The doctrine about epidemic

process.
Classification of infectious
diseases
 Plan of lecture
1. Epidemiology is a science about laws of epidemic process

2. Description of epidemiology process

3. Classification of carriage

4. Description of source of infection

5. Mechanisms of transmission of infectious diseases

6. Epidemiological classification of infectious diseases

 Epidemiology is a science about laws
of epidemic process.

Its value in public health services is

determined by high percent of infectious
diseases in the general disease of the
population and high lethality.

On the data the WHO annually in the world

16,4 million people die from infectious and
parasitic illnesses.
 Zabolotny D.K. (1866-
1929) was founder
epidemiology.
He was the initiator of
the opening of the first
faculty of epidemiology
in the Odessa medical
institute in 1920, wrote
the first scientific work
on epidemiology Bases
of epidemiology, and
he headed institute of
experimental medicine.
 Zabolotny D.K. headed many expeditions to
India, Mongolia, China on studying a plague
and a cholera.

In 1911 Zabolotny D.K. for the first time has

put forward a hypothesis that the wild rodents
are keepers of a plague agent in the nature and
a source of infection of the person.
 For last 20 years it was open more than
30 new infectious diseases (hemorrhagic
fevers Ebola, Marburg, agent of Lime
disease, HIV-infection, a respiratory
chlamidiosis and many others).

To the new infections belong earlier

not differentiated virus hepatitis. Now it
is registered nine independent virus
hepatitis: A, B, C, D, E, F G, V, SEN-V.
 Under the expert opinion of the International
agency on studying a cancer many viruses
participate in cancerogenesis. For example,
viruses of papillomas and viruses of a herpes
are the reason of occurrence of a cancer cervix
of the uterus.

Viruses of a hepatitis B and C are one of the

reasons of hepatocarcinoma. Dependence of
prevalence holangiocarcinoma the person from
affection the population with opisthorchosis is
proved.
 According to the WHO an estimation,
1,5 million (15 %) of new cases of a
cancer can be avoided by preventive
maintenance of the infectious and
parasitic illnesses provoking
development of a tumour.
 Epidemic process is a process of
distribution of infectious diseases among
people.
Epidemic process is the complex phenomenon.
To study epidemic process it is necessary to use
some methods simultaneously: historic-descriptive,
immunologycal, statistical, experimental, laboratory
(virologic, microbiological), a method of
epidemiological examination and supervision.
The totality of all these research work receptions
also forms a complex epidemiological method. The
given method allows to study the reasons of
occurrence and development of infectious diseases in
conditions of a social life of people.
Epidemic process is carried out at presence of
3 parts:
a source of an infection,
the mechanism of transmission and
susceptible of persons.
Epidemic process depends on social
conditions and an environment.
 The first part of epidemic process is
the source of an infection.
The source of an infection is the
infected organism of a person or object
of an environment in which there is a
process of natural accumulation of the
agent and from which the agent can
infect in different way the healthy people.
According to source of an infection all
disease are divided on anthroponosis,
zooanthroponosis, sapronosis.
 The basic group of infectious diseases
makes anthroponosis.

For infectious diseases cyclic of

current is characteristic: the incubation
period, the period of the high point of
illness, the period of recovery.

However the epidemiological danger of

a source of an infection during the
various periods is different.
 The high point of the disease is the most
dangerous in the epidemic relation. Illness, as
a rule, is accompanied by a number of
symptoms (for example, cough, diarrhea and
others) which contribute the spreading of the
agent.
Besides during a high point of illness
patients discharge many agents in an
environment. For example, the patient with
severe form of a cholera discharges during a
day from 3 up to 10 l of excrements. 1 ml of
excrements contains from 10 up to 1000000
vibrions.
 However, even at a high point of illness of some
diseases patients are most dangerous in the first days
of illness, at others - in later terms.

For example, at whooping-cough during the first

days of illness the patient is very dangerous, and with
the appearance of spasmodic cough contamination of
a patient every day is reduced.

For example, the patient with measles after the 4-th

day of occurrence of a rash is not so infectious. In a
case of a viral hepatitis A contamination sharply
decreases from the moment of occurrence of a
jaundice. However, for example, in a case of abdominal
typhoid the greatest epidemiological dangerous is
expressed from the second week of a fever.
 During the period recovery clinical recovery
can coincide with sanation of an organism
from agents. For example, influenza and other
diseases.

Unfortunately, at some diseases clinical

recovery overtakes bacteriological, that is
patients may become carrier. For example, in a
case of abdominal typhoid, paratyphoid A and
B, diphtheria, meningococcal infection,
dysentery, cholera and other disease.
It is necessary to do laboratory investigation
for diagnostic bacteriocarriers in such cases.
 Classification of carriage:

Acute carriage - till 3 months;

Linger carriage till 6 months;
Chronic - more than 6 months.
 The degree of severity of the infectious
disease has the great epidemiological
significance. At severe course of infectious
process the source of an infection excretes a
plenty of microbes. However, such patient is or
on a treatment in a hospital, or isolated at
home. It enables to isolate such patient from
susceptible people.
At easy course of infectious disease the
patient excretes small amount of agents.
However, the source of an infection can remain
not revealed during a long time. Therefore
patients with easy forms of illness are of big
epidemiological danger.
 The epidemiological significance has
typicalness of clinical manifestation of the
illness. For example, the patients with icteric
forms of a viral hepatitis A are hospitalized.
However, 40 % of patients ill with the viral
hepatitis A have the anicteric form. Therefore
to diagnose a viral hepatitis A for these
patients is difficult and they are examined for a
long time and are treated in policlinics.
Bacteria Carrie which works at the food
enterprises, in children's establishments are
especially dangerous in the epidemiological
relation.
 In zooanthroponosis infectious diseases
when the basic source of an infection for the
person is the infected animal.
Zooanthroponosis infections make about 30
% of infectious diseases of the person. As a
source of an infection for the person infected
birds (the bird's flu A H5N1, ornithosis), fishes
(opisthorchosis, diphyllobothriasis), animals
(brucellosis, leptospirosis and others) can be.
 Among the mammal rodents have the
greatest epidemiological significance. The
rodents are the basic sources of a plague,
tularemia, leptospirosis and others.
Rodents are not the only sources of many
infectious diseases. The epidemic significance
of rodents consists in that they are host of
many kinds of blood-sicking insects (ticks,
fleas, etc.) which are factors of transmission of
infectious diseases.
 Annually in Ukraine more than 1
thousand diseases with leptospirosis
with lethality more than 10 % is
registered; Lime disease, tularemia are
constantly registered.
The sources of infection can be wild
animals (foxes, wolves and others).
The animals with rashes are found in
all areas of Ukraine. Last years cases of
rabies are registered among people
(Vinnitsa, Donetsk, Kharkov, Nikolaev,
Kiev, Zaporozhye areas).
 The agricultural animals can be a source of
the Siberian ulcer, glanders, murrain,
salmonellosis, leptospirosis, toxoplasmosis,
trichinosis etc. Infection can occur place both
through food stuffs, and at the contact during
care of sick animals.
 Pets (cats, dogs) also can be a source
of an infection. The cats are the basic
source of toxoplasmosis (the agent is
discharged with feces). The dogs can
become a source of an infection of
leptospirosis, echinococcosis,
toxocariasis and other diseases.
 At a number of zooanthroponosis infections
it is possible to pick out the basic and
additional source of an infection. The basic
source is the specific owner of agents
providing its preservation as a biological kind
(a natural habitat of dwelling).

The person who was fallen ill

zooanthroponosis disease, as a rule, does not
transmit the agent to other susceptible people.
Patients with brucellosis, leptospirosis,
toxoplasmosis are not dangerous to other
people.
 The additional source of an infection at
zooanthroponosis illnesses is the nonspecific
owner of the activator who are not providing its
preservation in the nature as a biological kind.
For example, in case of plague with a
pulmonary form the person can become an
additional source of an infection.

Exact determination of sources of an

infection at this or that illness correctly
focuses our practical antiepidaemic actions.
 Sapronosis are the infectious diseases which
accumulation of agents are the objects of an
environment (ground, water) which serve as a place of
natural stay and reproduction of agents.
Agents of sapronosis get the epidemic significance
only in case it there is an opportunity for realization of
the mechanism of their transmission.
In sapronosis penetration of agents in an organism
of the person does not result in its preservation as a
biological kind.
Sapronosis can be caused by bacteria or protozoa.
Bacterias are the reason of development of a gas
gangrene, food poisonings B.cereus, Cr. erfringens,
legionellosis tetanus
 For example, a natural for legionella are warm
reservoirs. Use of water in system of the
conditioner, shower installations creates
conditions for accumulation and transmission of
the big infecting doze of the agent to the person.
The discovery of the agent of legionellosis is
connected with the congress of the organization
American legion in Philadelphia in 1976.
From 4400 participants of the congress 182
have an acute respiratory infection with a severe
pneumonia, 29 of them died. From the lung tissue
of died persons the infecting agent - legionella is
found.
 The mechanism of
spreading is a set
evolution developed
ways of moving of
infecting agents from
one organism into
another, providing its
preservation as a
biological kind.
In 1941 Ukrainian
scientist
L.V.Gromashevsky has
formulated the doctrine
about the mechanism
of spreading of agents.
 Process of transmission of infectious
diseases agents consists of 3 phases:

The first phase - discharge of the agent

from the infected organism. As a rule this
phase is realized during physiological
acts (for example, breath) and it is
activated during pathological (for
example, cough, etc.);
 The second phase - the period of stay
of the agent in an environment;

The third phase - invasion of the agent

in a susceptible organism.
 There are natural mechanisms of
transmission of an infection:
aerogenic,
feces-oral,
vertical,
transmissible,
contact.
Exist also artificial mechanisms of
transmission of an infection (for example
contamination infection with a virus
hepatites B, C during parenteral
interventions).
 Each mechanism of transmission can
be realized by means of one or several
ways of transmission.
For example, the fecal-oral mechanism
of transfer can be realized by water, food
and contact-household ways.
For example, the vertical mechanism of
transmission provides transition of
agents of infectious diseases from
mother to a fetus by 3 ways:
transplacental, ascending, intranatal.
 In transmissible diseases transmission
of an infection is possible only at a sting
of a blood-sicking carrier. Carriers can
be: mosquitoes, louses, fleas, ticks,
blood-sicking flies, bugs.
The blood-sicking factor is the unique
factor of transmission of an infection, it
transfers the agent from the blood of the
patient in to the blood healthy person.
Various agents of infectious diseases
have adapted to live and to reproduce in
the certain factor.
 For example, a unique carrier of the African
trypanosomosis is the fly, and American
trypanosomosis - the flying bugs of Reduviidae
family. Mosquitoes are carriers of Mosquitoe
fever, mosquitoes Japanese encephalitis,
louses - a typhus, a fleas - plagues, ticks
Lima-disease.

The third part of epidemic process is the

susceptible organism.
 EPIDEMIOLOGICAL CLASSIFICATION
OF INFECTIOUS DISEASES

Epidemiological of classification of
infectious diseases is based on the
principle of the
mechanism transmission of an
infection,
the source of an infection and
etiological factor.
 It provides division of all infections into 5
groups:
the intestinal infections,
infection transmissed by respiratory ways,
transmissible diseases,
infection covers, and
with various mechanisms of transmission.
 EPIDEMIOLOGICAL CLASSIFICATION
OF INFECTIOUS DISEASES
There are 3 subgroups in each group
according to a source of an infection:
anthroponosis,
zooanthroponosis,
sapronosis.
There is a division on according to
etiological sign in each subgroup:
viruses, bacteria, protozoas,
helminthes.
 For example, the subgroup of
anthroponosis intestinal infections

includes the illnesses caused

by viruses (viral hepatitis A,
poliomyelitis),
by bacteria (abdominal typhoid, cholera),
by protozoa (amebiasis),
by helminthes (ascaridiasis).
 The subgroup of zooanthroponosis
intestinal infections includes the
illnesses caused
by viruses (murrain, fever Lassa),
by bacteria (brucellosis),
by protozoa (toxoplasmosis),
by helminthes (diphyllobothriasis).
The subgroup of sapronosis intestinal
infections includes diseases caused by
bactheria B. cercus, Cl. erfringens.

The subgroup of anthroponosios infections of

respiratory ways includes the illnesses caused
by viruses (influenza, measles),
by bacteria (meningococcal infection, etc.), by
protozoa (pneumocystosis, etc.).
 The subgroup of zooanthroponosis includes
the illnesses caused by viruses (Marburg,
Ebola),
a subgroup of sapronosis includes diseases
caused by bacteria (legionellosis).
The subgroup of anthroponosis
transmissible infections includes the illnesses
caused by viruses (Mosquitoes fever),
by bacteria (typhus spotted fever),
by protozoa (malaria),
by helminthes (brugiosis).
 The zooanthroponosis subgroup includes virus
illnesses (tick-borne [vernal] encephalitis),
bacteriosis (Lime-disease), the illnesses caused by
protozoa (trypanosomosis).

The anthroponosis subgroup of infections of the

external covers includes bacteriosis (gonorrhoea),
the illnesses caused by viruses (HBV, a HIV), by
protozoa (trichomoniasis), helminthes
(strongyloidiasis).
 The zooanthroponosis subgroup
includes bacteriosis (the Anthrax),
the illnesses caused by the viruses
(furiousness), by protozoa
(leishmaniasis).

The sapronosis subgroup includes

bacteriosis - a gas gangrene