DISEASE EPIDEMIOLOGY

Dr . A.K.AVASARALA MBBS, M.D. PROFESSOR & HEAD DEPT OF COMMUNITY MEDICINE & EPIDEMIOLOGY PRATHIMA INSTITUTE OF MEDICAL SCIENCES, KARIMNAGAR, A.P.. INDIA: +91505417

avasarala@yahoo.com

PROMPT
DISEASE IS STILL A MYSTERY SOME DISEASES KILL AND SOME WONT KILL SOME ARE SHORT LIVED WHILE OTHERS ARE LONG LIVED SOME ARE TREATABLE AND SOME ARE NOT SOME ARE CURED BY MIRACLES (TO ACHIEVE SAINTHOOD, THERE ARE INSTANCES OF CURING BY MIRACLES)

LEARNING OBJECTIVES
THE STUDENT SHOULD LEARN DISEASE PROCESS WHAT IS DISEASE? WHAT ARE THE THEORIES OF CAUSATION OF DISEASE? HOW IS IT INITIATED? HOW IS IT CAUSED? HOW IS IT TRANSMITTED? HOW IT SPREADS? HOW IT IS DISTRIBUTED? AND WHY? HOW IT CAN BE PREVENTED? HOW IT CAN BE ERADICATED?

PERFORMANCE OBJECTIVE
STUDENT CAN USE EPIDEMIOLOGICAL APPROACH TO PREPARE A LESSON PLAN BY MAKING USE OF VON KIPLING'S SIX HONEST SERVING MEN (WHAT, WHY, WHEN, WHERE, WHOM AND HOW) TO DEVELOP A LECTURE

WHAT EXACTLY IS A DISEASE IS STILL A ?

IS IT A SEQUENCE OF PATHOLOGICAL CHANGES AND THEIR EFFECTS OCCURRING IN THE INDIVIDUAL? IS IT A COMPOSITE OF EFFECTS DUE TO DISTURBANCE IN MANS RELATIONSHIP WITH HIS ENVIRONMENT BY AN AGENT/FACTOR?

WHAT IS A DISEASE?
DISEASE CAN BE SIMPLY EXPLAINED AS DIS AT EASE OR ILL HEALTH

SOME DESCRIBE IT AS DISTURBANCE IN EQUILIBRIUM BETWEEN MAN AND HIS TOTAL ENVIRONMENT.

HOW THE DISEASE IS CAUSED?

1. SUPERNATURAL THEORY OF DISEASE 2. ECOLOGICAL THEORY 3. GERM THEORY 4. MULTIFACTORIAL CAUSATION THEORY

NO UNANIMOUS OPINION
AT LEAST 10% OF THE PEOPLE IN
DEVELOPED COUNTRIES AND 30% IN DEVELOPING COUNTRIES STILL BELIEVE IN SUPERNATURAL ORIGIN EVEN TODAY SUPERSTITIONS ARE BECOMING MAJOR OBSTACLES IN DISEASE CONTROL MOST OF THE LITERATES VIEW THAT DISEASE IS THE RESULT OF MICROBES MOST OF THE UNEDUCATED PEOPLE (90%) BELIEVE THAT DISEASE IS DUE TO BAD PHYSICAL ENVIRONMENT

SUPERNATURAL THEORY OF DISEASE:

IN THE EARLY PAST, THE DISEASE WAS THOUGHT MAINLY DUE TO EITHER THE CURSE OF GOD OR DUE TO THE EVIL FORCE OF THE DEMONS. ACCORDINGLY, PEOPLE USED TO PLEASE THE GODS BY PRAYERS AND OFFERINGS OR USED TO RESORT TO WITCHCRAFT TO TAME THE DEVILS.

ECOLOGICAL THEORY
AROUND 463 BC, HIPPOCRATES IS THE FIRST EPIDEMIOLOGIST WHO ADVISED TO SEARCH THE ENVIRONMENT FOR THE CAUSE OF THE DISEASE.

ENVIRONMENTAL INFLUENCE
INTERACTIONS AMONG HUMANS, OTHER LIVING CREATURES, PLANTS, ANIMALS, MICRO ORGANISMS, ECOSYSTEMS, AND CLIMATE, GEOGRAPHY, AND TOPOGRAPHY ARE SO COMPLEX THAT DESPITE MUCH STUDY WE ARE OFTEN UNCERTAIN WHAT IS REALLY HAPPENING.

ECOLOGICAL DETERMINANTS OF DISEASE

MCKEOWN HAS POINTED OUT, IMPROVED HEALTH OWES LESS TO ADVANCES IN MEDICAL SCIENCE THAN TO THE OPERATION OF NATURAL ECOLOGICAL LAWS

GERM THEORY
Germ theory: Microbes (germs) were found to be the cause for many known diseases. Pasteur, Henle, Koch were the strong proponents of microbial theory after they discovered the microorganisms in the patients secretions or excretions.

ROBERT KOCH

HENLE-KOCH POSTULATES
Henle and Koch have postulated that 1.Each disease will be caused by a germ 2.Without that germ that disease will not be caused 3.By introducing that germ , that disease can be caused in animals experimentally, 4.And that germ can again be isolated from that sick animal experimented with.

MULTIFACTORIAL CAUSATION THEORY

PETTENKOFFER STATED THAT AGENT, HOST AND ENVIRONMENTAL FACTORS WILL ACT AND INTERACT SYNERGISTICALLY AND ACT AS JOINT INDEPENDENT PARTNERS IN CAUSING THE DISEASE.

PETTENKOFFER

WHEN THE DISEASE OCCURS?

Agent (SEED) factors
DISEASE OCCURS ONLY WHEN THE HOST FACTORS AND ENVIRONMENTAL FACTORS MAKE THE AGENT SUFFICIENT ENOUGH TO CAUSE THE DISEASE

Host factors (SOIL)

Environmental factors (SHOWER)

CAUSAL CONSTELLATIONS
disease

ABCDE
Causal constellations 1

AFGHJK
2

ALMNPQ
3

ARSTX
4

A = NECESSARY CAUSE B TO X = CAUSAL PARTNERS

EXAMPLES
LUNG CANCER IS CAUSED BY A CONSTELLATION OF CAUSES LIKE SMOKING UNFILTERED CIGARETTES 10 YEARS DURATION AND HOST SUSCEPTIBILITY

TISSUE INSULT DUE TO CHRONIC IRRITATION

Chronic irritation of any tissue may lead to disease 1. MARJOLINS ULCER- in the past, barbers used to wipe their razors on their forearms frequently while shaving the beards of their clients. This chronic irritation has resulted in squamous epitheliomatous changes and cancers ( Marjolins ulcers) in barbers

PLANETS AND DISEASE

IT IS WELL KNOWN THAT PLANETS (EARTH,SUN, MOON ) AND THEIR MOVEMENTS, THEIR INTER DISTANCES AND RELATIONSHIPS WILL CAUSE SEASONS OF THE YEAR PLANETS INFLUENCE ON ORIGIN OF SEASONAL DISEASES AND THEIR CONTROL IS STILL A PANDORA BOX

INCUBATION
THE AGENT INCUBATES TO ACQUIRE THE CRITICAL DENSITY TO INITIATE THE DISEASE IT MULTIPLIES OR INCREASES IN INTENSITY FOR A SPECIFIC PERIOD BEFORE BECOMING OVERT AND CLINICAL

DISEASE INITIATION
THE DISEASE IS INITITED
AT THE CELLULAR LEVEL

WHEN THE NECESSARY CAUSE (AGENT) BECOMES SUFFICIENT I. E. COMPLIMENTED BY ITS CAUSAL PARTNERS

HOW IT PROGRESSES?
Natural history of disease
Disease initiation at Cellular level Carrier State Incubation Period/Generatio n time Prepathogenic period

Death

Pathogenic period Convalescent period

HOW THE DISEASE IS TRANSMITTED?

RESERVOIR/ SOURCE OF AGENT

MODE OF TRANSMISSION THROUGH SOME VEHICLE OR VECTOR

Susceptible Host/Non Immune/ Poor herd immunity

DISEASE DISTRIBUTION
TIME DISTRIBUTION OF THE DISEASE

1. 2. 3. 4.

SHORT TERM FLUCTUATIONS, LONG TERM FLUCTUATIONS, PERIODIC FLUCTUATIONS, CYCLICAL, SEASONAL, SECULAR TRENDS

CLUSTERING
THIS PHENOMENON IS USUALLY ASSOCIATED WITH INFECTIOUS DISEASES. DISEASE OCCURS IN CLUSTERS OR GROUPS AT A PARTICULAR PLACE WHEN THE PEOPLE ARE SUSCEPTIBLE AND ENVIRONMENT IS FAVOURABLE THERE.

ONION PEEL PHENOMENON

OLD DISEASES FADE AWAY GIVING PLACE TO THE NEW ONES JUST LIKE THE LAYERS OF THE ONION, THE OLD DISEASES WANE AND GIVE PLACE TO NEWONES. INFECTIOUS ONES WILL BE REPLACED BY NON INFECTIOUS ONES TO BE REPLACED LATER BY PERSONAL AND BEHAVIORAL PROBLEMS.

DISEASE PREVENTION
1. PRIMORDIAL PREVENTION-INTERVENTIONS TAKEN BEFORE THE DEVELOPMENT OF RISK FACTOR 2. PRIMARY PREVENTION -INTERVENTIONS TAKEN BEFORE THE DISEASE IS ESTABLISHED 3. SECONDARY PREVENTION-INTERVENTIONS TAKEN AFTER THE DISEASE IS ESTABLISHED4. TERTIARY PREVENTION -INTERVENTIONS TAKEN TO PREVENT COMPLICATIONS

DISEASE SURVEILLANCE
WATCHING THE DISEASE WITH SUSPICION, ATTENTION AND AUTHORITY 1. SUSPECT UNLESS AND UNTIL IT IS DISPROVED 2. BE ATTENTIVE AND CAUTIOUS 3. TRY TO GRASP THE ENTIRE NATURAL HISTORY OF THE DISEASE

PUBLIC HEALTH PROBLEM

DISEASE WILL BE A PUBLIC HEALTH PROBLEM WHEN IT CAUSES HIGH MORBIDITY AND MORTASLITY DEMANDS URGENT HEALTH ACTION EITHER IN THE FORM OF 1. CONTROL 2. ELIMINATION 3. ERADICATION

DISEASE CONTROL
CONTROL STRATEGY = REDUCING THE MORBIDITY AND MORTALITY A CONTINGENCY TEMPORARY MEASURE IN CASE OF EMERGENCY

DISEASE ELIMINATION
NEAR ERADICATION STAGE INTERMEDIARY BETWEEN CONTROL AND ERADICATION STATUS LESS PUBLIC HEALTH PROBLEM BASED MAINLY ON SURVEILLANCE ACTIVITIES

ERADICATION
RADICLE MEANS MAIN ROOT OF A PLANT ERADICATION MEANS REMOVING ALONG WITH THE MAIN ROOT i. e. IN ENTIRETY ALL OR NONE FORMULA

DISEASE ERADICATION
AGEENT IN MODE OF TRANSMISSION SUSCEPTIBLE RESERVOIROR POPULATION SOURCE

TO ERADICATE THE DISEASE ONE MUST: - ELIMINATE THE RESERVOIR/SOURCE OF THE AGENT - CUT OFF THE TRANSMISSION - MAKE THE PEOPLE IMMUNE TO THAT DISEASE

REFERENCES
Last JM: Public Health and Human Ecology, 2nd Edition. Stamford, CT: Appleton & Lange, 1998; pp 8-9.Thucydides: The Peloponnesian War. Translated by Rex Warner. Harmondsworth: Penguin Classics, 1954; Book 2, Chapter 5, pp 123-129 For a good introduction, see for example McNeill W: Plagues and Peoples. New York: Doubleday, 1976 Zinsser H, in Rats, Lice and History (Boston: Little, Brown & Co, 1935) gave a sparkling account of the influence of typhus on the outcome of wars. Diamond J, in Guns, Germs and Steel (New York: Norton, 1997) strains credibility with a grand theory based on flimsy factual foundations Semmelweiss IP: Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers. Pest, Wien und Leipzig: CA Hartleben, 1861