Chapter 20 Preventing Disease

Snow on Cholera
Time Frame Reference Ideas of Disease Causation Demons Divine retribution Miasma theory Problem with the aforementioned ideas of disease causation?

Water contaminated with deadly cholera flowed from the Broad Street pump

Distribution of Cases in Time from August and September, 1854

160 140 120 100 80 60 40 20 0
19 21 23 25 27 29 31 8 10 12 14 16 18 20 2 4 6

Pump handle removed

Epidemiologic Triangle
Environment

Agent

Host

Epidemiology
Study of occurrence of disease
when where how transmitted Epidemic disease outbreak affects many people Pandemic worldwide epidemic Endemic always present Sporadic occur only occasionally

Methods of Epidemiology
Sources of information
Public record Questionnaires Surveys Hospital records

Notifiable diseases
Physicians required to report certain diseases
Local agencies report to state and CDC Morbidity and Mortality Weekly Report (MMWR link)

Statistics
Incidence rate
rate of acquiring a disease during certain period

Prevalence rate
rate of having certain disease at specific time

Types of Epidemiological Studies

Descriptive general information about a disease incidence prevalence death rates Surveillance tracks epidemics monitor potential epidemic situations follow progress of epidemic assist in prevention or eradication Field and Hospital investigate source and spread of disease outbreaks

Descriptive Epidemiology
geographical distribution of tuberculosis

Ethnic distribution of tuberculosis

Surveillance Epidemiology
Example
tracking smallpox outbreaks use of vaccination programs to limit spread of disease result in eradication of smallpox worldwide

 2004 Wadsworth Thomson Learning

Field Epidemiology
Investigative work gather information collecting samples infected vectors or animals interviewing individuals interpreting the data

Hospital Epidemiology
Nosocomial infections
hospital acquired infection
immunocompromised patients invasive medical procedures development of antibiotic resistance

examples
urinary tract infections--catheterizatoin surgical wound infections pneumonia skin infections

Public Health
Public health organizations
Local health departments State health departments United States Public Health Service (USPHS)
Center for Disease Control and Prevention (CDC)

World Health Organization

Public Health
Areas of impact
Clean water Clean food Personal cleanliness Insect control Prevention of sexually transmissible diseases Prevention of respiratory diseases

Immunization
Active immunization
Develop immunity without disease

Vaccinations
attenuated microorganism or virus alive but incapable of causing disease inactivated killed by chemicals acellular contain only antigen molecules; toxoids DNA vaccines contain only DNA which encodes a protein

Acellular vaccine
Anti-toxin
Toxoid
purified exotoxin inactivated by heat or chemical

Tetanus Diphtheria
Figure 20.7

Attenuated and Inactivated

Attenuated
Live organisms genetically altered limited infection advantages organism multiples stimulates strong immunity long-lasting immunity

Inactivated
killed organisms chemicals destroys antigens immunity not long lasting require multiple injections

Passive immunization
Protection without developing immunity
gamma globulin antibodies from pooled serum human or animal general or special preparations advantages protection for immunocompromised immediate protection temporary protection while immunity develops disadvantages serum sickness (animal preparations) no lasting immunity