Epidemiology of Infectious Diseases

Dr.Narumol Sawanpanyalert
Dept. of Medical Services

Infectious Disease Epidemiology: Major Differences

A case can also be an exposure Subclinical infections influence epidemiology Contact patterns play major role Immunity There is sometimes a need for urgency

What is infectious disease epidemiology?

Epidemiology Deals

with one population Risk case Identifies causes

Infectious disease epidemiology

Two or more populations A case is a risk factor The cause often known

What is infectious disease epidemiology?

Two or more populations
Humans Infectious
Vectors
Mosquito

agents
bacteria, fungi, protozoa, viruses, prions

Helminths,

(protozoa-malaria), snails (helminthsschistosomiasis) Blackfly (microfilaria-onchocerciasis) bacteria?

Animals

and sheep/goats Echinococcus Mice and ticks Borrelia

Dogs

What is infectious disease epidemiology?

The cause often known
An

infectious agent is a necessary cause

What is infectious disease epidemiology then used for?

Identification of

causes of new, emerging infections, e.g. HIV, vCJD, SARS Surveillence of infectious disease Identification of source of outbreaks Studies of routes of transmission and natural history of infections Identification of new interventions

Routes of transmission
Direct
Skin-skin Herpes type 1 Mucous-mucous
STI

Indirect
Food-borne
Salmonella

Water-borne
Hepatitis A

Across placenta
toxoplasmosis

Vector-borne
Malaria

Through breast milk

HIV

Air-borne
Chickenpox

Sneeze-cough
Influenza

Ting-borne
Scarlatina

Exposure
A relevant contact depends on the agent
Skin, sexual intercourse, water contact, etc

Exposure to Infectious Agents

No infection

Clinical

Sub-clinical

Carrier

Death

Carrier

Immunity
Outcome

No immunity

(www)

Epidemiologic Triad

Disease is the result of forces within a dynamic system consisting of:

agent of infection host environment

Factors Influencing Disease Transmission

Agent
Infectivity

Environment
Weather Housing Geography Occupational setting Air quality Food
Age Sex

Pathogenicity Virulence Immunogenicity Antigenic stability Survival

Host

Genotype Behaviour Nutritional status Health status

(www)

Epidemiologic Triad-Related Concepts

Infectivity (ability to infect)

(number infected / number susceptible) x 100

Pathogenicity (ability to 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

Predisposition to Infections
(Host Factors)

Gender
Genetics Climate and Weather Nutrition, Stress, Sleep Smoking

Stomach Acidity
Hygiene

Infectious Agents

Bacteria

Viruses
Fungi Protoctists / Protozoa

Helminths

Reservoirs A host that carries a pathogen without injury to itself and serves as a source of infection for other host organisms
(asymptomatic infective carriers)

Vectors
A host that carries a pathogen without injury to itself and spreads the pathogen to susceptible organisms
(asymptomatic carriers of pathogens)

Infectious Disease Process Direct tissue invasion Toxins Persistent or latent infection Altered susceptibility to drugs Immune suppression Immune activation (cytokine storm)

Spreading of Infection

Reservoir of infection provides pathogen with conditions for survival

carriers, asymptomatic or latent Animal- zoonoses various routes Nonliving Reservoirs water, fertilizer ect
Human

Portals of entry and Exit

Pathogens have preferred portals of entry and exit. Most common portals

Respiratory

tract Gastrointestinal tract Urogenital tract Blood to blood

Nosocomial (Hospital-acquired) infections

5-15% get infections while in the hospital. Microbes in hospital Chain of transmission Compromised host Is a hospital the best place to be if you are sick?

Common Causes of Nosocomial Infections

Percentage of Total Infections 25% Percentage Resistant to Antibiotics 89%

Coagulasenegative staphylococci S. aureus Enterococcus Gram-negative rods C. difficile

16% 10% 23% 13%

80% 29% 5-32% None

Which Procedure Increases the Likelihood of Infection Most?

ANIMATION Nosocomial Infections: Prevention

Clinical Focus, p. 422

Control of Nosocomial

Aseptic techniques
Hand

washing (40% compliance)

Infection control staff

Exposure to Infectious Agents

No infection

Clinical

Sub-clinical

Carrier

Death

Carrier

Immunity
Outcome

No immunity

(www)

Epidemiologic Triad

Disease is the result of forces within a dynamic system consisting of:

agent of infection host environment