INFECTIOUS DISEASE

EPIDEMIOLOGY
 Can human beings exist without organism?
 Can organism exist without human beings?
 Will human beings get rid of organism or
organism get rid of human beings?
 Will human beings be exterminated by
pollution, source crisis or
organism?
 The history of infectious
disease epidemiology
 Hippocrates (460-361 BC) ‘the father of med-
ical science’ and Herodotus (484-425 BC) ‘the
father of history’ both related environmental
factors to health.
 The first public health measures based on case
reports of infectious disease taken in 1348
related outbreaks of pneumonic plague.
 The concept of quarantine was introduced in
1398.
 The first of the Bill of Mortality, was
published in London in 1532.
 The Registrar General was established in 1837.
 In 1849,John Snow (1813-1858), a London
physician, proved that cholera is mainly spread
by drinking infected water.
 In 1837 William budd (1811-1880), showed
how typhoid was caused.
 More recently, William Pickles (1885-1969),
was able to elucidate many of the epidemio-
logical characteristics of hepatitis and other
infections.
 The surveillance institutes of
infectious disease
 Communicable Disease Surveillance Center
(CDSC) in England and Wales
 Scottish Centre for Infection and Enviromental

Health (SCIEH) in Scotland

 Center for Disease Control (CDC) in Atlanta,

USA
 The World Health Organization (WHO) is on

a world-wide basis.
 Achievement
 The most outstanding achievement of inter-
national surveillance was the development of
a program for smallpox eradication.
 The polio will also be exterminated in near

future.
 The incidence rate and mortality rate of some

folk infectious diseases and parasitic diseases

such as measles, pertussis, tetanus have desc-
ended in many countries.
 Diphtheria broke out in 15 countries including Russia
and plague in human beings broke out in many big
and middle cities in India such as Bombay.
 The tuberculosis is critical in the whole world in
1993.
 Ancient infectious diseases haven’t been contr-
olled efficiently and new infectious diseases emerged
out continuously such as AIDS, Leg- ionnaires’
disease, O139 cholera, Hemorrhagic colitic (HC)
attributed to Ecoli O157 etc.
Problems
 The present situation
 Prevention and control of infectious disease
has gained great achievement.
 We face new problems about the prevention
and control of infectious diseases.
 Prevention and control of infectious disease is
still very important in a long time.
Part І The Epidemic Process
of Infectious Disease
The Basic Factors of Infectious Disease’s
happening and transmitting
 The Micro-organism

 The Host  The Environment

 The micro-organism
 The degree of virulence depends on invasive-
ness and toxigenicity.
 The dosage of organism.
 The portal of entry.
 The variation of organism.
• Resistance variation
• Antigen variation
• Toxigenicity variation including toxigencity
boosting or lowering.
 The host
 The reaction of the host to a micro-organism will
depend on the ability to resist infection.
 The individual may possess specific protective
antibodies or cellular immunity.
 The micro-organism must invade host through
particular entry and settle in particular site.
 The host discharges the micro-organism throu-
gh particular route.
 The environment
 The environment plays a major role in the
causation, spread and control of infection.
 The decrease in overcrowding and infestation
together with the demand for cleaner water
supplies and better sanitation have been of
paramount importance.
 The Spread of Infection
 Infection process is defined as body reacts with
pathogen each other when pathogen invades into
body.
(It is a individual process.)
 Spectrum of infection includes no infection, ina-

pparent infection, light infection, middle infecti- on,

serious infection and death.(It is influenced by
transmitting capacity, the capacity of resultin- g in
disease and the immune situation of the host.)
no~ inapparent~ light~ middle~ serious~ death
 There are 3 categories of
spectrum of infection.
 some cases are  Apparent infections
inapparent infections.
 some cases are apparent  Inapparent infections
infections.
 few cases will be dead.  Healthy people
 Epidemic process is defined as a process in
which the infectious disease emerge and
spread.
(It is a society process.)
 There are 3 links of epidemic process includi-
ng source of infection, route of transmission
and susceptible persons.
 There are two kinds of factors in epidemic pro-
cess including natural factors and societal fact-
ors.
 Section 1 Source of Infection
 Source of infection is defined as human beings
or animals that they can reproduce pathogen in
their bodies and discharge pathogen out of the-
ir bodies.
 These may be :
1. cases
2. carriers
3. Infected Animal
 І Source of infection is human cases
1.Incubation period
Incubation period is defined as a period betw-een
pathogen entering body and clinical feat- ures appearing.
 Different infectious disease has different incu- bation

period. (varicella:14d AIDS:7-8y)

 Incubation period of same infectious disease

• The shortest incubation period: varicella 12d

• The longest incubation period: varicella 21d

• The usual incubation period: varicella 14d

 The patients that go down with some infecti-
ous disease can discharge pathogen in the end
of the incubation period.
 The epidemiologic significance of
incubation period
 Judging the time of infected and determining the
source of infection and the route of transmission.
 Determining the quarantining and medical observ-
ing period.
 Determining the time and category of prophylactic
inoculation.
 Evaluating the efficacy of prophylactic measures.
 Influencing the epidemic characters of disease.
2.Clinical features period
Clinical features period is the period that patie-
nt has special clinical symptom and body char-
acters.
During the period, most cases not only have in-
fectivity but also the infectivity is the
strongest.
3. Recovery period
In this period, clinical symptom is disappear;
body immunity appear; pathogen has been di-
scharged; usually it can be the source of infec-
tion.
But some patients with some disease still can
discharge pathogen in this period such as
hepa- titis B, typhoid fever and diphtheria etc.
 ІІ The source of infection is carrier
Carrier is those people or animals that they ha- ven’t
any clinical symptom but they can disch- arge
pathogen.
 Incubatory carrier

 Convalescent carrier

• Temporary convalescent carrier

• Chronic convalescent carrier

 Healthy carrier: During the whole process they all

haven’t clinical features.

 The significance of carrier being the
source of infection can be influenced
by some factors:

 The type of the carrier, the dosage of the path

-ogen that the carrier discharges and the
durati- on.
 The carrier’s profession, personal sanitary hab-
its and moving range are more important.
 ІІ The source of infection is
infected animal
Zoonosis is defined as a infectious disease
that is transmitted to human beings by animals.
The infected animal is source of infection.
There are 3 categories:
 Most cases are animals (e.g. forest meningitis)

 Most cases are people (e.g. human T.B)

 People are as important as animals.

(e.g. schistosomiasis)
True zoonosis is defined as the pathogen’s live
history must complete in human’s body and ani-
mal’s body together. (e.g. malaria)
 Some animals can cause zoonosis
 Beast
• Ox, sheep: anthrax, brucellosis, leptospirosis
• Goat: schistosomiasis, brucellosis
• Pig: meningitis, brucellosis, leptospiirosis
 Wild animal
• Wolf: rabies, leptospirosis
• Rodent: plague, schistosomiasis, leptospirosis
• Bird: meningitis
 Section 2 Route of transmission
 Route of transmission is defined as the route
that pathogen experiences in extrinsic envir-
onment when it changes host.
 Factor of transmission is the articles that can
transmit pathogen.
 Mechanism of transmission is a process that
pathogen changes host constantly.
1. Pathogen is discharged from host.
2. Pathogen stays in extrinsic environment.
3. Pathogen invades new susceptible body.
 The usual route of transmission
 Air-borne transmission
 Water-borne transmission
 Food-borne transmission
 Contact infection
 Vertical transmission
 Insect-borne transmission
 Soil-borne transmission
 Iatrogenic infection
 1. Air-borne transmission
 Method: droplet infection
(meningitis, influenza)
droplet nucleus infection
(diphtheria, tuberculosis, varicella, mumps)
dust infection (tuberculosis)
 Epidemic characters:
• Seasonality (usually in winter and spring)
• Cyclic change
• Children are more infected
• Air-borne infection often outbreaks in those
areas with high population density and bad
living conditions.
 2. Water-borne transmission
 Method: Via sewage-polluted drinking water
Via contacting infected water
 Epidemic characters (via drinking water)
• The distribution of cases is coincident with the range of water
supply.
• Every herd can fall ill except for infant.
• The disease can outbreak and be endemic.
• After people stop drinking the sewage-polluted water or disinfect
the water, the epidemic stops.
 The major infectious diseases via water- borne
infection are schistosomiasis.
 3. Food-borne infection
 Method:Food contains pathogen
Food is contaminated during the course
of making, processing and transferring.
 Epidemic characters:
• People who eat the food fall ill, others aren’t ill.
• The disease can outbreak.
• After people stop supplying the food, the epid-
emic stops.
 The major infectious diseases via food- borne
infection are cholera, typhoid fever, dysentery,
etc.
 4. Contact infection
 Method: Via direct contact
Via indirect contact (daily living
contact)
 Epidemic characters (via indirect contact):
• It hasn’t seasonality.
• It often take place in that areas in which people’s sanitary
habits and sanitary conditions are bad.
• It is usually sporadic.
 The major infectious diseases via direct cont-
act are STD and rabies.
 The major infectious diseases via indirect
cont- act are diphtheria and tuberculosis and
so on.
 5. Vertical transmission
Vertical transmission is the method that
mother transmits pathogen to her children
before or d- uring the course of parturition.
 Method: infected in womb

Transmitting during the course of

childbirth.
Upward transmission
 The major infectious diseases via vertical
transmission are STD and hepatitis B.
 6.Iatrogenic infection
Method:
• Transmitting during the course of diagnosis,

treatment or prevention.
• Transmitting via contaminated drugs or blood.
 Section 3 Herd susceptibility

 Herd susceptibility is the susceptible degree of

a whole herd .
herd susceptibility =
(the whole population – immune
population)
the whole population
 Factors that increase the herd susceptibility:
• The number of neonate rises.
• Susceptible people move in.
• The immunity of immune people decreases
naturally.
• The immune people died.
 Factors that decrease the herd susceptibility:
• Prevention
• After disease prevailed, the number of immune
people increase.
• Inapparent infection (It can increase the numb-
er of immune people.)
 Herd susceptibility is intimately related to the
epidemic of infectious disease .
• High herd susceptibility is a prerequisite of the
infectious disease prevailing.
• Low herd susceptibility restrains the infectious
disease prevailing.
 Section 4 Infectious focus
 Infectious focus is defined as the range that the
source of infection transmits pathogen around.
 The factors that influent the dimension of infe-
ctious focus
• The moving range of the source of infection
• The characters of route of transmission
• The people’s immunity around source of infe-
ction
 The prerequisites of exterminating the infect-
ious focus
• The source of infection hasn’t existed.
• The pathogen that source of infection spread in
the surroundings has been cleared away.
• The susceptible people who contacted patients
don’t fall ill after the longest incubation period.
 Section 5 Epidemic process
 A series of infectious focus that relate to each
other and occur continuously are made up epi-
demic process.
 The factors that influence epidemic process
• Natural factors including geographic factors
and climatic factors.
• Societal factors including living conditions,
living surroundings, people’s activities, habits,
religious belief , etc.
 source of infection
Natural factors
route of transmission
Societal factors
susceptible persons
 Part Ⅱ Prevention and
control of infectious disease
 Prevention strategies operate in three general
areas:
• Interruption or prevention of transmission
• Prevention of infection
• Prevention of disease
 Prevention measures:
• Improving sanitary conditions
• Prophylactic immunization
• propaganda
• Sanitary quarantine in frontiers (plague, cholera,
yellow fever)
1. Import quarantine
2. Sanitary surveillance
3. Export quarantine
 The measures of controlling
infectious disease
 Managing the source of infection
 Cutting the route of transmission
 Protecting the susceptible persons
 The emergency measures about outbreak and
epidemic
 Section 1 Managing the source of
infection

1.Patient: finding early, diagnosing early, treati-

ng early and isolating early
Some patients with serious disease such as
plague, cholera, AIDS, pneumonic anthrax
are forced to be isolated and treated.
 Patients with some infectious diseases such as
hepatitis, tetanus, tuberculosis, diphtheria,
per- tussis, etc can go to work after they cure
their disease.
If they do special job such as nursing, cooki-
ng, they must be managed strictly.
The patients with STD (sexually transmitted
disease) must stop working and be isolated in
the hospital or in home.
2. Contactor
 Quarantining

 Medical observation

 Lash-up vaccination

 Chemoprophylaxis for close contacts

The time of quarantining correspond to the

longest incubation period of the infectious
disease since the day of the last contact.
3. Carrier
 Treatment and isolation

 Exchanging job

 Education

 Treatment

 Part of carriers can’t contribute their blood.

4. Animal as source of infection
We can deal with the infected animals accord-
ing to their economic value.
 Kill, burn or deep burying (the economic value

is low such as sheep, dog, chick, etc.)

 Treatment and isolation (the economic value is

high such as ox, horse, camel, etc.)

 Section 2 Cutting the route of
transmission
1. Different infectious disease has different rou- te of
transmission, so the measure of cutting the route of
transmission is different.
 The infectious disease via food- and water- borne
transmission (faecal- oral route)
• Disinfect the contaminated articles.
• Disinfect the surroundings.
 The infectious disease via air- borne transmiss-
ion
• Ventilation
• Disinfect the air
 The infectious disease via insect- borne trans-
mission
• Kill insect
2. Disinfection
Disinfection is defined as a measure killing the
micro-organisms which result in infectious di-
sease in the surroundings via physical, chemi-
cal or biological methods.
 Prophylactic disinfection

 Disinfection in infectious focus

 Prophylactic disinfection: disinfect the places
and articles that may be contaminated by path-
ogen but in which there are not apparent sour-
ce of infection.
 Disinfection in infectious focus: disinfect the
infectious focus in which there are (were) sou-
rce of infection .
• Current disinfection
• Terminal disinfection
• Current disinfection refer to disinfect the infe-
ctious focus in which there is source of infec-
tion now in order to kill the pathogen quickly.
• Terminal disinfection refer to disinfect the infe-
ctious focus thoroughly after the source of inf-
ection has been cured, died or left.
Usually we carry on the terminal disinfection ai-
ming at the high micro-organism with high resi-
stance such as plague, typhoid, cholera, anthrax,
polio, tuberculosis, diphtheria, brucellosis, etc.
 The methods of disinfection:
• Physical disinfection (heating, burning, freez-
ing, ultraviolet etc.)
• Chemical disinfection (alcohol, iodine, deter-
gent, etc)
Section 3. Protecting susceptible
persons
 Prophylactic immunization
 Chemoprophylaxis
 Personal precaution
 Occupational protection
Part Ⅲ Prophylactic
Immunization
 Ⅰ Rationale of Immunization
The objective is to produce, without harm to
the recipient, a degree of resistance sufficient
to prevent a clinical attack of the natural infec
tion.
 Ⅱ Passive Immunization
Artificial passive immunization is defined as
Serum which include antibody or pharmaceutical were
injected into body to give temporary protection
It is used in clinical practice when it is considered
necessary to protect a patient at short notice and for a li-
mited period.
Antibodies, which may be antitoxic, antibac- terial or
antiviral, in preparations if human or animal serum are
injected to give.
 Homologous and heterologous sera
• The effect of homologous antisera persist for
3-6 months.
• The protection afford by a heterolous serum is
likely to last for only a few weeks.
 Ⅲ Active Immunization
The pathogen or its’metabolized products were
Vaccinated and made body producing special
immunization
1.Types of vaccine
 Toxoids
• Tetanus toxoids
• Diphtheria toxoids
 Inactivated vaccines
• Inactivated influenza vaccine
• Inactivated polio vaccine
 Attenuated live vaccines
• Measles vaccine
• Live-virus polio vaccine
• Yellow fever vaccine
 Special procedures
Hepatitis B is bio-engineered.
 Ⅴ Hazards of immunization
 Mild or moderate pain at the site of injection
 Fever and malaise for a day or two after

 Anaphylactic are very rare

 Febrile convulsions

 Some of these events will coincide with the

period shortly after a vaccine was given.

 Ⅵ Herd Immunity
When most of the people in a community are
immune to a particular infection that is spread
from person to person, the natural transmission
of the infection is effectively inhibited.
Bear in mind that herd immunity operates
only for infections transmitted from person to
person. Tetanus is not transmitted in this way.
 The emphasis of this chapter
Definition: infection process, epidemic process, source
of infection, incubation period, route of
transmission, herd immunity, infectious focus
How many stages does spectrum of infection include?
What are they?
How many categories of spectrum of infection? What
are they?
What are the 3 links of epidemic process?
What is the epidemic significance of incubation
period?
The name of usual route of transmission
What is mechanism of transmission?
The methods, epidemic characters and major diseases
of air- borne transmission, water- borne
transmission and food- borne transmis- sion.
The content of the measures of controlling infectious
disease.
How many kinds of prophylactic immunization?
What are they? Write down some vaccines
when write every type of prophylactic immu-
nization.