INTRODUCTION TO EPIDERMINOLOGY:

Epidemiology is the study of patterns of health and illness and associated

factors at the population level. It is the cornerstone method of public health
research, and helps inform evidence-based medicine for identifying risk factors for
disease and determining optimal treatment approaches to clinical practice and for
preventative medicine. In the study of communicable and non-communicable
diseases, epidemiologists are involved in outbreak investigation to study design, data
collection, statistical analysis, documentation of results and submission for
publication. Epidemiologists rely on a number of other scientific disciplines such as
biology (to better understand disease processes), biostatistics (the current raw
information available), Geographic Information Science (to store data and map
disease patterns) and social science disciplines (to better understand proximate and
distal risk factors).

DEFINITION OF EPIDEMIOLOGY:
The word ‘epidemiology’ is derived from the Greek terms epi = upon, among; demos
= people, district; logos = study. Hence it is defined as the “study of the distribution
and determinants of health-related states or events (including disease), and the
application of this study to the control of diseases and other health problems.”

THE AIMS OF EPIDEMIOLOGY

1. To describe the distribution and magnitude of health and disease problems in
human populations
2. To identify etiological factors (risk factors) in the pathogenesis of disease
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 (IEA).
The ultimate aim of epidemiology is-
a. To eliminate or reduce the health problem or its consequences
b. To promote the health and wellbeing of society as a whole.
EPIDEMIOLOGICAL APPROACH:
The epidemiological approach to problems of health and disease is based on two
major foundations:
A. ASKING QUESTIONS
B. MAKING COMPARISONS

1. BY ASKING QUESTIONS:

 Related to health problems

a. What is theevent?(the problem)
b. What is itsmagnitude?
c. Wheredidit happen?
d. Whendidit happen?
e. Whoareaffected?
f. Whydidit happen?
 Related to health action
a. What can be done to reduce these problem andits consequences?
b. How can it be prevented in the future?
c. What actions should be taken by the community?
d. By the health services? By other sectors?
e. Where and for whom these activities be carried out?
f. What resources are required? How are the activities to be organized?
g. What difficulties may arise, and how might they be overcome?

2. MAKING COMPARISONS:
Comparison is the essence of epidemiology. We use populations for our studies
but measure specific characteristics and outcomes at the individual level. The
following approaches are used to analyze and determine factors that affect cancer
rates.
  Case-control studies
 Cohort studies
 Meta-analysis
 Human experimentation
Once an association between an environmental or genetic factor is suspected
from an ecologic association, case control studies or the more resource intensive
cohort studies can be designed. The accumulation of data from several separate
studies can be analyzed using methods such as meta-analysis . For some risk or
protective factors it may be possible to design human experimental trials to test the
effects on a controlled population.

MEASURES IN EPIDEMIOLOGY:
The scope of epidemiology is very broad and unlimited and includes the following:
a. Measurements of mortality
It includes the crude death rates
Number of deaths during the year × 1000

Mid- year population

b. Measurements of morbidity
c. Measurements of disability
d. Measurements of natility
e. Measurements of characteristics and the attributes of the diseases
f. Measurements of environmental and other factors considered in causing the
disease
g. Measurements of demographic variables
In studying the course of a disease or other health-related event, epidemiologists
are interested in two very important measures. The prevalence of an event refers to
the total number of existing cases at a point in time. The incidence of a health event
refers to the number of new cases during a certain time period. These quantities may
seem very similar, but they actually serve very different purposes. The prevalence of
a disease or health-related condition is useful for those in the health professions who
must deliver services to the public in the form of medicine, hospital beds or medical
equipment. These services depend on having enough equipment or health care
providers. The incidence of a disease is used for a fundamentally different purpose.
Epidemiologists want to understand what the risk factors are for a particular health
problem, and they search for the sources and causes of diseases or injuries. To
accomplish this goal they will need to measure different variables and assess
whether or not they are related to the number of new cases of a disease or health-
related event.
Incidence and prevalence are defined as fractions and are usually presented in
decimal form.

When fractions are defined with time as the measure in the denominator,
they are usually referred to as rates, and therefore the terms incidence rate and
prevalence rate* are defined as follows:
(Number of new cases of a disease occurring in the
population during a specified period time)
Incidence rate=
(Number of persons exposed to risk of developing the disease
during that period of time)

(Number of cases of disease present in

the population at a specified time)
Prevalence rate=
(Number of persons at risk of having
the disease at that specified time)
The good news about health-related events is that they are fairly rare. The
bad news is that the rarity of these events can lead to pretty small decimals that are
difficult to interpret easily because there are lots of zeros before the first significant
digit. For this reason, the incidence and prevalence rates are frequently expressed in
the form of cases per 100 or cases per 1000 for easier understanding. For example,
incidence and prevalence rates per 1,000 might be expressed using the following
formula:
(Number of new cases of a disease occurring in the population
during a specified period time)
Incidence rate= ×1000
(Number of persons exposed to risk of developing the disease
during that period of time)

(Number of cases of disease present in

the population at a specified time)
Prevalence rate= ×1000
(Number of persons at risk of having
the disease at that specified time)

EPIDEMIOLOGICAL METHODS:
They as further classified as experimental studies and observational studies:

1. EXPERIMENTAL STUDIES
 Randomized controlled trial
- Double-blind randomized trial
- Single-blind randomized trial
- Non-blind trial

 Nonrandomized trial (quasi-experiment)

- Interrupted time series design (measures on a sample or a series of samples
from the same population are obtained several times before and after a
manipulated event or a naturally occurring event) - considered a type of quasi-
experiment

2. OBSERVATIONAL STUDIES
 a. Decreptive studies
b. Anatical studies:

 Cohort study
o Prospective cohort
o Retrospective cohort
o Time series study
 Case-control study
o Nested case-control study
 Cross-sectional study
o Community survey (a type of cross-sectional study)
 Ecological study

OUTLINE OF THE PROCESS OF AN EPIDEMIOLOGICAL STUDY:

1. Establish that a problem exists
 Full epidemiological studies are expensive and laborious undertakings. Before
any study is started, a case must be made for the importance of the research.
2. Confirm the homogeneity of the events
 Any conclusions drawn from inhomogeneous cases will be suspicious. All events
or occurrences of the disease must be true cases of the disease.
3. Collect all the events
 It is important to collect as much information as possible about each event in
order to inspect a large number of possible risk factors. The events may be
collected from varied methods of epidemiological study or from censuses or
hospital records.
 The events can be characterized by Incidence rates and prevalence rates.
4. Characterize the events as to epidemiological factors

 Predisposing factors
 o Non-environmental factors that increase the likelihood of getting a disease.
Genetic history, age, and gender are examples.
 Enabling/disabling factors
o Factors relating to the environment that either increase or decrease the
likelihood of disease. Exercise and good diet are examples of disabling factors.
A weakened immune system and poor nutrition are examples of enabling
factors.
 Precipitation factors
o This factor is the most important in that it identifies the source of exposure. It
may be a germ, toxin or gene.
 Reinforcing factors
o These are factors that compound the likelihood of getting a disease.
They may include repeated exposure or excessive environmental stresses.
5. Look for patterns and trends
 Here one looks for similarities in the cases which may identify major risk
factors for contracting the disease. Epidemic curves may be used to identify
such risk factors.
6. Formulate a hypothesis
 If a trend has been observed in the cases, the researcher may postulate as to
the nature of the relationship between the potential disease-causing agent
and the disease.
7. Test the hypothesis
 Because epidemiological studies can rarely be conducted in a laboratory the
results are often polluted by uncontrollable variations in the cases. This often
makes the results difficult to interpret. Two methods have evolved to assess
the strength of the relationship between the disease causing agent and the
disease.
  Koch's postulates were the first criteria developed for epidemiological
relationships. Because they only work well for highly contagious bacteria and
toxins, this method is largely out of favor.
 Bradford-Hill Criteria are the current standards for epidemiological
relationships. A relationship may fill all, some, or none of the criteria and still
be true.
8. Publish the results

USES OF EPIDEMIOLOGY:
The ten uses of epidemiology will now be defined and discussed briefly:
1. To determine which in the three possible sets of disease factors, host, agent and
environment, are important in the occurrence of a specific disease or class of
diseases, the extent to which those factors are important and the manner in which
they interact.
- The epidemiologist obtains information about the occurrence of disease from
a variety of sources, e.g., his own studies, all branches of medicine and the natural
sciences including clinical medicine, demography, sociology and psychology, and any
official, voluntary or private agency that collects and/or interprets pertinent data.
-Furthermore, he arranges the data in orderly fashion, so that whenever possible, he
can analyze them by acceptable techniques. He realizes that an investigator should
not employ a technique that is not designed for his type of problem or one that is not
widely known without establishing a rationale for its use.
- Vital statistics rates vary with age and other host characteristics.
Consequently, in analyzing information on the occurrence of disease, the
epidemiologist may wish to adjust for those characteristics. For example, by applying
the age specific rates of groups being compared to a standard age distribution, he
can eliminate age as a source of variation in overall rates and thereby study the
effects of other factors. However, such adjustments are not entirely foolproof and
should be interpreted with caution. It should be apparent from the foregoing
discussion that the epidemiologist and clinician do not function independently. The
epidemiologist cannot study the occurrence of certain diseases unless the clinician
supplies him or the health department with case records; the clinician may find it
difficult to make an adequate diagnosis unless he is provided with information
regarding the occurrence of disease by age, by sex and by any other factors that may
help to characterize a disease.

2. To study the occurrence of disease in a population for purposes of community

diagnosis and prognosis.
- A clinician sees a disease as it occurs in an individual; he obtains a history,
examines his patient for signs, symptoms, laboratory and radiological findings and
then makes a diagnosis. The physician is concerned not only with the diagnosis but
the prognosis as well. As a clinician, he does not deal exclusively with the sick, but
must study normal subjects in order to recognize the sick.
In addition, some of his patients are well persons.
The epidemiologist is interested in the individual, too, but his attention is primarily
directed toward the group, in this instance, the community at large.
Through morbidity, mortality and population data, contained in existing records or
collected in his own surveys, he determines which diseases are prevalent in a
community and whether as single entities or in association with each other they are
severe enough to endanger the health of the community.
Of course, his diagnosis also depends on knowledge of the reaction of a society to
certain diseases and on information regarding the unaffiliated, for they are part of
the community as well. The prognosis in a community illness is based on similar
experience elsewhere or in the same community at an earlier date and on the
availability mof means to cope with the problem.
The severity of disease in a community can be gauged by several indices: whether it
is a leading cause of death; whether its prevalence attains highly endemic or
epidemic proportions; whether it has a high case fatality or other measure of
complications; whether it is a source of mass hysteria and panic; whether it involves
a large proportion of the young; whether it leaves permanent disability, defect or
impairment; whether it adversely affects the economic status of a community;
whether it contributes to excessive absenteeism in essential industry; or whether it
requires extensive mobilization of resources.
For reasons cited above, the role of the epidemiologist can be described as that of a
communitydiagnostician.

3. To describe the epidemiology of a disease or class of diseases.

Facts or events relating to the occurrence of a disease (or class of diseases)
constitute its epidemiology.
- The occurrence of a disease and its severity and outcome are resultants of a
complex of interacting factors, some of which are host factors and others, agent
and/or environmental. A description of the epidemiology of a disease involves a
thorough study of that disease in all its aspects including its frequency in various
populations and subpopulations, and known and suggested factors in the pre
morbid, morbid and post morbid periods. Furthermore, gaps in knowledge are
bridged by reference to animal studies, postmortem exaininations and observations
on healthy carriers and medically and surgically treated patients. The description
may contain information on age, sex, race, social class, occupation and agent and
environmental characteristics. Information can be expressed in qualitative terms,
presented graphically, arranged in tables or summarized in averages, proportions
and measures of variation. The pre morbid period is the period preceding the
inception of a disorder, the morbid period, the pathological and clinical course and
the postmorbid period, the aftermath. Pathogenesis is a term usually restricted to
the early stages of the morbid period, although it can be applied to the premorbid
period,
In as much as disease does have its origin in events that antedate pathological
changes in a host? A disease is initiated at the cellular or functional level. The point
at which it becomes manifest or detectable will depend on the disease and the
sensitivity of its indicators, this can be labelled the clinical horizon. A disease may be
aggravated or relieved and at times stationary or arrested.
"Natural history" is an expression inherited from the past. It imparts a mystical
quality to disease which may suggest something more than a study of occurrence.

4. To measure risk.
When the denominators are appropriate, the epidemiologist may use rates of
the type listed in parentheses. These rates approximate the separate probabilities
that, under conditions similar to those in which the rates were derived, a person will
acquire a particular disease during a given period of time (attack rate, morbidity rate,
case incidence rate); have a particular disease at a given point in time (prevalence
rate); die of a particular disease during a given period of time (mortality rate, death
rate); or if he has a particular disease, that he will die of it during a given period of
time (case fatality rate). Such probabilities are measures of risk and they are useful in
prognosis and for actuarial purposes.

5. To study the occurrence of disease or death with time as a variable. Such a study is
referred to as a historical study.
In historical studies, it often is convenient to speak of trends, namely, secular
trends and cyclic trends. A secular trend ranges over a long period such as a century,
and portions of it may increase, decrease or remain stationary. A cyclic trend must
exhibit periodic fluctuations regardless of its duration; consequently, it is a trend
within a trend. For example, in the United States at least, the monthly death rate for
all forms of tuberculosis usually reaches a peak in late winter or early spring and falls
to a low point in late summer or early fall.
A plot of monthly rates computed on an annual basis shows a series of alternating
waves or spikes. However, the annual rate has declined almost continuously since
1900.
6. To aid in the search for causes of disease.
The mechanism of disease production is so intricate that causes are not easily
isolated, and it may be advisable from a public health point of view to work with
assumed causes. An assumed cause may be nothing more than a correlate of a
cause.
In general, a cause can be defined as an agent or any host or environmental
factor that is influential in producing disease or accelerating its appearance.
It is beyond the scope of this presentation to indicate what type of evidence is
necessary to establish a cause. In cancer and arteriosclerosis, the evidence is chiefly
circumstantial.
Although all agents and certain host and environmental factors can be
described as causes of disease, it is their interactions that produce the effect.
The consensus today is that all diseases have more than a single cause. This is the
concept of multiple causation. Host susceptibility varies from one individual to
another and in the same individual. As far as can be determined, one or more agents
and/or the environment must also play a part. Therefore, it would be improper to
speak of "the" cause of a disease. "A" cause is preferred, and each cause is a
contributory cause regardless of its relative importance.
Studies on causes of disease are often futile attempts to discover agents. Not
only must an ;agent be influential in producing disease or accelerating its
appearance, but it must exist as an entity and not to be confused with a host or any
of his characteristics. Conceivably, there are diseases in which none of the causes
conform to this description and others in which conventional agents are elusive.
7. In disease prevention and control.
The epidemiologist helps to control a disease when he identifies it, describes its
epidemiology, demonstrates its existence in a community and investigates its source.
Primary control or disease prevention is the ideal control measure. Secondary
control consists of diagnosis and treatment, and tertiary control involves
rehabilitation of the disabled and correction of defect or impairment. It is interesting
to note that primary control is peculiar to the premorbid period, secondary control,
the morbid period and tertiary control, the postmorbid period.

8. To aid in the identification of clinical syndromes.

 A syndrome is a group of signs and symptoms that occur together and
characterize a disease. Some diseases closely resemble each other in signs and
symptoms. The object is to distinguish among these diseases on the basis of their
subtle peculiarities.
This falls within the domain of differential diagnosis. Problems of this nature are of
frequent concern to the epidemiologist, especially since they are important in case
finding.

9. To aid in the detection of pre symptomatic and latent disease.

Many diseases such as tuberculosis, diabetes, hypertension, glaucoma, cancer
of the cervix, neoplasm’s of the lung and syphilis can be detected before the onset of
symptoms or the development of serious changes. The way to accomplish this is
through mass screening techniques (both mono and multi phasic), pre-employment
physical examinations, periodic health examinations, special surveys and routine
examinations in hospitals and clinics.

10. In administrative medicine and operations research.

One might evaluate the success of a disease control program; the needs of a
hospital in terms of equipment, personnel and space; the quality of medical care in a
community; and the efficiency of hospital administration as compared with private
industry. These are areas in which the investigative experience of an epidemiologist
may prove rewarding.

 NATURAL HISTORY OF DISEASE

 In a restricted sense, preventive medicine follows the dictum “to intercept the
cause is to prevent or dissipate its effect”. In a wider sense, as dictated by the all
inclusive concept of prevention, the conventional boundaries of preventive medicine,
name, health promotion and disease prevention are surpassed. And in consequence,
the span and scope of preventive medicine expands to cover natural history of
diseases in their entirely covering all the three phases; pre-pathogenesis,
pathogenesis and, post pathogenesis; and involving five levels of prevention: health
promotion, specific protection, early diagnosis and prompt treatment, disability
limitation, and rehabilitation. The first two level which fall in pre-pathogenesis
constitutes primary prevention, the next two levels which apply to pathogenesis
constitute secondary prevention, and the last level of rehabilitation which
corresponds to post-pathogenesis constitutes the tertiary level of prevention.

EPIDEMIOLOGY OF INFECTIOUS DISEASE

Epidemiology is the study of the determinants, occurence, distribution, and control
of health and disease in a defined population. Keywords and/or concepts of
importance:
 Infection in Individuals
Infection is the term used to indicate the presence of an infectious agent in an
individual or population. Infection, as opposed to passive contamination, implies
colonization of the host's cells, tissues or body cavities, to the benefit of the
organism.
Colonization indicates the presence of the organism without clinical or
subclinical disease, whereas contamination refers to the presence of microbes on a
body surface without invasion or response.
Depending upon the host-microbe interaction, infection can be silent
(inapparent, asymptomatic, subclinical), or overt, causing a disease of infection.
Infecting organisms causing disease are termed pathogens. Individuals who are
infected and can transmit infection to others are infectious. Silent or asymptomatic
infections, such as HIV infection during the early phase, can still be infectious.
A carrier is a person who is infected with an organism but shows no evidence of
disease, although disease may have been present earlier.
Acute infection implies a 'short-lived' infection, such as influenza, with or
without symptoms; the period of infectivity is also short.
Chronic infection refers to a 'long-standing' condition during which the pathogen
continually replicates and the patient may be persistently infectious to others, e.g.,
hepatitis B infection.
Latent infection refers to a persistent infection with the possibility of
intermittent shedding of pathogens, e.g., varicella zoster virus causing shingles or
herpes simplex virus causing cold sores or genital herpes.

 Infection in Populations
Endemic infection refers to infection or disease that occurs regularly at low or
moderate frequency.
Epidemics occur when there are sudden increases in frequency above endemic
levels.
 Pandemics are global epidemics. The size of 'outbreaks is dependent upon
factors such as the ratio of susceptible to immune subjects, period of infectivity,
population density, etc.
The prevalence of infection describes the number of acses in a population at a
point in time, whereas the incidence refers to the number of cases arising over a
defined period of time.
Secular trend refers to a change in the prevalence of infection over years. This
relates to better living conditions, better hygiene, and vaccination. An example of a
secular trend is the decrease in tuberculosis in the United Kingdom.
Seasonal trend refers to changes in the prevalence of infection occurring over
the year, e.g., RSV outbreaks - the reason the seasonality is unclear but changes of
temperature, crowding and humidity may play a role.
Sero prevalence refers to the number of individuals who have antibodies to a
particular pathogen. It shows how common the pathogen is in the population.
Seroprevalence is usually measured in age-bands to identify the age at which
transmission is greatest.

 Spread of Infection
With respect to the spread of infection, people can be divided in to those who are
susceptible, those who are infected but are not yet infectious, those who are
infected and infectious, and those who are immune. Recovery from infection usually
gives immunity. There are four main routes of infection:
1. Contact. Infection can be transmitted by direct contact from skin to skin,
mucosa to mucosa, skin to mucosa or mucosa to skin of the same or another
person, e.g., herpes simplex causing primary oropharyngeal herpes or genital
herpes. Infection may also spread through indirect contact via water and
surfaces (fomites) as in communal bathing or an HIV or hepatitis B infected
needle shared by several people. It may also be spread by droplets, produced
by talking or sneezing, that are usually greater than 5µ, whose route of
transmission is through the air. Because of their large size they are spread no
 further than about 1 metre. Examples include measles, and streptococcal
pharyngitis.
2. Common vehicle. A single inaminate vehicle serves to transmit the infection
to multiple hosts. The most commonly involved common vehicles are food
and water; but vaccines, blood can serve as a common vehicle. An animal
causing rabies through biting other animals and man could also be included as
a common vehicle.
3. Air borne. Air borne infected particles are spread by droplet nuclei or dust.
Droplet nuclei represent the residua of droplets that have evaporated to a size
of less than 5µ in diameter. Skin squames can also serve as air-borne vehicles
of infectious agents. Coughing and sneezing result in droplet nuclei and
tuberculosis is an example of disease spread from man to man by this means.
Psittacosis and Q fever are examples of infections spread from animals to man
by the air-borne route.
4. Vector borne. This refers to transmission by insects who may carry organisms
on their surface or ingest it. Examples include malaria, dengue fever and
Chaga's disease.

 Portals of Entry
Man can be infected through various portals of entry including the mouth
through ingestion of food, water, and milk, sucking or kissing; the respiratory tract
through inhalation; the eye through direct contact; the skin through direct and
indirect contact; penetration of the skin through injuries, surgery, insect and animal
bites; through blood transfusion and intravenous drug abuse; transplantation; the
urogenital tract through sexual intercourse and catheterisation, and across the
placenta.
The portals of exit include the anus with faeces as infected material; the mouth
with saliva, sputum and droplets as vehicles; the eyes through tears and exudate;
body surfaces through skin, hair, crusts, and exudate; skin puncture through blood;
the urogenital tract through urine, secretions, and semen, and the placenta.
Recognition of the epidemiology of infectious disease provides the means of
preventing infection by public health measures,rather than preventing it by
vaccination (which may be unsuccessful e.g., HIV) or treating established infection,
which may be of limited effect (e.g. HIV, hepatitis B and C).
EPIDEMIOLOGICAL TRIAGE:
INTRODUCTION:
- The present epidemiologic approach is based upon the interaction of the host,
the causative agent, and the environment.
-Among these factors there exists a dynamic
situation in which efforts to prevent and/or
control disease are constantly challenged:
populations are highly mobile and tend to live
longer, thereby creating circumstances of
increased risk of exposure and infection;
urbanization and suburbanization have exerted greater and greater pressures on the
environment; biological agents of disease have shown remarkable adaptability to
modern control measures; nonbiological agents are often introduced into the milieu
despite precautions of interested groups.

The science of epidemiology emerged and evolved from the study of

infectious diseases. However, its application has extended to the study of
noninfectious diseases and to the study of health conditions in general. We may,
therefore, speak of the epidemiology of heart disease, accidents, cancer, and
hypertension. The same principles of interaction among the agent(s), host, and
environment apply.

EPIDEMIOLOGIC APPROACH
The present epidemiologic approach is based upon the interaction of the host,
the causative agent, and the environment. The science of epidemiology emerged and
evolved from the study of infectious diseases. However, its application has extended
to the study of non-infectious diseases and to the study of health conditions in
general. We may, therefore, speak of the epidemiology of heart disease, accidents,
cancer, and hypertension. The same principles of interaction among the agent(s),
host, and environment apply.
 Agent Factors
The current scope of epidemiology requires an expansion in perception of the
causative agents of disease. Causative (etiologic) agents are not limited to biological
agents; they may also be chemical or physical.
Definition of Agent
A microorganism, chemical, nutritive element or physical factor whose
presence or absence is essential for a particular disease or condition to occur. Eg.
Micro-organisms like
 Bacteria
 Virus
 Protozoa
 Parasite
 Fungi
 Diet deficiency
 Diet excess
 Radiation
Chemicals like
 Endogenous
 Exogenous
Physical agents like
 Heat, cold
 Genetic traits
 Stress

- These agent enter and exit the body via various routes i.e. via oral,
fecal, respiratory, skin etc

Host Factors
- Host factors include a wide variety of characteristics. All of the preceding host
factors, and some others, are important to the extent that they affect, first, the risk
of exposure to a source of infection, and second, the host's resistance or
susceptibility to infection and disease. Age usually is the single most important host
factor related to disease occurrence.
- The influence of malnutrition, both under and over nutrition, is gaining more
importance even in the relatively affluent and apparently well-fed populations of the
United States. The connection between malnutrition and decreased general and
specific host-resistance is slowly being disclosed.
- Host facotors may include: age, sex, ethnic group, nutritional status,
socioeconomic status
Personal behaviors: smoking, diet, drinking, sexual practices, exercise
Immunization status: vaccinated or unvaccinated
Physiologic states: pregnancy, puberty, fatigue, immuno compromised, pre-existing
disease.
Environmental Factors
Some of the numerous environmental factors are:
 Water
 Food
 Housing conditions
 Milk
 Plants
 Meteorological conditions and effects
 Noise
 Animals
 Environmental pollutants
The agent-host-environment factors interrelate in extremely varied
combinations to produce disease in humans. Investigators should be aware of this
fact to assist them in analyzing disease problems and to reach proper conclusions
regarding prevention and control measures.
 Factors Influencing Disease Transmission
ENVIRONMENT
AGENT -Weather
-Infectivity - Housing
- Pathogenicity - Geography
-Virulence - Occupational setting
-Immunogenicity - Air quality
-Antigenic stability - Food
-Survival
HOST
-Age
- Sex
- Infectivity (ability-Genotype
to infect)
(number infected-/Behaviour
number susceptible) x 100
-Nutritional status
-Pathogenicity (ability to status
- Health cause disease)
(number with clinical disease / number infected) x 100
-Virulence (ability to cause death)
(number of deaths / number with disease) x 100
All are dependent on host factors

CHAIN OF INFECTION:

DISEASE PREVENTION AND CONTROL:

Disease control depends on all the following factors:
- Controlling the reservoir
 Early diagnosis
 Notification of the case
 Epidemiological investigations
 Isolation
 Treatment
- Interruption of the route of transmission
These cases mean to change some environmental factors that lead to the
infection. Hence by breaking the chain of infection we can stop the spread of the
disease
- The susceptible host
This is done by the methods of active and passive immunization of the
susceptible person who are in the risk factor to contract the disease.
 BIBLIOGRAPHY:
- Gordis L. Epidemiology. 2nd ed. Philadelphia: WB Saunders; 2000.
Lilienfeld DE, Stolley PD. Foundations of Epidemiology. New York: Oxford
University Press; 1994.
- Rothman KJ, Greenland S. Modern Epidemiology. 2nd ed. Philadelphia: Lippincott
Williams & Wilkins; 1998.
- Park.K, “Text book of Preventive and Social medicine”, edition 18 th , Bhanot
Publication, New Delhi , Pp 48-108
- Basvant Thappa B.T, “Community Health Nursing”, edition 2nd , Jaypee
Publications, Pp 23-112

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JG COLLEGE OF NURSING

SUBJECT: - Advanced Nursing Practice

TOPIC : - Assignment On Epidemiology

SUBMITTED
TO
Mr. P. Yonatan
Associate professor
JG College of Nursing SUBMITTED BY
Ms. Ami M. Patel
1 st Yr M.Sc Nursing
Roll no:7
JG College of Nursing

ROLE OF NURSE IN EPIDEMIOLOGY

 Implements procedures for recognizing and reporting nosocomial infections

on a systematic and current basis.
 Makes patient rounds and participates in epidemiological investigations;
 Reviews hospital admissions for possible infection control hazards and
conditions;
 Reviews autopsy reports, medical records and lab reports for any previously
undetected nosocomial infections;
 Works with other hospital departments such as medical services, nursing,
housekeeping, administration and others to insure implementation of proper
protocols, asceptic techniques and environmental cleanliness;
 Conducts studies and audits related to infection control; issues and prepares
recommendations based on the analysis of the results;
 Participates as a member of the Infection Control Committee and other
related committees as required;
 Acts as resource person on issues dealing with infection control, including
participation in In-Service training programs;
 Maintains a current Infection Control Manual in coordination with the
Infection Control Committee;
 Acts as a liaison with Public Health agencies and other community or
regulatory agencies;
 Prepares reports and statistics as required.
 Implements procedures for surveillance of reportable communicable diseases
and health conditions;
 Implements procedures for the epidemiologic investigations of clusters of
diseases, and outbreaks of diseases and other health conditions;
 Provides information and advice to health care providers, other health care
professionals and the general public regarding communicable diseases and
other health conditions.
 REQUIRED KNOWLEDGE, SKILLS, ABILITIES AND ATTRIBUTES: Good knowledge
of modern nursing techniques, particularly as they apply to accepted method
for the control of infectious diseases, including nosocomial infections and
isolation procedures;
 familiarity with modern microbiology and hospital bacteriology laboratory
methods;
 ability to establish and maintain effective working relationships with all levels
of medical, nursing and non-professional staff;
 ability to analyze data related to infections and make recommendations for its
control; resourcefulness; tact; flexibility; assertiveness; initiative; physical
condition commensurate with the requirements of the position.