CHAPTER THREE

EPIDEMIOLOGY OF COMMUNICABLE DISEASES

Learning objectives
By the end of this chapter, students will be
expected to:
• List the major components of the infectious
disease cycle
• Describe the type of carriers and roles in the
infectious disease transmission
 Describe the different modes of disease

transmission
 Describe the different methods of controlling

communicable diseases
Infectious diseases
 Infectious diseases: are caused by pathogens

that are transmitted either directly between

persons or indirectly via a vector or the
environment
 An infectious disease is defined as a disease

caused by an infectious agent or its toxic

products
 Infectious Disease Cycle
 The spread of an infectious disease through
populations is determined by characteristics of the
infectious agent, the host, and the environment-
Epidemiological Triangle
 It refers to the process by which infectious

diseases are transmitted from infectious host to

susceptible host
 It is also called transmission cycle or chain of

infection
THE INFECTIOUS DISEASE PROCESS
Communicable diseases
 illnesses due to specific infectious agents or

its toxic products

 arise from transmission of agents or toxic

products by direct or indirect mode of

transmission through an intermediate host,
vector or inanimate environment
Components of infectious disease process
• Infectious diseases result from the
interaction of infectious agent, susceptible
host/reservoir and environment that brings
the host and the agent together.
Agent: is an infectious micro-organism- virus,
bacteria, parasite, or other microbe.
Host: Host factors influence individual's
exposure, susceptibility or response to a
causative agent.
 e.g.- age, sex, race, socioeconomic status,
and behaviors (smoking, drug abuse,
lifestyle, sexual practices and contraception,
eating habits) affect exposure.
Environment: are extrinsic factors which affect the
agent and the opportunity for exposure.
 Physical factors - geology, climate,
 physical surrounding (maternal waiting home,

hospital);
 biologic factors such as insects that transmit the

agent;
 socioeconomic factors such as crowding,

sanitation, and the availability of health services

Chain of Infection:
A model used to understand the infection
process is called the chain of infection.
• It is logical sequence of factors or links of a
chain essential to the development of infectious
agent and to propagation of disease.
• Each link must be present and in sequential
order for an infection to occur.
 Understanding the characteristics of each link
provides with methods to prevent the spread
of infection.
• Sometimes the chain of infection is referred
as the transmission cycle.
Components of Chain of Infection
- six components
1. Causative Agent
2. Reservoir host
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host
I. THE AGENT
 This ranges from viral particles to complex multi-

cellular organisms.
 Host agent interaction is characterized by:

a. Infectivity: the ability of an agent to produce

infection (to invade & multiply in a host).
 It is from exposure to infection.
 = (Number of infected)/ (number of susceptible

and exposed) x 100

b. Pathogenecity: the ability to produce clinically
apparent infection/disease.
 It is from infection to disease.
 = (Number of clinical cases)/ (number of

subclinical cases)
c. Virulence: the proportion of clinical cases resulting
in severe clinical disease(from disease to outcome)
 = (Number of fatal cases)/ (total number of cases)

d. Immunogenicity: infection’s ability to produce

specific immunity.
Factors affecting disease development
1. Strain of the causative agent
2. Dose of agent
3. Route of infection
4. Host age
5. Host nutritional status
6. Host immune response
Infectious agent may bring about pathogenic
effects through different mechanisms like:
 Direct tissue invasion
 Production of toxin
 Immunologic enhancement of allergic

reaction
 Enhancement of host susceptibility to drugs
 Immune suppression
II. RESERVOIR
• The reservoir of an agent is an organism or habitat
in which an infectious agent normally lives, grows,
and multiplies.
E.g. humans, animals, plants and other inanimate
objects
 As a general rule, the greater the number of

different reservoirs for a given disease, the

greater the difficulty in controlling that disease.
(e.g., malaria)
 The case of Typhoid Marry (Marry Malon)
 A person who does not have apparent clinical
disease, but is a potential source of infection
to others people is known as a carrier.
 Typhoid Marry [Mary Malon] was a carrier of
Salmonella typhi who worked as a cook in
New York City, in different households over
many years.
 She was considered to have caused at least

10 outbreaks of Typhoid fever in New York City

with several deaths.
She was the first known case of a carrier.
Carriers can be classified as:
1. Asymptomatic carriers: transmitting disease
without ever showing signs and symptoms of
the disease.
 e.g. polio in 95% of cases, amoebiasis, viral

hepatitis-A in 67- 95%, meningococcus ,etc.

2. Incubatory carriers: transmitting disease
during incubation period
i.e. from first shedding of the agent until the
clinical onset or before onset of symptoms or
manifestations of disease
 e.g. Measles, chicken pox, mumps, viral

hepatitis, AIDS, rabies.

3. Convalescent carriers: transmitting disease
during convalescence period i.e. from after the
time of recovery to when shedding stops.
 E.g. Typhoid fever (about 10% after treatment
infectious for about 3 months), Diphtheria,
Hepatitis B virus
4. Chronic carriers: transmitting disease for a
long period of time, or even indefinitely.
 e.g. viral hepatitis B, typhoid fever
Importance of carriers
1. Their Number- carriers may outnumber
cases- constitute a significant number of
reservoirs
2. Difficulty in recognition/detectability-
carriers don’t know that they are infected
3. Mobility- carriers are more freely so that
have more contacts, but cases are
restricted/bed ridden
4. Chronicity- carriers re-introduce infection
and contribute to endemicity
III. PORT OF EXIT
 Port of exit is the way the infectious agent

leaves the reservoir.

 Possible ports of exit - all body secretions

and discharges: saliva, tear, breast milk,

vaginal and cervical discharges, excretions
(urine, faeces), blood, and tissues.
 semen, pus, exudates from wounds are the

usual portals of exit.

 Respiratory: through exhalation, talking and

coughing:
 Skin and mucus membranes
IV. MODE OF TRANSIMISSION
 it is the mechanism by which an infective agent

exits from a reservoir host and enters into a

susceptible host.
two major modes:
1. Direct Transmission- immediate transfer of the
agent from a reservoir to a susceptible host by
direct contact or droplet spread.
Direct contact
 Touching
 Kissing
 Sexual intercourse
 Biting
 Passage through birth canal
 Blood transfusion
 Direct projection of saliva droplets by expiratory
activities, coughing, sneezing, spitting, talking and
singing.
 usually limited to a distance of one
meter or less.
 Trans-placental, maternal to fetus with

passage through the placenta

2. Indirect Transmission- an agent is carried from
reservoir to a susceptible host by:
- suspended air particles or
-animate (vector-mosquitoes, fleas, ticks...) or
-inanimate (vehicle-food, water, biologic
products, fomites) intermediaries.
Indirect Transmission can be classified as:
A. Vehicle-born: transmission occurs through
indirect contact with inanimate objects (like
surgical instruments, iv fluid, towels, toys)
and contaminated food, or water.
B. Vector-borne: the infectious agent is carried
from reservoir to a susceptible host by an
arthropod.
 biological or mechanical.

• Biological vector: if the agent multiplies in the

vector before transmission.
E.g. -malaria by the anopheles mosquitoes
-Typhus by ticks or lice
• Mechanical vector: if the agent is carried by
the legs or proboscis. E.g. trachoma by flies
C. Airborne: which may occur by dust or droplet
nuclei. e.g. tuberculosis

V. PORT OF ENTRY: the site where an agent

enters a
susceptible host. examples
– Nasal mucosa--------------common cold
– Respiratory mucosa ------tuberculosis
– Vaginal mucosa -----------sexual
transmission diseases
– Skin--------------------------hookworm
– Injury site-------------------tetanus
VI. HOST
A person lacking sufficient resistance to a particular
pathogenic agent to prevent disease if exposed.
• The susceptible human host can be seen at the individual
level and at the community level.
• At the individual level: it is the interaction between
genetic and environmental factors.
e.g. -Genetic factors: sex, blood type, ethnicity etc
-Environmental factors: immunity acquired as a result
of past infection.
 At the community level: host resistance at a
community level is known as herd immunity.
• Herd immunity is the resistance of a
community (group) to invasion and spread of an
infectious agent, based on a high proportion of
individuals in a community.
• The high proportion of immune individuals
prevents transmission by decreasing the
probability of contact between reservoirs and
susceptible hosts.
Herd immunity operates best when there is:
1. A single reservoir (the human host),
2. Direct transmission,
3. Total immunity,
4. No shedding of the agent by immune hosts
(no carrier stage),
5. A uniform distribution of immunes, and
6. No overcrowding
Immunity: - is the state of defence carried out by
specific immunological reaction in the body
 and the process to induce such a state is called

"immunization".
Types of immunity
A. Natural
(i) Active: Infection by an agent stimulates the host
to produce antibodies
(ii) Passive: Antibodies produced by the mother
cross the placenta into the blood stream of the
fetus i.e. maternal antibodies
B. Artificial
(1) Active: Host is stimulated to produce
antibodies by the injection of an attenuated
pathogen (an antigen)
i) Killed vaccine
ii) Modified live vaccine
(2) Passive: Host receives antibodies produced
elsewhere
 Transmission
Cases
 Index – the first case identified
 Primary – the case that brings the infection into a population
 Secondary – infected by a primary case
 Tertiary – infected by a secondary case

T
S
Susceptible P
S
Immune
S
T
Sub-clinical

Clinical

(www)
 Definitions
Endemic: Habitual presence of a disease in a
given geographic area.
Epidemic: Occurrence of a group of illnesses of
similar nature within a given community or
region in excess of normal expectancy
Pandemic: A worldwide epidemic.
Herd immunity: Resistance of a group of to an
attack by a disease to which a large
proportion of members of the group are
immune.
 Herd immunity: The indirect protection from
infection of susceptible members of a population,
and the protection of the population as a whole,
which is brought about by the presence of
immune individuals.

02/29/2024 41
Principles of Communicable Diseases Control
Defn. :Communicable Diseases Control
- Is reduction of incidence and prevalence of
communicable diseases to a level where it can
not be a major public health problem.
 Three broad areas of prevention and control:-
1. Attacking the source (reservoir) of infection.
 That is to reduce the number of infective

organisms.
This is done by:
 Treatment of cases and carriers through mass

treatment, as in typhoid fever, schistosomiasis,

tuberculosis.
 Isolation: separation of infected persons for a

period of communicability.
 N.B. Isolation is indicated when
diseases:
 have high mortality and morbidity.
 have high infectivity.

c. Quarantine: limitation of movement of

person or animal who has been exposed to
infectious disease for a maximum incubation
period for the disease
D. Reservoir control by mass
vaccination to cattle and sheep
and killing & burning infected
animals (rabies, anthrax).
E. Active surveillance of contacts
F. Effective reporting system
2. Interrupting the chain of transmission: is control
of modes of transmission from reservoir to the
new host.
A. Environnemental sanitation: - intestinal parasites
control.
B. Personal hygiene: - trachoma and scabies control.
C. Vector control (mosquito and snails control) –

malaria
and schistosomiasis.
D. Disinfection and sterilization: - purification of
potable water, pasteurization of milk, disinfection
of air.
3.Reducing host susceptibility:
A. Immunization - herd immunity
B. Better and improved nutrition
C. Health education
D. Chemoprophylaxis:-malaria, meningitis,
tuberculosis
E. Person protection: - mosquito nets, clothing,
repellents, shoes, etc.
 THANK YOU
 ANY QUESTIONS