Académique Documents
Professionnel Documents
Culture Documents
DEFINITION
EPIDEMIOLOGY :
The study of the distribution and determinants of
health related states (or) Events in specified populations , and the
application of this study to the control of health problems
Concept of disease:
Germ theory of disease:
The germ theory of disease is
generally referred to as a one-to-one relationship or single
cause idea between causal agent and disease.
Disease Agent
Man
Disease
Multifactorial causation:
Pettenkofer of munich (1819- 1901)
Epidemiological triad
Agent
Host
Environment
stress
Smoking
Emotional disturbances
Lack of exercise
Hypertension
Aging&other
Coronary atherosclerosis
Coronary occlusion
Myocardial ischemia
Myocardial infarction
PERIOD OF PATHOGENESIS
Hos
t
Environment( bring
agent and host together)
Agent
Death
Defect or chronic
Disability
stage
illness
Signs and symptom
recovery
Tissue and physiological
changes
Agent
multiplication
In the human host
Host re
interaction
Of host and
stimuli
Levels of prevention
Primary prevention
Early
pathogenesis
early
lesions
Secondary
Tertiary
disease convalescence
prevention
prevention
Aims of epidemiology
1.To describe the distribution and magnitude of
health and disease problems in human
populations.
2.To identify aetiological factors (risk factors) in the
pathogenesis of the diseases.
3.To provide the data essential to the planning
,implementation and evaluation of services for the
prevention,control and treatment of disease and to
the setting up of priorities among those services
Uses of Epidemiology
1. To study historically the rise and fall of disease in
the population
2. Community diagnosis
3. Planning and evaluation
4. Evluation of individuals risk and chances
5. Syndrome identification
6. Completing the natural history of disease
7. Searching for causes and risk factors
MEASUREMENTS IN EPIDEMIOLOGY
1.
2.
3.
4.
5.
Measurement of mortality
Measurement of morbidity
Measurement of disability
Measurement of natality
Measurement of the presence, absence (or)distribution of
the characteristics (or)attributes of the disease
6. Measurement of medical needs,health care
facilities,utilization of health services and other health
related events
7. Measurement of demographic variables
TOOLS OF MEASUREMENT
RATE :
The occurrence of some particular events in a
population during a given period of time
Death rate =Number of deaths in one year x 1000
Mid year population
RATIO :
Measure of disease freguency in a ratio .it
expresses a relation in size between two random
guantities
PROPORTION
The number of children with scabies at a certain
Time
--------------------------------------------------------------x100
The total number of children in the village at the same
time
Methods of Epidemiology
1.Observational studies
a. Descriptive studies
b. Analytical studies
(i) Ecological or correational , with populations as unit of
study
(ii)cross sectional or prevalence, with individuals as unit
of study
(iii)case control or case reference with individuals as unit
of study
Descriptive Epidemiology
a. When is the disease occuring ?
- Time distribution
- Place distribution
- person distribution
Short term
fluctuation
Place distribution
International
variation
National variation
Rural-urban
variation
Local distribution
Periodic
fluctuation
Common source
epidemic
Single
exposure
Person distribution
Age,sex,occupation,
Marital status,habits,social
class,
Stress,migration.behavior
Repeated
exposure
Season
al trend
Cyclic
trend
Propagated
epidemic
Long term
fluctuation
Slow
epidemic
Types of Epidemics
Three major types of epidemics
A. Common sourse epidemics
a. Single exposure or point sourse epidemics
b. Continuous or multiple exposure epidemics.
B. Propagated epidemics
a.
b.
c.
Person to person
Arthropod vector
Animal reservoir
Analytical Epidemiology
CASE CONTROL STUDY
Factor
Present
(or)
Absent
Cases with
Individual
particular disease
Controls
Individual without
particular disease
Individual exposed to
particular factor
Individual unexposed to
particular factor
TIME
Relative Risk
Incidence of disease (or death) among exposed
RR = ________________________________
Incidence of disease (or death) among non - exposed
Attributable Risk
Experimental Epidemiology
Two types are:
1. Randomized controlled trails
2. Non- randomized trails
Drawing up a protocol
Selecting reference and experimental population
Randomization
Manipulation or intervention
Follow up
Assessment of outcome.
Those not
eligible
RANDOMIZE
Experimental
group
Control group
Manipulation & follow -up
Assessment
MEASUREMENT OF MORBIDITY :
INCIDENCE RATE
PREVALENCE RATE
INCIDENCE RATE:
x1000
Prevalence rate:
Point prevalence
Period prevalence
Point prevalence :
It is the number of all current new and old
cases of a disease at one point of time in relation to a defined
population
Number of current new and old cases of a specified disease existing at a
given point of time
x100
Period prevalence:
It is the frequency of all current new & old
cases during a defined period of time in relation to a defined
population .
= No.of current new& old cases of a specified disease during a given period of
time interval
x 100
Estimated mid- interval population at risk
MEASUREMENT OF MORTALITY:
Age
Group specific:
Sex
=No.of deaths among females
during a calender year x1000
Source
Or
reservoir
Modes
Of
Mo
transmissi
on
Susceptible
host
Human reservoir
cases
Clinical cases
carriers
Sub clinical
cases
latent
Investigator:
Primary case- It is the first case of a communicable disease
introduced into the population being studied.
Secondary case Those cases which develop from the contact
with primary case .
Index case This term refers to first case which has come in
attention of investigator.
Mode of transmission:
1.Direct transmission:
Direct contact
Droplet infection
Contact with soil
Inoculation into skin or mucosa
Transplacental(vertical )
2.Indirect transmission :
Vehicle borne
Mechanical
Vector borne
Air borne
biological
droplet
dust
Fomite borne
Unclean hands and fingers
1.Direct transmission:
Direct contact:
skin to skin,mucosa to mucosa or mucosa to skin of the
same person or another.
Droplet infection:
Direct projection of spray of saliva or naso
pharyngeal secretions
Contact with soil:Ex: hook worm infestations,tetanus etc
Inoculation into skin or mucosa:
ex: rabies virus by dog bite,heptitis B by
contaminated needles
Transplacental transmission:
Ex:TORCH(Toxoplasma gondi,rubella virus, cyto megalo virus,
herpes virus)
2.Indirect transmission:( 5 Fs flies,fingers,fomites,food,fluid)
a.Vehicle born
Transmission of infectious agent
through water,food,raw
vegetables,fruits,milk,ice,blood,serum
b.Vector born
(Arthropod, vertebrate, non-vertebrate)
Invertebrate type: (Arthropod)
Flies and mosquitoes,fleas,cockroaches,sucking
lice,bugs,ticks,mites,cyclops.)
vertebrate type:Mice,rodents,bats
By transmission chain:
A . Man and a non-vertebrate host:
Man-arthropod-man (malaria)
Man-snail-man (schistosomiasis)
B . Man, vertebrate host ,and a non vertebrate host:
Mammal arthropod man(plaque)
Bird arthropod man(encephalitis)
c. Man and 2 intermediate hosts :
Man cyclops fish Man (fish tape worm)
By methods in which vectors transmit agent:
Biting, regurgitation, scratching in of infective faeces,
contamination of host with body fluids of vectors
Airborne :
Droplet,dust(1 -10 micron range)
Fomite borne :other than water or food (soiled
clothes,towels,linen,glasses etc)
Unclean hands and fingers
III.The vector born transmission on the basis of involvement of
vector and propagation of parasites,is of 2 types,
Mechanical transmission: The infectious agent doesnot develop
or multiply on or within the vector and is transmitted
mechanically by arthropods through soiling of its feet.
Biological transmission: The infectious agent multiply or replicate
or both occur in the vector before transmission.
Cyclo propagative
Cyclodevelopmental
MULTIPLICATION
yes
yes
No
DEVELOPMENT
No
yes
yes
EXAMPLE
Malaria prasites
Microfilaria in
mosquito
CHARACTERISTICS
Epidemiology : Terminologies
1.Infection :
The entry and development or multiplication of an
infectious agent in the body of man or animals .
2.Contamination :
The presence of an infectious agent on a body surface
,also on or in clothes, beddings ,toys , surgicl instruments or
inanimate articles or substances including water, milk ,food.
3.Infestation:
For persons or animals the lodgement ,
,development and reproduction of arthropods on the surface of the
body or in the clothing .
Ex :lice, itch mite
Host :
A person or animal, including birds and arthropods ,that
affords subsistence or lodgement to an infectious agent
under natural conditions .
Obligate host - the only host Ex : man in measles ,typhoid
Definite host or primary - Host in which the parasite attains
maturity or passes its sexual stage .
Intermediate or secondary - Larval or Asexual stage.
Transport host - Carrier
Infectious disease :
A clinically manifest disease of man or
animals resulting from an infection .
Contagious disease :
A disease that is transmitted through
contact.
Ex: Scabies,trachoma
Communicable Disease :
An illness due to a specific infectious
agent or its toxic products capable of being directly or
indirectly transmitted from man to man ,animal to animal or
from the environment( air,dust,soil).
Epidemic:
Epi = upon , demos = people,the unusual occurrence in
a community or region of disease ,specific health related
behaviour or health related events clearly in excess of
expected occurrence.
Endemic :
En = in ,demos = people ,It refers to the constant
presence of a disease or infectious agent within a given
geographic area or population group .
Sporadic :
The word sporadic means scattered about ,the cases
occur irregularly ,haphazardly from time to time ,and
generally infrequently . Ex :polio
Pandemic:
An epidemic usually affecting a large proportion of
the population
Ex : Section of a nation, the entire nation Ex :chleora.
Exotic:
Diseases which are imported into a country in which
they do not other wise occur.
Ex: rabies
Zoonoses :
An infection or infectious disease transmissible
under natural conditions from vertebrate animals to man .
Ex: rabies ,anthrax
Epizootic :
An outbreak(epidemic) of disease in an animal
population .
Ex: Anthrax, JE
Epizootic :
An outbreak (epidemic) of disease in an animal
population .:
Ex: influenza
Epornithic :
An outbreak (epidemic) of disease in a bird
population.
Enzootic :
An endemic occuring in animals
Ex: anthrax
Noso comial Infection:
Nosocomial (hospital acquired )infection is
an infection originating in a patient while in a hospital or
other health care facility.
Opportunistic Infection:
This is infection by an organism that takes the
opportunity provided by a defect in host defence to infect the
host and hence cause disease.
Ex:AIDS
Iatrogenic (physician Induced)disease:
Any untoward or adverse consequence of a
preventive ,diagnostic or therapeutic regimen or procedure
,that causes impairment ,handicap, disability or death resulting
from a physicians professional activity.