EPIDEMIOLOGY

EPIDEMIOLOGY

The science that deals with when and where diseases occur. How they are transmitted in the human population.

EPIDEMIOLOGY

Modern epidemiology began in 1854 when John Snow reasoned that cholera was transmitted by contaminated water. He questioned some victims of a cholera epidemic in London and found that most of them obtained water from the Broad Street well.

EPIDEMIOLOGY

He determined that the incidence of cholera was higher among people who drank from the London section of the Thames River than among the population using cleaner water upstream.

EPIDEMIOLOGY

Etiology Identifies other possible factors and patterns concerning the persons affected. Age, gender, occupation, personal habits, history of immunization, presence of any other diseases, and the common history of affected individuals. Most concerned with the rate of a disease.

RATE OF DISEASE IN A POPULATION

Attach ratethe proportional number of cases developing in a population exposed to the infectious agent. For example, if 100 people at a party ate chicken that was contaiminated with Salmonella, and 10 people cam down with symptoms of disease, then the attack rate was 10%.

RATE OF DISEASE IN A POPULATION

MORBIDITY RATE - is calculated as the number of cases of an illness in a given time period divided by the population at risk. Contagious diseases have a high morbidity rate because each infected individual may transmit the infection to several others.

RATE OF DISEASE IN A POPULATION

MORTALITY RATE- reflects the percentage of the population that dies from the disease.

OCCURRENCE OF DISEASE

INCIDENCE measures the number of new cases over a certain time period, as compared with the general healthy population. PREVALENCE total number of existing cases with respect to the entire population usually represented by a percentage of the population.

OCCURRENCE OF DISEASE

SPORADIC when occasional cases are reported at irregular intervals. ENDEMIC disease that exhibits a relatively steady frequency over a long period of time in a particular geographic locale. EPIDEMIC when prevalence of a disease is increasing beyond what is expected. PANDEMIC epidemic across continents

PATTERNS OF DISEASE OCCURRENCE

EPIDERMIOLOGIC STUDIES

RESVOIRS OF INFECTION PORTAL OF EXIT TRANSMISSION PORTALS OF ENTRY DISEASE

OVERVIEW OF DISEASE

RESERVOIRS OF INFECTION

The reservoirs of infection is important because it affects the extent and distribution of a disease. Recognizing the reservoir can help protect a population from disease, because measures can then be instituted to prevent the people from coming into contact with the source.

HUMAN RESERVOIRS

SYMPTOMATICshow signs and symptoms of the disease. ASMYPTOMATIC CARRIERdo not show signs or symptoms of the disease.

ANIMAL RESERVOIRS

Both wild and domestic animals are living reservoirs of microorganisms that can cause human disease. Diseases that occur primarily in wild and domestic animals and can be transmitted to humans are called zoonose. Examples include rabies, Rocky Mountain spotted fever.

ENVIRONMENTAL RESERVOIRS

The two major nonliving reservoirs of infectious disease are soil and water. Soil harbors such pathogens as fungi, and Clostridium botulinum. Water that has been contaminated by the feces of humans and other animals is a reservoir for microorganism which are responsible for gastrointestinal diseases.

PORTALS OF EXIT

Microorganism must leave one host in order to be transmitted to another. Respiratory, saliva Skin Fecal exit Urogenital tract Removal of blood

TRANSMISSION OF DISEASE
The causative agents of disease can be transmitted from the reservoir to a susceptible host by 4 routes. 1. ContactDirect 2. A common vehicleIndirect 3. Airborne route 4. Vectors

CONTACT TRANSMISSION

DIRECT CONTACTreservoir to host INDIRECT CONTACTreservoir to vehicle to host.

Vehicle inanimate material, food, water, biological products, fomites

DROPLETreservoir to air (short distance) to host

TRANSMISSION

Common vehicle transmission refers to the transmission of disease agents by a common inanimate reservoir (food, drugs, blood) to an individual.

Airborne transmission refers to the spread of agents by droplet nuclei or dust at a distance of more than 1 meter from the reservoir to host.

VECTORS

A vector, animals that carry pathogens from one host to another.

Biological: Bite or feces Mechanical:Transported
on feet

PORTALS OF ENTRY
To cause disease, not only must a pathogen be transmitted from its reservoir to a new host, it must also colonize a surface of or enter the new host.

PORTALS OF ENTRY

Mucous membranes Skin Gastrointestinal tract Respiratory tract Urogenital tract

PORTALS OF EXIT

MUCUS MEMBRANES
Mucus membranes are present in respiratory, gastrointestinal, genitourinary tracts, and the conjunctiva of the eye. The respiratory tract is the easiest and most frequently traveled portal of entry for infectious microbes. Examples include: cold, pneumonia, influenza, measles, and smallpox.

MUCUS MEMBRANES
Microorganisms can gain access to the gastrointestinal tract in food and water. Most microbes that enter the body are destroyed by HCl and enzymes. Those that survive can cause disease. Examples include: hepatitis A, poliomyelitis, typhoid fever, and cholera.

MUCUS MEMBRANES
An important pathogen capable of penetrating the mucous membranes of genitourinary tract is Trponema pallidum, the causative agent of syphilis.

SKIN
Some microbes gain access to the body through the openings in the skin, the hair follicles and sweat gland ducts. Examples include some fungi and hookworms.

PARENTERAL ROUTES
Parenteral routes are the result of penetration or injury to the surface epithelial tissue and connective tissue. Punctures, injections, bites, cuts, surgery call all establish parenteral routes.

INFECTIOUS DOSE (ID)

minimum number of microbes required for infection to proceed microbes with small IDs have greater virulence
1 rickettsial cell in Q fever 10 bacteria in TB, giardiasis 109 bacteria in cholera

Lack of ID will not result in infection ID50 dose that infects 50% of those exposed

LETHAL DOSE

LD50 lethal dose that 50% of those exposed

PATHOGEN PENETRATION
Once pathogens gain entry to a host, almost all of them have some means of attaching themselves to host tissue. The attachment between pathogen and host takes place by means of surface molecules on the pathogen called adhesins or ligands that bind specifically to complementary surface receptors on the cells of certain host tissues. Once attached, the pathogen is ready to invade a sterile body compartment.

MECHANISMS OF ADHESION

VIRULENCE ENHANCING ENZYMES

Leukocidinsdestroy WBCs by degrading lysosomes in WBC. Ex. Streptococci Hemolysinslyse RBCs. Ex. Streptococci,

Staphylococci, Costridium

Coagulasesclot blood. Ex. Staphylococcus Kinasesdissolve clots therefore bacteria can travel throughout body and prevents isolation of bacteria. Ex. streptokinase, staphylokinase. Hyaluronidasedissolve matrix of connective tissue. Ex. collagenase from Clostridium

TOXINS

Exotoxins proteins secreted by grampositive and gram negative bacteria.

Endotoxins lipid A of LPS of gramnegative bacteria.

EXOTOXINS
Characteristics: 1. usually from Gram + organisms. 2. Proteins 3. Secreted from the bacteria while the bacteria is alive. 4. Generally destroy host cells or inhibit metabolic functions.

ENDOTOXINS
Characteristics:
1. Usually from Gram organisms. 2. Lipopolysaccharide which is part of bacterial cell wall. It is released after the bacteria dies. 3. Illicit side effects such as fever, weakness, and shock. 4. Example: Salmonella typhi--typhoid fever

EXOTOXINS
Examples: 1. Cytotoxinskills host cells. Ex. diphtheria. 2. Neurotoxinsinterfere with nerve functions. Ex. Botulism. 3. Eneterotoxinsaffect cells of GI tract. Ex. Staphylococci food poisoning.

HERD IMMUNITY
A phenomenon that occurs when a critical concentration of immune hosts prevent the spread of an infectious agent.

NOSOCOMIAL INFECTIONS

NOSOCOMIAL INFECTIONS

Nosocomial infections are hospital acquired infections. Not surprising because of the high density of susceptible people. In the US about 5-6% of patients admitted to the hospital develop a nosocomial infection.

NOSOCOMIAL INFECTIONS

Nosocomial infections are defined as hospitalacquired infections Numerous factors determine which organisms and agents are responsible
Length of time of exposure Manner of exposure Virulence and number of organisms State of host defenses Infections may range from mild to fatal

NOSOCOMIAL INFECTIONS

Commonly implicated organism include

Enterococcus species

Part of normal intestinal flora

Escherichia coli and other species in family Enterobacteriaceae

Part of normal intestinal flora Common cause of nosocomial pneumonia and urinary tract and burn infections

Pseudomonas species

Staphylococcus aureus

Survives in environment for prolonged periods Easily transmissible to fomites

Often part of normal skin flora

Other Staphylococcus species

NOSOCOMIAL INFECTIONS

Reservoirs of infectious agents in hospitals

Other patients

Patients can harbor infectious agents and discharge into environment Certain bacteria do not require many nutrients and can survive long periods on surfaces Many of these organism are antibiotic resistant
Due to continual exposure to antibiotics

Hospital environment

NOSOCOMIAL INFECTIONS
Health care workers

Outbreaks can sometimes be traced to hospital worker

Often as a result of improper handwashing or sterile technique

Patients own normal flora

Invasive treatments often introduce surface flora to interior regions of body

NOSOCOMIAL INFECTIONS

Transmission of infectious agents in hospitals

Medical devices

Devices routinely breach first-line barriers

Catheterization, mechanical respirators, and inadequately sterilized instruments

Healthcare personnel

Handwashing between patients effective against spread of disease Airflow is regulated to specific parts of hospital
Keeps certain areas contained

Airborne

NOSOCOMIAL INFECTIONS

Preventing nosocomial infections

Most important step is to recognize their occurrence and establish policies to prevent their development

Infection Control Committee

Committee often chaired by hospital epidemiologist trained in hospital infection control

Infection control practitioner

Active surveillance of types and numbers of infections occurring in the hospital setting