Epidemiology and

Public Health

Panganiban
Tarlac
Abay Abay
Learning Objectives
 Define epidemiology
 Differentiate among infectious, communicable, and
contagious diseases;
 Differentiate between the incidence of a disease and the
prevalence of a disease
 Distinguish among sporadic, endemic, nonendemic,
epidemic, and pandemic diseases
 Name three diseases that are currently considered to
be pandemic
 List in the proper order, the six components of the
chain of infection
Learning Objectives cont.
 List five modes of infectious disease
transmission
 List four examples of potential biological
warfare (BW) or bioterrorism agents
 Outline the steps involved in water treatment
Epidemiology
 Epidemiology- is the study of factors that
determine the frequency, distribution, and
determinants of disease in human population
and ways to prevent, control or eradicate
disease in population.

Both pathology and epidemiology can be loosely

defined as the study of diseases, but they involve
different aspect of disease.
 Pathologist- studies the structural and
functional manifestations of disease and is
involved in diagnosing diseases in
individual
 Epidemiologist- studies the factors that
determine the frequency, distribution and
determinants of diseases in human
populations
Epidemiologic Technology
 Use term to describe the status of a
particular infectious disease in a given
population.
Communicable and Contagious
Diseases
 Communicable disease – infectious
disease transmissible from one human to
another
 Contagious disease- is defined as a
communicable disease that is easily
transmitted from one person to another.
Zoonotic Diseases
 Infectious diseases that human acquire
from animal source
Incidence and Morbidity Rate
 Incidence – define as the number of new
cases of the disease in a defined
population during a specific time period
 Morbidity rate – usually expressed as
the number of new cases of a particular
disease that occurred during a specified
time period per a specifically defined
population.
Prevalence proportion of a particular
population found to be affected by a medical
condition.
 Two types of prevalence:
 Period Prevalence – is the number of
cases of the disease existing in a given
population during a specific time period
 Point prevalence –is the number of cases
of the disease existing in a given
population at a particular moment in time
Mortality rate
 Is the ratio of the number of people who
died of a particular disease during
specific time period per a particular
population.

 Mortality refers to death

Sporadic diseases
 Is a disease that occurs only occasionally
within the population of a particular
geographic area.
Endemic diseases
 Disease that are always present within the
population of a particular geographic area.
Epidemic diseases
 Is defined as a greater than usual number
of cases of a disease in a particular region,
usually occurring within a relatively short
period of time.
Epidemics that have occurred in
the United State within the past
35 years:
1976
 Respiratory disease (Legionnaires disease or
legionellosis) occurred during an american legion
convention in philadelphia.
 Resulted in approximately 220 hospitalization and
34 deaths.
 Pathogen was present in the water being
circulated through the air-conditioning system of
the hotel where the affected legionnaires were
staying. Aerosols of the organism were inhaled by
occupants of some of the rooms in the hotel.
 Virtually all epidemics of legionellosis have
involved contaminated water or colonized water
pipes and aerosols containing the pathogen
1992-1993
 Escherichia coli
 Contaminated hamburger meat
 Resulted in approximately 500 diarrheal
cases, 45 kidney failure as resulted hemolytic
uremic syndrome and the death of several
young children
 The ground beef used to make the
hamburger had been contaminated with
cattle feces during the slaughtering process.
The hamburger had not been cooked long
enough, or at a high enough temperature, to
kill the bacteria.
1993
 Hantavirus pulmonary syndrome (sin
nombre virus)
 Approximately 50 to 60 cases, including 28
deaths
 Present in the urine and feces of deer mice
and some of which had gained entrance to
the homes of villagers
 Aerosols of the virus were produced when
resident swept up house dust containing the
rodent dropping. The pathogen was then
inhaled by individuals in those homes.
1993
 Cryptosporidiosis
 Resulted from drinking water that was
contaminated with the oocysts of
cryptosporidium parvum.
Waterborne disease outbreak
 Associated with both with drinking water
and water that is not intended for
drinking.
 Death were caused by Legionella
 Campylobacter and or E. coli
 Viral causes included norovirus and
hepatitis A virus
 Protozoan parasite cause included Giardia
and Cryptosporidium.
Foodborne disease outbreak
 Disease can be transmitted through food,
cause by microbes or toxins and metals
 Illnesses caused by identified pathogen
are caused by Salmonella and listeria Spp.
And toxoplasma
Pandemic disease
 Is a disease that is occurring in many
countries simultaneously sometimes
worldwide.
Currently Occurring in Pandemic
proportions.
 HIV/AIDS
 Malaria
 Tuberculosis
Interaction among pathogens, hosts,
and environment
 Infectious disease occurs depend on many
factors, some of which are:

 Factors pertaining to the pathogen:

 The virulence of the pathogen
 A way for the pathogen to enter the body
 The number of organisms that enter the body
 Factor pertaining to the host
• The person’s health status
• The person’s nutritional status
• Other factors pertaining to the susceptibility of
the host
 Factors Pertaining to the environment
• Physical factor such as geographic location,
climate, heat, cold, humidity and season of the
year.
• Availability of appropriate reservoir,
intermediate hosts, and vectors
• Sanitary and housing condition: adequate
waste disposal: adequate healthcare
• Availability of portable water
Chain of Infection
Strategies for breaking the chain of
infection
 To prevent infections from occurring, measures must be
taken to break the chain of infection at some point.
Some of the goals are to:

 Eliminate or contain the reservoirs of pathogens or

curtail the persistence of a pathogen at the source
 Prevent contact with infectious substances from exit
pathways
 Eliminate means of transmission
 Block exposure to entry pathways
 Reduce or eliminate the susceptibility of potential hosts
 Strategies for breaking the chain of
infection
 Specific methods of breaking the chain of infection are:
 Practice effective hand hygiene procedures
 Maintain good nutrition and adequate rest and reduce
stress
 Obtain immunizations against common pathogens
 Practice insect and rodent control measures
 Ensure proper decontamination of surfaces and medical
instruments
 Dispose of sharps and infectious waste properly
 Use gloves, gowns, masks, respiratory and other personal
protective equipment, whenever appropriate to do so
 Use needle safety device during blood collection
Reservoirs of Infection
 RESERVOIRS – is any site where the
pathogen can multiply or merely survive
until it is transferred to a host.
 Maybe a living host or inanimate objects
or materials
Living Reservoirs
 Include humans, household pets, farm
animals, wild animals, certain insects and
certain arachnids.
Human Carriers
 Carrier is a person who is colonized with
particular pathogen, but not currently causing
disease in that person.

 Several types of carrier:

 Passive carriers – carry the pathogen without
ever having had the disease.
 Incubatory carriers – is a person who is capable
of transmitting a pathogen during the incubation
period of a particular infectious disease
Human Carriers
 Convalescent carriers – harbor and can
transmit a particular pathogen while recovering
from an infectious disease
 Active carriers – have completely recovered
from the disease, but continue to harbor the
pathogen indefinitely.
Animals
 Zoonoses – acquired by direct contact
with the animal, by inhalation or ingestion
of the pathogen or by injection of the
pathogen by an arthropod vector.
Arthropods
 May first take a blood meal from an
infected person or animal and then
transfer the pathogen to a healthy
individual.
Nonliving reservoirs
 Air, soil, dust, food, milk, water and
formites

 Air can become contaminated by dust or

respiratory secretions of human expelled
into the air by breathing, talking, sneezing
and coughing

 Fomites – materials which are likely to

carry infection
MODES OF TRANSMISSION
 Five Principal modes
 Direct or Indirect contact
 Droplets – generated by coughing,
sneezing, and even talking
 Airborne – transmission involves the
dispersal of droplet nuclei, which are the
residue of evaporated droplets and
smaller than 5 micrometer in diameter.
MODES OF TRANSMISSION
 Vehicular – transmission involves
contaminated inanimate object such as
food, water, dust, and fomites
 Vector – include various types of biting
insects and arachnids.
MODES OF TRANSMISSION
Communicable diseases infectious diseases that
are transmitted from person to person
commonly transmitted in the following:
 Direct skin to skin
 Direct mucous membrane-to-mucous
membrane contact by kissing or sexual
intercourse
 indirect contact via airborne droplets off
respiratory secretions, usually produced as a
result of sneezing or coughing.
MODES OF TRANSMISSION
 Indirect contact via food and water
contaminated with fecal material.
 Indirect contact via arthropod vectors
 Indirect contact via fomites that become
contaminated by respiratory secretions,
blood, urine, feces, vomitus, or exudates
from hospitalized patient.
 Indirect contact via transfusion of
contaminated blood or blood product from
an ill person or by parental injection using
non sterile syringes and needles
Public Health Agencies
 Help by educating the public, explaining
how diseases are transmitted, explaining
proper sanitation procedures, identifying
and attempting to eliminate reservoirs of
infection, carrying out measures to isolate
diseased persons, participating in
immunization programs, and helping to
treat sick persons.
World Health Organization
 Specialized agency of the United Nations,
to promote technical cooperation for
health among nation, carry out programs
to control and eradicate diseases and
improve the quality of human life.
Centers for disease control and
prevention
 In the united state, a federal agency called
US department of health and human
service and CDC, which assist state and
local health department in the application of
all aspects of epidemiology.
 CDC– are able to work with most
dangerous pathogens known to science
because of the elaborate containment
facilities that are located there.
Centers for disease control and
prevention
 Prevention and control of epidemics is a
never ending community goal. To be effective,
it must include measures to:
 Increase host resistance through the
development and administration of vaccines
that include active immunity and maintain it
in susceptible persons
 Ensure that persons who have been exposed
to a pathogen are protected against the
disease
 Centers for disease control and
prevention
 Segregate, isolate, andtreat those who have
contracted a contagious infection to prevent
the spread of pathogens to others
 Identify and control potential reservoir and
vectors of infectious diseases: this control may
be accomplished by prohibiting healthy
carriers from working in restaurants, hospitals,
nursing homes and other institutions where
they may transfer pathogens to susceptible
people and by instituting effective sanitation
measures to control diseases transmitted
through measures to control diseases
transmitted through water supplies, sewage
and food
Bioterrorism and Biological Warfare
agents
 In times of war, the use of microorganisms in
this manner is called BIOLOGICAL
WARFARE (BW)
 Microbes are referred as biological warfare
agents
 The possibility that members of terrorist or
radical hate groups might use pathogens to
create fear, chaos, illness, and death always
exists. These people are referred as
biological terrorist or bioterrorist.
Bioterrorism and Biological Warfare
agents
 Bioterrorism agents – specific pathogen
they use.

Four pathogen most potential

bioterrorism agents
 B. anthracis
 C. botulinum
 Smallpox virus
 Y. pestis
Anthrax
 Infections involve marked hemorrhaging
and serious effusion in various organs and
body cavities and frequently fatal.
Botulism
 May cause nerve damage, visual difficulty,
respiratory failure, flaccid paralysis of
voluntary muscles, brain damage, coma
and death within a week of untreated
Smallpox
 A serious, contagious and sometimes fatal
viral disease. Patient experience fever,
malaise, headache, prostration, severe
backache, characteristic skin rash,
occasional abdominal pain and vomiting.
Plague
 A zoonosis and is usually transmitted to
human by flea bites.
Water supplies and Sewage disposal
 Water is the most essential resource necessary
for the survival of humanity.

 Two general types of water pollution

Chemical Pollution – when industrial installations
dump waste products into local waters without
proper pretreatment, when pesticides are used
indiscriminately and when chemicals are expelled
in the air and carried to earth by air (acid rain)
Biological Pollution - waste products of humans
fecal material and garbage that swarm with
pathogens.
Sources of Water Contamination
 Rainwater falling over large areas collects
in lakes and rivers and thus is subject to
contamination by soil microbes and raw
fecal material.
Water treatment
 Water must be properly treated to make it safe for
human consumption.

 Steps involved are:

 The water first is filtered to remove large pieces of

debris such as twigs and leaves. Next the water
remains in a holding tank, where additional debris
settles to the bottom of the tank; this phase of the
process is known as SEDIMENTATION or
SETTLING.
 Alum(Aluminum potassium sulfate) is then added to
coagulate smaller pieces of debris, which then settle
to the bottom; this phase is known as
COAGULATION or FLOCCULATION
Water treatment
 The water is then filtered through sand or
diatomaceous earth filters to remove the
remaining bacteria , protozoan crysts and oocysts
and other small particles

 In some facilities, charcoal filter or

membrane systems are also used. The
membrane filtration will remove tiny giardia
lamblia cysts and c parvum oocysts.

 Last, chlorine gas or sodium hypochorite is

added to a final concentration of 2.0 to 1.0 ppm;
this kills most remaining bacteria.
Water treatment
 Some water treatment facilities, OZONE
(O3) treatment or ulotra violet light
may be used in place of chlorination
Sewage Treatment
 Raw sewage consists mainly of water,
fecal material and garbage and bacteria
from the drains of houses and other
building.

 If sewage is adequately treated in a

disposal plant, the water it contains can
be returned to lakes and rivers to be
recycled
Primary Sewage Treatment
 In the sewage disposal plant, Large debris is
first filtered out called SCREENING
skimmers remove floating grease and oil and
floating debris is shredded or ground
 Solid material settles out in a primary
sedimentation tank
 FLOCCULATING substance can be added
to cause other solids to settle out.
 The material that accumulates at the bottom
of the tank is called PRIMARY SLUDGE
Secondary Sewage Treatment
 Liquid called PRIMARY EFFLUENT then
undergoes secondary treatment, which
includes aeration.
 AERATION is to encourage the growth of
aerobic microbes, which oxidize the
dissolved organic matter to CO2 and H2O.
 TRICKLING FILTRATION accomplish he
same thing but in a different manner
 After either, the activated sludge is
transferred to a settling tank, where any
remaining solid material settles out.
Secondary Sewage Treatment
 Remaining liquid called SECONDARY
EFFLUENT is filtered and disinfected
usually by CHOLARINATION, so that
effluent water can be returned to rivers
or oceans
Tertiary Sewage Treatment
 Some desert cities, where water is in short
supply, the effluent water from the sewage
disposal plant is further treated.
 So that it can be returned directly to drink
water system; very expensive process
 Treatment involves the addition of chemicals,
filtration (FINE SAND OR CHARCOAL),
chlorination and sometimes distillation.