What is Epidemiology? Epidemiology - Originated from the Greek words epi, meaning “upon”, demos, meaning “people” and logos, meaning “study”
- Study of the distribution and determinants of health-related states or events
in specified populations, and the applications of this study to the prevention and control of health problems
This field of study makes use of concepts and methods from numerous other fields such as: biology, sociology, demography, geography, environmental science and policy analysis and most notably from statistics. Definition of Terms 1. Study - Includes surveillance, observation, hypothesis testing, analytic research, experiments 2. Distribution - Analysis by time, places, classes of people affected 3. Determinants - All biological, chemical, physical, social, cultural, economic, genetic and behavioral factors that influence health 4. Health-related states or events - Diseases, causes of death, behaviors (tobacco use) positive health states, reactions to preventing regimens and provision and use of health services 5. Specified population – Identifiable characteristics (eg: occupational groups) 6. Application to prevention and control – aim of public health to promote, protect, and restore good health Epidemiological Principles 1. Diseases don’t occur at random 2. Diseases have causal and preventive factors which can be identified 3 Diseases and health have distribution 4. Focuses on population rather than individual persons AIMS of EPIDEMIOLOGY DESCRIBE the health status of the community EXPLAIN the etiology of the disease PREDICT the frequency and distribution of the disease CONTROL diseases in populations PATTERNS OF DISEASE OCCURRENCE 1. Epidemic – a situation wherein the proportion of the susceptibles are high compared to the proportion of the immunes. Usually characterized by a situation with high incidence of new cases of a specific disease in excess of the expected Ex: epidemic of cholera, measles, malaria, dengue fever
2. Endemic – a situation wherein there is a habitual presence of a disease
in a given geographic location accounting for the low number of both immunes and susceptibles. The causative factor of the diseases is constantly available or present in the area. Ex: HIV2 -endemic in W. Africa only 3. Sporadic – A situation wherein a disease occurs every now and then, affecting only a small number of people relative to the total population Ex: sporadic disease of tetanus, rabies, plague
4. Pandemic – Global or worldwide occurrence of a disease
Ex: COVID 19, SARS
5. Outbreak – Occurrence of cases of disease in excess of what
would normally be expected in a defined community, geographical area or season Ex: outbreak of diarrhea Practical aPPlications of ePidemiology Ø Assessment of the health status of the community or community diagnosis Ø Elucidation of the natural history of disease Ø Determination of disease causation Ø Prevention and control of disease Ø Monitoring and evaluation of health interventions Ø Provision of evidence for policy formulation stages in natural history of disease and levels of Prevention ØStage susceptibility Ø Stage of subclinical disease Ø Stage of clinical disease Ø Resolution stage Stage of Susceptibility - “Prepathogenesis stage” - Person is not yet sick - May be exposed to the risk factors of the disease (e.g. multiple sex partners of cervical cancer)
Primary level of prevention is applied to avoid the
development of the disease (e.g. Health education and Immunization) Stage of Subclinical Disease - Person is still healthy - No clinical manifestations are present - Pathologic changes(damages) have started to occur in the body - Disease can only be detected through special test
Secondary level of prevention can detect the early stage
(e.g. PAP Smear) Prompt treatment can be initiated to avoid progression of the disease Stage of Clinical Disease - Patient manifests recognizable signs and symptoms (e.g. vaginal bleeding)
Tertiary levels of prevention are applicable to limit disability and
restore functional capability (e.g. Support groups for cancer survivors help maintain the emotional and mental well-being of the cancer patient that renders functional members of society) Resolution Stage This will lead to either: - Patient recovers completely from the disease - Disease becomes a chronic case - Patient dies from the disease Triangle Model of Disease Causation Ø Epidemiologic triad Ø Uses one of two schematic presentations
ØModel presentation of infectious disease composed of external agent,
susceptible host and the environment that brings the host and agent together Ø Agent originally referred to an infectious microorganism or pathogen: a virus, bacterium, parasite, or other microbe. Ø Host refers to the human who can get the disease. Ø Environment refers to extrinsic factors that affect the agent and the opportunity for exposure.
q As long as balance is maintained or is titled in favor of the host (due to good
nutritional status and high levels of immunity) = Disease does not occur q However, when the balance is tilted in favor of the agent (through virulence, pathogenicity of the agent) = Disease eventually occurs q The environment such as climate can also tilt the balance in favor of the agent. (e.g. rainy season) The triad consists of: an external agent a susceptible host an environment that brings the host and agent together. ØAgent, host, and environmental factors interrelate in a variety of complex ways to produce disease. Ø Different diseases require different balances and interactions of these three components. Ø Development of appropriate, practical, and effective public health measures to control or prevent disease usually requires assessment of all three components and their interactions. Outbreak Ø Theoccurrence of cases of disease in excess of what would normally be expected in a defined community, geographical area or season (WHO) Ø Criteria: üA previously known disease ü Has never occurred in the area where the lone case is observed ü Has been absent from the population for a long time qImpending Outbreaks can be detected through: Ø Surveillance systems Ø Perceptive Clinicians Ø Infection control nurses Ø Laboratory workers (who reports an unusual disease) Surveillance Systems Ø defined as the “ongoing systematic collection, analysis, and interpretation of health data that are essential to the planning, implementation, and evaluation of public health practice” Ødeveloped for monitoring high burden diseases, detecting diseases outbreaks that could escalate into epidemic proportions & monitoring progress toward attainment of targets for the control, elimination or eradication of a specific disease Types of Surveillance ØSentinel Surveillance Ø Accelerated Disease Control ü National Active ü National Passive Sentinel Surveillance Ø Used when high-quality data are needed about a particular disease that cannot be obtained through a passive system. Ø Selected reporting units with high probability of seeing cases of the disease in question, good laboratory facilities and experienced well- qualified staff, identify and notify on certain diseases. Ø The data collected in a sentinel system can be used to signal trends, identify outbreaks and monitor the burden of disease in a country. Accelerated Disease Control qNational Active Ø Involves visiting health facilities, talking to health-care providers and reviewing medical records to identify suspected cases of disease under surveillance
q National Passive Ø A passive system that relies on the cooperation of the health-care providers, laboratories, hospitals, health facilities and private practitioners to report the occurrence of vaccine-preventable disease. Steps in Outbreak Investigation 1. Operationally define what constitutes a case. 2. Based on the operational definition, identify the cases. 3. Based on the number of cases identified, verify the existence of an outbreak. 4. Establish the descriptive epidemiologic features of the cases. 5. Record the clinical manifestations of cases. 6. Based on the clinical manifestations, incubation period, available laboratory findings and other information gathered, formulate a hypothesis regarding the probable etiologic agent, the sources of infection, the mode of transmission, and the best approach for controlling the outbreak. 7. Test the hypotheses by collecting relevant specimens from the patients and from the environment. 8. Based on the results of the investigation, implement prevention and control measures to prevent recurrence of a similar outbreak. 9. Disseminated the findings of the investigation through media and other forms to inform the public.
