission
Selected Definitions

The Source:
 The person, object or substance from which an

infectious agent passes to the host.

A Reservoir:
 Any person, animal, arthropod, plant, soil or

substance (or combination of these) in which an

infectious agent lives and multiplies and can be
transmitted to the susceptible host (Natural Habitat).
Types of reservoir

 Human reservoir
 Animal reservoir
 Reservoir in Non-living.
1- Human Reservoir

 Cases:
(a case is a person in the population identified as
having the particular disease, health disorder or
condition under investigation).
 Cases may be:
1. Clinical cases, or
2. Subclinical cases, or
3. Latent infection
Human Reservoir

 Carriers
A carrier is an infected person or animal that
hides a specific infectious agent in the absence
of apparent clinical disease and serves as a
potential source of infection to others.

 Carriers are less infectious than cases, but they

are more dangerous than cases.
Elements in carrier state

 Presence in the body of disease agent

 Absence of recognizable symptoms and signs
of disease.
 The shedding of the disease agent.
:Carriers may be classified according to
1. Type
 Incubatory – can transmit the disease during the
incubation period
 Convalescent – can transmit the disease during
the convalescent period
 Healthy- can transmit the disease while healthy
2. Duration
 Temporary
 Chronic
3. Portal of exit
:Transmission depends upon the following factors

 The infectious agent

 Portal of entry
 Ecological conditions
Modes of transmission

 Direct transmission
 Indirect transmission
Direct transmission

 Direct contact
 Droplet infection
 Contact with the soil
 Inoculation into skin or mucosa
 Tran placental (vertical).
Direct contact

 From skin to skin, mucosa to mucosa, or

mucosa to skin of the same or another person.
 Examples: AIDS, leprosy, skin and eye
infections.
Droplet infection

 During coughing, sneezing, or speaking

 Examples: many respiratory, infections,
tuberculosis
 Spread increases in overcrowding and lack of
ventilation.
Contact with the soil

 Examples: Tetanus
Inoculsion into skin or mucosa

 Rabies virus by dog bite

 Hepatitis B by contaminated needles.
Tranplacental

 Examples: TORCH
 Toxoplasma gondii
 Rubella virus
 Cytomegalovirus
 Herpes virus.
Indirect transmission

5 Fs
1. Flies
2. Fingers
3. Fomites
4. Food
5. Fluid
Indirect transmission

1. Vehicle borne
2. Vector-borne
3. Air-borne
4. Fomite-borne
5. Unclean hands and fingers.
Vehicle-borne

 Transmission of infectious agent through the

agency of food, water, blood.
 Examples: acute diarrhea, food poising.
:Features of vehicle transmission

 If the dose is heavy, the outbreak may be

explosive.
 When vehicle controlled the epidemic
subsides.
 Cases are initially confined to those who are
exposed.
 The distance traveled by the agent might be
great.
 The source of outbreak is often traceable.
Vector – borne

 Vector:
An arthropod or any living carries that
transports an infectious agent to susceptible
individual
Vector borne

 Mechanical
 Biological
Mechanical transmission

 The agent s transmitted by crawling or flying

arthropod, but no multiplication.
Biological transmission
The agent undergoes replication, or development or
both:
.
Air-borne

 Droplet-nuclei
 Dust
Fomite-borne

 Soiled clothes, towels, cups…

Unclean hands and fingers

 Examples: typhoid fever, hepatitis.

Dynamics of Disease
Transmission III
The Susceptible Host
Susceptible host

Successful parasitism: 4 stages

 Portal of entry

 Site of selection

 Portal of exit

 Survival of the organism in the external

environment.
Incubation period IP

The time interval between the invasion by an

infectious agent and appearance of the first
sign or symptom of the disease in question.

…….Why is it important?
Other definitions

 Latent period:
Incubation period in non-infectious diseases.

It is defined as:
(the period from disease initiation to disease
detection).
Host defenses

Active immunity
 Humoral immunity

 Cellular immunity

 Combination of both.

Passive immunity
 Normal human Ig (immunoglobulin)

 Specific human Ig

 Animal antitoxins or antisera

…….What is herd immunity?

Herd immunity

Is the level of a resistance of a community or a

group of people to a particular disease

Important elements
 Occurrence of clinical and subclinical

infection
 Immunization of the herd

 Herd structure.
Disease prevention and control

 Controlling the reservoir

 Interruption of transmission
 Controlling the susceptible host.
Controlling the reservoir

1. Early diagnosis
2. Notification
3. Epidemiological investigation
4. Isolation: Separation, for the period of
communicability of infected persons or
animals from others).
Purpose of isolation:
To protect the community by preventing the
transmission.
Controlling the reservoir

5. Treatment
6. Quarantine: The limitation of freedom of
movement of such persons or animals
exposed to communicable disease for a
period of time no longer than the longest
usual incubation period of the disease)
….now replaced by active surveillance.
:Surveillance

 Surveillance
The continuous scrutiny of the factors that
determine the distribution and occurrence of
disease

 Objective:
Prevention of disease.
Interruption of transmission

Example:
 Hand washing

 Adequate cooking

 Vector control.
Controlling the susceptible host

 Active immunization
 Passive immunization
 Combined immunization
 Chemoprophylaxis
 Non-specific measures (better housing, water
supply, nutrition, education…)
Disinfection

 Killing of the infectious agent outside the body

by direct exposure to chemical or physical
agents.
Thank you