Introduction to Epidemiology

At the end of this lesson, students are able to:

1. State Father of Occupational Medicine, Father of Immunology,

Father of Modern Epidemiology and Typhoid Mary

2. Define epidemiology
3. State the uses of epidemiology
4. Describe the natural history of disease

5. Illustrate the epidemiologic triangle

LESSON OUTLINE
1. History / evolution of epidemiology
2. Terminology in Epidemiology
3. Uses of epidemiology
4. Natural history of disease
5. Epidemiologic triangle

History / Evolution of
Epidemiology

Bernardino Ramazzini
(1633 - 1714) Italy

Father Of Occupational
Medicine
Occupational diseases
What is your occupation?

Edward Jenner (1749 1823) England

Father of Immunology
Pioneer of smallpox vaccine
Saved more lives than the work of
any other man"
In 1979, the World Health
Organization declared smallpox an
eradicated disease

John Snow (1813 1858) England

Father of Modern Epidemiology

Mapping of cholera cases in East

London during cholera epidemic in 1854
Traced source to a single well on Broad
Street that had been contaminated by
sewage

Dot / Spot Map

Source of
outbreak

Mary Mallon (1869 1938) US

Known as Typhoid Mary

Asymptomatic / healthy carrier
Cook
Typhoid fever

Typhoid Mary
Mary Mallon, a cook responsible for 1904 typhoid fever epidemic
When source of disease was traced, Mary had disappeared only to
resurface in 1907 when more cases occurred
Again Mary fled, but authorities led by George Soper, caught her and
had her quarantined on North Brother Island
In 1910 the health department released her on condition that she
never accept employment involving the handling of food
Four years later, Soper began looking for Mary again when two new
epidemics broke out; Mary had worked as a cook at both places
She was found and returned to North Brother Island, where she
remained the rest of her life until a paralytic stroke in 1932 led to her
slow death, six years later

Statistics & Biostatistics

Statistics the science and art of dealing with variation of
data in order to obtain reliable results and conclusions
Biostatistics the application of statistics to problems in
the biological sciences, health and medicine
Eg:
Computing age-adjusted cancer incidence rates to
determine trends over time and locality
Calculating statistical measures of the risk of developing
brain tumors following cell phone use
Quantifying the relationship between use of Cox-2
inhibitors and quality of life

Epidemiology
Epidemiology is a word with Greek origins:
epi, meaning on, upon or befall,
demos, meaning people, and
logos, meaning the study of.

The study of what is upon the people

Definition of Epidemiology
The study of the distribution and
determinants of health-related states
or events in specified populations,
and the application of this study to
the control of health problems
(WHO)

Distribution
the frequency and pattern of health events
in a population.
Frequency refers to the number of health
events

 Pattern refers to the occurrence of healthrelated events by time, place, and person.
Time patterns may be annual, seasonal, weekly,
daily, hourly, that may influence health events
occurrence.
Place patterns include geographic variation,
urban/rural differences, and location of work sites or
schools.
Personal characteristics include demographic
factors such as age, sex, marital status,
socioeconomic status, behaviors and environmental
exposures.

Frequency & Pattern

Determinants
Are the causes and factors that influence the
occurrence of health-related events.
Eg. Eating contaminated food causes
diarrhea

Health-related events
Anything that affects the well-being of a population.
disease epidemic
endemic diseases
chronic diseases
occupational health & safety injury, disease
environmental health water supply, foods
behaviors lack of exercise, unhealthy eating,
smoking

1. To determine the etiological or causal factors of

diseases
2. To determine the frequency and distribution of a disease
in a community
3. To evaluate preventive, therapeutic and intervention
activities
4. To develop public health policies and regulations

5. To solve epidemics/outbreaks.
6. To predict disease occurrence, impact and distribution in
a community.
7. Surveillance for new disease and changes in old ones.
8. To plan current and future health care needs.

It is the description of the progression of a disease from the first sign

or manifestation of the disease until recovery or death

Ending

Beginning

Incubation Period

It is important to know about the natural history of a disease to help

prevent, treat and control a disease

The Triangle has three components:

Agent, or microbe that causes the disease (the what

of the Triangle)

Host, or organism harbouring the disease or carrier

(the who of the Triangle)

Environment, or those external factors that cause or

allow disease transmission (the where of the Triangle)

It is the model of infectious disease causation.

It has 3 components: an external agent, a susceptible

host and environment that brings the agent and the
host together.

Disease has been classically described as the result of

an epidemiologic triangle.

Infectious diseases result from the interaction of agent,

host, and environment

1. US Department of Health and Human Services, Center for

Disease Control and Prevention, 2012. Principles of
Epidemiology in Public Health Practice, 3rd Edition, Atlanta.

2. R. Bonita, R. Beaglehole and T. Kjellstrom, 2006. Basic

Epidemiology, 2nd Edition, World Health Organization,
Geneva.
3. Karuthan C. and Krishnakumari K., 2009. Biostatistics for the
Health Sciences. Mc Graw Hill.