EPIDEMIOLOGY OF COMMUNICABLE DISEASE

Dr. Nelson E. Hora

Chain of Infection
6 links
I. II. III. IV. V. VI. Etiologic agent Reservoir Portal of Exit Mode of Transmission Portal of Entry Susceptible Host

I. Etiologic Agents
seven categories of biological agents that can cause infectious diseases:
1. 2. 3. 4. 5. 6. 7. Metazoa Protozoa Fungi Bacteria Rickettsia Viruses Prions

I. Etiologic Agent
Host-Parasite (Infectious Agent) Interactions
Infectivity
Ability of an agent to invade and multiply (produce infection) in a host

Pathogenicity
Ability to produce clinically apparent illness

Virulence
Proportion of clinical cases resulting in severe clinical manifestations (including sequelae)

Immunogenicity
Infections ability to produce specific immunity

I. Etiologic Agent
Pathogenetic Mechanisms
1. direct tissue invasion 2. production of toxin 3. immunologic enhancement or allergic reaction leading to damage to the host 4. persistent or latent infection 5. enhancement of host susceptibility to drugs of otherwise minimal toxicity 6. immune suppression

II. Reservoir
Human Animals Environment

II. Reservoir
Human Reservoir
Levels
1. Colonization 2. Inapparent infection (covert or subclinical infection) 3. Infectious disease

All infected persons, including those with colonization only, are potential sources of infection to others

II. Reservoir
Human reservoir
Carrier an infected person who does not have apparent clinical disease but is, nevertheless, a potential source of infection to others Type of Carrier
Inapparent throughout Incubatory carrier Convalescent carrier Chronic carrier

II. Reservoir
Animal Reservoirs
Zoonoses - infections transmissible under natural conditions form vertebrate animals to man

Environmental Reservoirs
Plant, soil and water

III. Portal of Exit

The route by which the disease agent may escape from the human or animal reservoir
1. Respiratory 2. Genitourinary 3. Alimentary 4. Skin 5. Transplacental

IV. Mode of Transmission

Necessary to bridge the gap between the portal of exit form the reservoir and the portal of entry into the host Two Basic Modes
1. Direct 2. Indirect

IV. Mode of Transmission

. Direct transmission
Consists of essentially immediate transfer of an infectious agent form an infected host or reservoir to an appropriate portal of entry Include spray by droplets

IV. Mode of Transmission

. Direct transmission
Person-to-person spread of disease
Three important aspects
Generation time Herd immunity Secondary Attach Rate

IV. Mode of Transmission

number of new cases in group minus initial Secondary attack case(s)

rate = number of susceptible

persons in group minus initial case(s)*

during specified time period

IV. Mode of Transmission

Indirect transmission
Vehicle borne Vector borne Air borne
2 types of particles implicated
Dust Droplet nuclei

V. Portal of Entry
Usually the same as the portal of exit form the reservoir

VI. Susceptible Host

Susceptibility is affected by:
Genetic factors General resistance factors Specific acquired factors

THE INFECTIOUS DISEASE SPECTRUM

Some do not become infected at all Some become infected but develop no symptoms Some become infected and develop mild or moderate symptoms Some become infected and develop severe symptoms Some die as a result of their infection

THE INFECTIOUS DISEASE SPECTRUM

Part of this variation is due to the capacity of the agent to produce disease and to differing levels of resistance of the hosts.

THE INFECTIOUS DISEASE SPECTRUM

The existence of the infectious disease spectrum can make it challenging to find out the extent of transmission in a particular population. Most cases with inapparent or mild symptoms will never be discovered or reported, since these people will not seek health care. So when moderate or severe cases are reported they may represent the tip of the iceberg

THE INFECTIOUS DISEASE SPECTRUM

Another challenge is posed by the fact that many diseases look alike. A variety of agents may produce essentially similar clinical syndromes. That is why laboratory identification of the specific disease agent is so important in any epidemiological investigation.