Natural History of Disease

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 Important Terminologies
 Induction period
Time from exposure to disease initiation
 Latent period
The time interval from exposure to development of infectiousness
 Incubation period
The time interval between infection to development of clinical disease (manifestation
of symptoms)
 Infectious period
The time during which the host can infect another susceptible host
 Non-infectious period
The period when the host’s ability to transmit disease to other hosts ceases
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Benichou, 2000)2
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 Natural History of the Disease
 The process by which diseases occur and progress in humans in
the absence of intervention.

 Each disease has a natural history of progression if no medical

intervention is taken and the disease is allowed to run its full
course. There are four common stages relevant to most diseases.
1. Stage of susceptibility
2. Stage of pre-symptomatic disease
3. Stage of clinical disease
4. Stage of recovery, disability, or death.

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 Stage of Susceptibility
This stage precedes the disease and involve the likelihood a host has of developing ill
effects from an external agent. The lack of immunity is called susceptibility.
 Stage of Pre-symptomatic disease
The disease begins with exposure and subsequently pathologic changes that occurs
before the onset of symptoms. This is also typically called the incubation period.
For chronic diseases the time from exposure and clinical symptoms is typically called
latency periods.
 Stages of clinical disease
This stage begins when signs and symptoms are manifest.

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 Stage of recovery, disability, or death
The final stage reflects the expected prognosis. Several factors may influence
these stages including early detection and effective treatment.

With regard to prevention,

 primary prevention may occur during the stage of susceptibility
 Secondary prevention may occur during the stage of pre-symptomatic
disease or the stage of clinical disease.
 The tertiary prevention may occur at the stage of clinical disease and the
final stage.

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Time
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 Changes have Detectable signs Disease has
Risk factors which
occurred to and/or progressed to
assist the
lead towards symptoms of the point of
development of
illness but disease exist causing residual
disease exist, but
disease is (Emphysema effect (Person
disease has not
not yet detected by has difficulty
developed
clinically pulmonary
(Smoking)
detectable function test) breathing)
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(Alveoli
deteriorate )
 If latent period is relatively short, infectious period occurs (many
years) before the onset of symptoms.

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 RESISTANCE TO
INFECTION

Immunity (specific antibody General Resistance

reactions, general immune system (skin, mucous membrane, tears,
response, vaccines) gastric acids and cilia)

Active Immunity (Body Passive Immunity

produces its own (Antibodies produced by
resistance through mild another person or Naturally Acquired
cases or vaccinations) animal) Passive Immunity
(antibodies pass from
mother to fetus)

Naturally Acquired
Artificially Acquired Artificially Acquired
Active Immunity
Active Immunity Passive Immunity (serum
(through acquired case of
(through vaccination) containing antibodies or
the disease)
antibiotics injected)
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 Screening

 Screening is the use of tests to help diagnose diseases (or their

precursor conditions) in an earlier phase of their natural history or
at the less severe end of the spectrum

 Screening attempts to uncover the iceberg of disease.

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Screening

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 The Epidemiology Triangle

This triangle is based on the communicable disease model and is useful in

showing the interaction and interdependence of the agent, host and environment,
and time as used in the investigation of diseases and epidemics.
 The agent is the cause of the disease
 The host is the organism, usually a human or animal that harbors the disease
 The environment includes those surroundings and the conditions external to
the human and animal that cause or allows disease transmission.
 Time accounts for the incubation periods, life expectancy of the host or the
pathogen and duration of the course of the illness or condition.
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 Mode of disease transmission
 Direct Transmission
The direct and immediate transfer of an agent from host/reservoir to a susceptible host.
Direct transmission can occurs from direct physical contact such as, an exposure to the
person or animal or its waste products.
 Indirect Transmission
Occurs when an agent is transferred or carried by some intermediate items, organism,
means, or process to a susceptible host, resulting in disease.
 Air Borne Transmission
Occurs when droplets or dust particles carry the pathogen to the host and cause infection.
This may results when person sneezes, coughs or talks.
 Vector borne Transmission
When an arthropod (such as a mosquito, flea, or tick) conveys the infections agents.
 Vehicle Borne Transmission
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When fomites, food or water that acts as conveyance.
 The Chain of Infection
 There is a close connection between triangle and chain of
infection
 Disease transmission occurs when the pathogens leaves the
reservoir through a portal of exit and is spread by one of several
modes of transmission. The pathogen or disease-causing agent
enters the body through a portal of entry and infects the host if
the host is susceptible.

Mode of
Agent Reservoir Host
Transmission

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 Epidemiological approach to the
investigation of disease problems

 The epidemiological investigations usually have the basic

objective of describing and quantifying disease problems and of
examining associations between determinants and disease.
 With these objectives in mind, epidemiological investigations
are normally conducted in a series of stages, which can be
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 Epidemiological Approach
 A diagnostic phase,
in which the presence of the disease is confirmed
 A descriptive phase,
which describes the populations at risk and the distribution of the disease,
both in time and space, within these populations. This may then allow a series of
hypotheses to be formed about the likely determinants of the disease and the effects
of these on the frequency with which the disease occurs in the populations at risk.
 An investigative phase,
which normally involves the implementation of a series of field studies
designed to test these hypotheses.
 An experimental phase,
in which experiments are performed under controlled conditions to test these
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hypotheses in more detail, should the results of phase 3 prove promising.
 An analytical phase,
In which the results produced by the above investigations are analyzed. This is often
combined with attempts to model the epidemiology of the disease using the information
generated. Such a process often enables the epidemiologist to determine whether any vital bits
of information about the disease process are missing.
 An intervention phase,
in which appropriate methods for the control of the disease are examined either under
experimental conditions or in the field. Interventions in the disease process are effected by
manipulating existing determinants or introducing new ones.
 A decision-making phase,
in which a knowledge of the epidemiology of the disease is used to explore the various options
available for its control. This often involves the modelling of the effects that these different
options are likely to have on the incidence of the disease. These models can be combined with
other models that examine the costs of the various control measures and compare them with
the benefits, in terms of increased productivity, that these measures are likely
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to produce. The
optimum control strategy can then be selected as a result of the expected decrease in disease
 A monitoring phase,
which takes place during the implementation of the control measures
to ensure that these measures are being properly applied, are having
the desired effect on reducing disease incidence, and that
developments that are likely to jeopardize the success of the control
programme are quickly detected.

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 Epidemiological approach in community settings

The three main types of epidemiological study:

 Prospective studies,
which look forward over a period of time and normally attempt to examine associations
between determinants and the frequency of occurrence of a disease by comparing attack
rates or incidences of disease in groups of individuals in which the determinant is either
present or absent, or its frequency of occurrence varies.
 Retrospective studies,
which look backward over a period of time and normally attempt to compare the
frequency of occurrence of a determinant in groups of diseased and non- diseased
individuals.
 Cross-sectional studies,
which attempt to examine and compare estimates of disease prevalence
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populations and subsets of populations at a particular point in time.
Prospective studies

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Retrospective studies

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Ambidirectional Cohort Study

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