 Endemic- occurrence of expected number of cases Lines of defense

among a group of people over time 1. Skin and secretions- acts as initial barrier, mucus
 Incidence- # of new cases in a population catches pathogens, enzymes kill pathogens
 Prevalence- # of cases in a population (per 10,000 or 2. Inflammatory response- injury/tissue damage
100,000) releases chemical signal, blood flow increases: heat,
 Outbreak- more cases of a particular disease than redness, pain, swelling
expected in a given area over a given time 3. Phagocytosis- ingests and destroys microorganisms:
 Epidemic- large numbers of people over geographic neutrophils, macrophages
area distribution affected with the same disease 4. Natural killer cells- kills tumor cells and infected
 Pandemic- an epidemic spanning a very wide area cells with viruses
5. Interferon- infected cell makes protein and releases
 Vector- an animal intermediate that transmits a
into bloodstream, interferes with reproduction
pathogen to humans
Epidemiology
 Virulence- Degree or intensity of pathogenicity of an
 Study of health of population
organism
 Uses scientific method
 Compromised host- host with lowered resistance to  Studies distribution and causes of disease in human
infection populations
 Nosocomial infection - an infection that is traced back to  Attempts to control these diseases investigates
a hospital health concerns in relation to disease
 Infectivity - capacity to cause infection in a 1) Prepare for field work- Research disease, prepare to
susceptible host travel, make arrangements with personal contacts
 Pathogenicity - capacity to cause disease in a host 2) Establish the existence of an outbreak- compare current
 Virulence - severity of disease that the agent causes number of cases to previous cases, use health records,
to host documents, etc.
 Case definition- The onset of ____ (symptoms) in a _____ 3) Verify diagnosis- Review clinical and laboratory results
(person) at ____ (time and place) for the cases, interview patients
 Confirmed- diagnosis by lab verification 4) Define and identify cases- establish case definition,
 Probable- many factors point to diagnosis, but no lab have clinical info, characteristics of the people, place,
verification time, etc.
 Suspected- some factors point to diagnosis 5) Describe and orient the data in terms of person, place,
 Reservoir- site that harbors pathogenic organisms and time- use epi curve to describe how many cases at
(human, animal, soil) what time
 Morbidity rate- # sick divided by # exposed 6) Develop hypotheses- consider disease, interview people
 Mortality rate- # dead per 100000 population who are ill, try and notice what certain characteristics
 Case Fatality rate- # dead divided by # sick make people have the disease
7) Evaluate hypotheses- compare with established fact,
 Modes of transmission: droplet (through air, flu, TB,
use statistics, use case-control or cohort studies
SARS, hantavirus), blood (sexual or injected, HIV,
8) Refine Hypotheses- study environment, use data for
hepatitis), direct contact (touching, leprosy, chicken
more insight
pox), oral-fecal (contaminated water, cholera, giardia),
9) Control and Prevention measures- immunization,
vector (spread by animal, malaria, lyme disease)
medicine, isolation, carry out as soon as possible
 AIDS- acquired immunodeficiency syndrome, spread by
10) Communicate findings- Oral briefing for local health
blood/ sexually, attacks immune system
authorities, written report for archives
 Tuberculosis- caused by bacteria, cough, fever, fatigue,
weight loss, treated by antibiotics, attacks respiratory ____________________________________________________________
system or other parts of body Cohort Study- used for outbreaks in small, well-defined
 Malaria- caused by protozoan, spread by mosquitoes populations, moves forward or backward from exposure
(anopheles), cyclic fever and chills
 2 Triads: Person, Place, Time; Agent, Host, Environment Disease? Ye No
 Index Case: The first case in an outbreak s
 Virus: Viruses are small, much smaller than bacteria. Exposed (A) (B
They are not composed of cells. Viruses have 2 basic )
components: DNA or RNA covered in protein. Viruses Unexpos (C) (D
can only reproduce inside the cells of other living ed )
organisms (rabies, AIDS, SARS, ebola, measles) Attack Rate- exposed A/(A+B)
 Bacteria: Bacteria have 1 cell and no nucleus. DNA and unexposed C/(C+D)
ribosomes float in the cell. They have flagella to help Relative Risk- [A/(A+B)]/[C/(C+D)]
them swim. They have no cell organelles. Gram + Relative Risk> 1: more likely
bacteria have a strong cell wall with peptidoglycan and Relative Risk<1: possible protective effect
a capsule. Bacteria also have pili that help stick. (E. coli, 0-----------------------1------------------------
streptococcus, diptheria, MRSA, lyme disease) Possible protective effect More likely
Shapes: spherical (cocci) Arrangements: Case control Study- used when groups are not well-defined
staph (clumps) compares people with the disease to people without, works
Rod (bacilli) backward
Strep (chain) Expose Case Contro
Spiral (spirilla or spirochete) d↓ Patients ls
Yes (A) (B)
Immunity Inherited-develops before birth, inborn No (C) (D)
Acquired-Active/natural-exposed to antigen naturally Odds ratio: (A x D)/(B x C)
 Passive/natural-milk, placenta A= number of case patients exposed
 Active/artificial-injections, vaccines of antigens B= number of control people exposed
 Passive/artificial-injections of antibodies C= number of case patients unexposed
D= number of control people unexposed

 Cholera- Vibrio Cholerae (oral-fecal)

 Campylobacter Enteritis- campylobacter jejuni
(oral- fecal)
 Chicken Pox- varicella zoster (droplet and direct
contact)
 Chlamydia- Chlamydia trachomatis (sexually)
 E. coli- Escherichia coli (oral-fecal)
 Malaria-plasmodium (vector, anopheles mosquito)
 MRSA- staphylococcus aureus (direct contact)
 SARS-coronavirus (droplet)
 Leprosy-mycobacterium leprae (direct contact)
 Schistosomiasis- schistosoma (oral/contact with
water)
 Shingles-herpes zoster (contact, droplet)
 Strep throat-streptococcus(droplet)
 Tuberculosis- mycobacterium tuberculosis
(droplet)
 Tetanus-clostridium tetani (contact)
 Ebola-filoviridae (contact/blood)
 Athlete’s foot- tinea pedis (contact)
 Jakob- Cruztfelt- prion(ingestion)
 Tapeworm- nematode (ingestion)
 Hepatitis- hepatitis a, b, c virus (a: oral fecal, b:
sexually)
 Giardia- giardia lamblia (direct contact)
Types of epidemic
 Point source - An epidemic in which all cases
are infected at the same time, usually from a
single source or exposure.
 Continuous source - An epidemic in which
the causal agent (e.g. polluted drinking water,
spoiled food) is infecting people who come into
contact with it, over an extended period of
time.
 Person-to-Person (a.k.a. Propagated) - An
epidemic in which the causal agent is
transmitted from person to person, allowing
the epidemic to propagate
Path of infection
Reservoir:
Susceptible Host:
Portal of Entry:
Portal of exit:

Koch’s postulates

1) Collect samples from different people

2) Grow contents on Petri dishes
3) Look for similar organisms from each of the
patients
4) Inoculate suspect organism into healthy
animal
5) Wait for symptoms to occur
6) Isolate organism from diseased animals

Study Strength Weakness

design
Case- Good for rare disease Possible error in
control or recalling past
long latency, examine exposure (Recall
multiple exposures Bias). Possible time-
from a single outcome; order confusion
less
expensive and quicker
to
conduct than cohort
study
Cohort Examining multiple Not good for rare
outcomes for a single diseases; costly in
exposure; examine time and resources;
rare possible loss to
exposures (such as follow up over time;
asbestos but not for factor, which may
rare disease); can be many years in
calculate the incidence the past or may be
of disease (while case seen as socially
control cannot); best (un)desirable
technique for
an outbreak in a small,
well defined
population; most
accurate observational
study
Cross- Relatively short Since exposure and
sectional duration; can study disease status are
several outcomes; measured at the
least expensive same point in time,
 it may
not always be
possible to
distinguish whether
the
exposure preceded
or
followed the
disease.
Experimen Most scientifically Time consuming
tal or sound; best measure and
Trial of exposure Expensive;
Unethical for
Harmful Exposures

Hill’s criteria

1. Strength of Association - relationship is

clear and risk estimate is high
2. Consistency - observation of association
must be repeatable in different populations at
different times
3. Specificity - a single cause produces a
specific effect
4. Alternative Explanations - consideration of
multiple hypotheses before making conclusions
about whether an association is causal or not
5. Temporality - cause/exposure must
precede the effect/outcome
6. Dose-Response Relationship - an increasing
amount of exposure increases the risk
7. Biological Plausibility - the association
agrees with currently accepted understanding of
biological and pathological processes
8. Experimental Evidence - the condition can
be altered, either prevented or accelerated, by an
appropriate experimental process
9. Coherence - the association should be
compatible with existing theory and knowledge,
including knowledge of past cases and
epidemiological studies