1.

Descriptive epidemiology: principles, uses, time, place, person

distribution of disease with eg, measurement, comparison with
known indices, formulation of hypothesis

Definition: Study of distribution of disease, in terms of time, place and

person. This is the first step taken towards identifying disease etiology

Procedure/principles:
1. Identify study population
If we want to study the problem of measles in a given PHC area,
during a given year, the study population will be under-fives in the
jurisdiction of the PHC during that year.
2. Identify disease under study
Operational definition of the disease is needed to identify and
measure it with a degree of accuracy.
3. Describe disease based on
a. Time distribution
b. Place distribution
c. Person distribution
4. Measurement of disease
Measuring the disease load/magnitude of the problem via mortality,
morbidity and disability indicators. Mortality – death rates;
morbidity – incidence (longitudinal study) and prevalence (cross-
sectional study)
5. Comparison with known indices
The observations are compared with other groups. This helps
identify etiological factors and at risk population.
6. Formulation of etiological hypothesis
After studying the population and disease, an etiological hypothesis
must be developed that takes into account the study population, the
specific cause being considered, the outcome or disease, the dose-
response and time-response relationship. Eg: “smoking 3-40
cigarettes per day causes lung cancer in 10% of smokers after 20
years of exposure”
Uses:
- Identify magnitude of the problem
- Gives clues to identify etiology
- Gives background data needed to plan, organize and evaluate
preventive and curative services
 - Contributes to research

Describing the disease:

Time distribution
Three kinds of time trends:
1. Short term fluctuations
Sudden occurrence of disease in a given area, lasting for a short
period – epidemic
a. Common source epidemic
- common source single exposure: food poisoning, fire
accident
- common source repeated exposure: well with
contaminated water causing cholera outbreak
b. Propagated epidemic: person to person spread - measles
c. Modern/ slow epidemic: non-communicable diseases like
diabetes are on the rise
2. Periodic fluctuations
a. Seasonal trend: diarrheal diseases in summer
b. Cyclic trend: epidemic of measles occurs every 2-3 years
3. Long term fluctuations (secular trend)
Changes in occurrence of disease over long period of time: diabetes
showing upward trend, TB showing downward trend
Place distribution
1. International variations: stomach CA common in Japan, unusual in
US
2. National variations: goitre in sub Himalayan region
3. Rural-urban variations: non-communicable diseases more common
in urban regions
4. Local distribution of disease: spot map
Person distribution
Age: measles among pre-schoolers, AS among elderly
Sex: AS more common in men
Marital status: cancer cervix more common in married women
Occupation: respiratory diseases common among industrial workers
Social class: socioeconomic class, poverty, illiteracy – nutrition,
Behaviour: smoking, drinking
Stress
Migration: spread of diseases
 2. Incidence: def
It is the occurrence of new cases of a specified disease in a given area
during given period of time (min 1 yr). Expressed for 1000 population at
risk.
Incidence = (no. of new cases in a given area during a given period of time
/ population at risk during that period) x 1000

3. Prevalence: def
It is the existence of both old and new cases in a given area during a given
point of time
Prevalence = (no. of all current cases/total population) x 100

4. Inference from incidence and prevalence

Incidence – longitudinal studies; useful in formulating and testing
etiological hypothesis
Prevalence – cross-sectional studies: useful to know magnitude of the
problem

5. Epidemiology def
Study of distribution and determinants of health related states or events,
in specific populations and the application of this knowledge for the
control and prevention of health problems.

6. Epidem approach
An approach to achieve certain objectives by collecting data, aiming to
answer the following questions:
- What is the nature of the event? (Nature of the disease)
- Where did the disease occur? (Place distribution)
- When did the disease occur? (Time distribution)
- Who are affected by the disease? (Person distribution)
- What is the extent of the problem? (Magnitude of the problem)
- Why did it occur? (Etology and risk factors)
- How can the problem be reduced? (Control measures)
- How can it be prevented in the future? (Preventive measures)

7. Uses of epidem
- Find out the distribution of the disease in the community
 - Find out the magnitude of the problem
- Identify risk and etiological factors
- Plan for implementation of prevention and control measures
- Eliminate or eradicate disease
- Evaluate control and prevention measures
- Ultimately promote health and well-being of people

8. Carriers: def, types esp based on duration

Def: infected individuals harbouring the pathogen , but not showing any
clinical signs. Diagnosis is made through lab testing. Represents the
submerged part of the iceberg phenomenon. They serve as a source of
infection to susceptible individuals in the community. Such carriers are
seen in typhoid, diphtheria, meningitis, hep B, AIDS, gonorrhoea,
salmonellosis
Types
- Based on stage of disease
o Incubatory carriers: during incubation prd – measles, mumps,
diphtheria, hep A, B. Become cases after incubation period
o Convalescent carriers: during recovery phase, clinically cured
but not bacteriologically – typhoid, amebiasis
o Healthy – subclinical infection, eg nursing staff – never sick
though; cholera
- Based on duration
o Temporary: only spread disease for a period of several days –
incubatory, convalescent carriers
o Chronic: harbour pathogen and spread disease for indefinite
periods - weeks to months to years; persistence of pathogens
in gall bladder in typhoid, liver in Hep B, tonsils in diphtheria
- Based on route of exit: urinary carriers (typhoid), intestinal
(typhoid), biliary (typhoid), cutaneous (staph), nasal (diphtheria),
genital (AIDS)

9. Incubation period def, epidem

It is the time period b/w entry of pathogen into body and development of
first sign/symptom of disease. Short incubation prd (h-d): food poisoning,
bacillary dysentery; (d-w) chicken pox, (m-y) AIDS. Helps in diagnosis,
tracing source, immunization making use of lengthy IP, prognosis,
quarantine of contacts

10. Zoonoses def

A disease that is naturally transmitted between vertebrate animals and
humans in either direction.
Anthropozoonoses: animals to man – rabies from dogs, plague from rats,
Japanese encephalitis from pigs
Zooanthroponoses: man to animals – human TB from man to cattle
Amphixenoses: either direction – Chaga’s disease, reservoir being both
humans and armadillos

11. Secondary attack rate, sign

The probability that a susceptible individual will develop the disease
following known contact with an infectious person or source within a
reasonable incubation period. = new cases among contacts/total contacts
Measure of speed of disease spread or rate of morbidity in a susceptible
population. Useful to determine if a disease of unknown etiology is
communicable or not.

12. What are the types of reservoirs?

a. Human reservoirs: cases and carriers
Most important reservoirs
b. Animal reservoirs: 100 and more zoonotic diseases
Bacterial: leptospirosis, plague from rat
Viral: rabies from dogs
Helminths: Hydatid disease from dog
Genetic recombination between animal and human viruses could produce
new strains: influenza
c. Non-living thing reservoirs: E. coli in water, clostridium in soil
measles elimination, small pox eradicated