Introduction To Basic Epidemiology and Emerging Diseases

Introduction to Basic epidemiology and
Emerging Diseases
part 1
CLS 351
The history of epidemiology
❖ It starts with Hippocrates in 400 BC.
❖ In his book, Of the Epidemics he provided information about

age, gender, place of residence and the seasonal conditions
at the time of onset of the illness.
❖ In another book, On Airs, Waters and Places, concepts in this

book is the association of place, water and food with
physical and emotional health. Hippocrates observed that a
person’s diet and alcohol consumption were directly
associated with disease.
❖ Ibn An-Nafis A commentary on Hippocrates’ "Of the Epidemics"

(Sharh Kitab Al-Epidemia) 1200AD.
❖ Ibn An-Nafis tries to provide biological plausibility for this notion

by giving a potential biological mechanism.
❖ John Graunt the founding father

of modern demography, and vital
statistics (1600AD).
❖ He estimated age and rate of

population growth and patterns
of mortality.
❖ John Snow conducted studies in 1854 when an

epidemic of cholera erupted in the Golden
Square of London determining where in this
area persons with cholera lived and worked.
Useful recourses
• Gordis, L., 2014. Epidemiology.
• Macera, C.A., Shaffer, R. and Shaffer, P.M., 2013. Introduction to

Epidemiology: Distribution and Determinants of Disease.
• Bailey L, Vardulaki K, Langham J, Chandramohan D., 2005.

Introduction to Epidemiology.
• Pearce N., 2005. A Short Introduction to Epidemiology.
• https://www.cdc.gov/training/publichealth101/epidemiology.html
By the end of this lecture you will be able to:
• Define epidemiology.
• Comparing epidemiology & clinical medicine.
• Identify the three components of epidemiology.
• Enumerate uses of epidemiology.
• Types of epidemiological research.
• Concepts of epidemiology.
What is Epidemiology?
Description of…
• A health-related variable
– Continuous: birth weight, blood pressure, total cholesterol…
– Discrete: death, sex, ethnicity, disease (e.g. cancer, flu,
diabetes), genotype….
• In a population of interest
– Newborns in the US, people over 50 years, construction
workers, residents in Iceland.
Two central tasks in epidemiology
• Describing disease variation

– Distribution of disease frequency.
– To quantify the occurrence of disease.
– “Time, person, place”
• Causal inference
– Determinants of disease frequency.
– To estimate the causal effect of an exposure on a disease.
• E.g. does obesity affect the risk of cancer?
Epidemiology: definition
❑ The study of the distribution of disease in human populations

and of the factors that determine that distribution.
❑ Epidemiology is defined as the “study of the frequency, distribution

and determinants of health related phenomena in human
populations and the application of this study to control of health
problems”.
❑ Main objective is to understand the etiology (causes) of

diseases, and hence identify effective preventive measures.
❑ Look for differences and similarities ('compare and contrast') in

disease patterns of populations to gain understanding of the causes
and control of disease.
Epidemiology is based on fundamental assumptions
• Human diseases are not distributed randomly in the

population.
• Distribution indicates something about how and why disease process
occurred.
• They have causal and preventive factors that can be identified through
systematic investigation of different populations or same population
in different places or at different periods of time.
Clinical medicine vs. epidemiology
•Clinical medicine is concerned with cases of disease and the

disease burden for the individual patient.
•Epidemiology is concerned with disease rates and the burden of

disease in populations.
There have been major improvements in health:
- Worldwide life expectancy has increased from 50 to 67 years

since 1960;
- Smallpox has been eradicated;
- Deaths from measles fell by 48%, from 871,000 in 1999 to an
estimated 454,000 in 2004 then further dropped to an estimate
of 128,000 people in 2021.
BUT ...
In absolute numbers, there are even larger disparities in health:
-There are over 6 billion people in the world, one billion of whom can
expect to lead a long and healthy life, but 5 billion are not so
fortunate. For example:
- A child born in Japan has a life expectancy of 82 years, but one born in
Eswatini (Swaziland) will only live an average of 32 years.
AND
Health issues are not confined within national or regional borders:

-The outbreak of SARS in China in 2002 rapidly spread across the globe and
within 8 months involved 8422 probable cases and 916
deaths in 29 countries.
-COVID-19 originated in Wuhan China in Dec, 2019 and spread rapidly causing
a global pandemic declared March 31, 2020, more than 800,000 total
confirmed cases and 40,000 deaths.
Control programmes need to be approached at an international level.
Purposes of Epidemiology
1. Identify causes and/or risk factors for diseases.
2. Determining the extent of a disease in a community.
3. Studying natural history (from start to end) and prognosis (outcomes) of a

disease.
4. Conducting surveillance of a disease and heath related events in populations.
5. Investigating outbreaks (e.g. Food poisoning).

6. Evaluating effectiveness of preventive and therapeutic health programs and
services.
Epidemiology includes:
• Surveillance,
• Observation,
• Hypothesis testing,
• Analytical research, and/or experiments.
Characteristics of Epidemiology
1 – Observational rather than experimental (intervention).
2 – Dealing with populations rather than individuals.
3 – Quantitative rather than qualitative.
4 – Focusing on free living populations rather than a group of highly-selected

individuals present in clinics/ laboratory.
5 – Involving measures and comparison.
6 – Take multidisciplinary approach to understand or solve a problem (statistics,

biology, demography, microbiology, administration, toxicology, environmental
science,. etc).
Introduction to Basic epidemiology and
Emerging Diseases
part 2
CLS 351
Disease patterns
(Place, Person and Time)
Disease patterns..
Patterns of disease refers to occurrence of health-related events by:

Time (when), Place (where), Persons affected (who).
1 – Time ( when):
▪ Distribution of a disease (there is increase or decrease),

▪ Time interval between appearances of first case till the lase one,
▪ Peak times, Changes in disease frequency.
Time distributions may take on of the following forms:

A – Short term fluctuations (epidemic) e.g. : waterborne cholera epidemic, measles.
B – Periodic fluctuations (cyclic) trends e.g. : depend on time of the day/month/year.
C – Long term (secular) trends e.g. :TB, cancer, diabetes.
Predicted and actual caesarean section rate between the years of 1994 and 2010
Disease patterns (time/ occurrence) terms..
✓ Sporadic
A disease that can occur occasionally at irregular levels (irregular intervals) e.g Rabies.
✓ Endemic
Constant presence of disease/ infectious agent in a population within a geographic area (may also
refer to constant presence of a disease within a given population without importation from
outside) e.g Malaria endemic in Kenya.
✓ Hyperendemic
Persistence, high levels of disease occurrence (Dengue fever in Venezuela).
✓ Epidemic
Unexpected increase in the number of disease cases in a specific area (a disease that affects a large
number of people within a community, population, or region) e.g Yellow fever in America.
✓ Outbreak
Carry the same definition as epidemic, but more often related to limited geographical area
(Norovirus in nursing-home).
✓ Pandemic
An epidemic that has spread over several countries/ continents (a worldwide epidemic) e.g
COVID-19.
Disease patterns..
2 – Place (where):
A – International variations (Cancer, Breast cancer).
B – National variations (Malaria).
C – Urban and rural variations (Accidents, zoonotic disease).
D – Local variations (Rheumatic fever).

Disease patterns..
3 – Personal characteristics (who):
A – Demographic (age, gender, race, religion, culture).

B – Biological (blood levels of Abs, enzymes).
C – Socio-economic (class, education, income, marital status).
D – Genetic characteristics.
E – Personal habits (smoking, physical exercise, diet).
Trends in death rates from (A) lung cancer and, (B) cardiovascular diseases in
adults 30 years of age and older in selected countries.
Obesity Trends* Among U.S. Adults BRFSS,
1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults
BRFSS, 1988
No Data <10% 10%–14%

BRFSS, 1991
No Data <10% 10%–14% 15%–19%

BRFSS, 1996
No Data <10% 10%–14% 15%–19%

BRFSS, 1998
No Data <10% 10%–14% 15%–19% ≥20%

BRFSS, 1999
No Data <10% 10%–14% 15%–19% ≥20%

BRFSS, 2001
No Data <10% 10%–14% 15%–19% ≥20% ≥25%

BRFSS, 2004
No Data <10% 10%–14% 15%–19% ≥20% ≥25%

BRFSS, 2006
No Data <10% 10%–14% 15%–19% ≥20% 25%–29% ≥30%

Millions of Cases of Diabetes in 2000 and Projections for 2030,
with Projected Percent Changes
Basic concepts in epidemiological research
• An important aspect of epidemiology is to identify,

describe, quantify factors that increase or decrease the risk
of disease or death.
• If we find out that a particular factor or exposure

i.e. smoking or taking a drug is associated with the risk of a
particular health outcome, we can then asses if the
association is likely to be causal or not and hypothesize a
causal mechanism, i.e. risk of smoking in poorer segments
of the population.
Basic concepts in epidemiological research
1. Exposure
– It is used to describe something that might affect an
outcome.
– It may refer to an environmental hazard or infectious agent
but also used in epidemiology to describe other factors such
as genetic factors (i.e thalassemia), or demographic
characteristics such as social class.
2. Outcome
– Can be disease, death or sometimes recovery.
3. Confounder
– Refers to any factor that is associated with both exposure and
the outcome under study which can lead to bias and wrong
conclusions.
– Example: there is an association between playing football and going bald.
Before concluding that football causes baldness it is important to control for
gender which is associated with exposure (football) and outcome(baldness).
– Common confounders (age, sex, socioeconomic status,
smoking).
4. Bias:
-Bias is a deviation from the truth that can occur in studies.
-Example: a study aims to estimate the prevalence of HIV in a whole population,
and the sample used in people attending sexual health clinics, the result will be
an overestimate of the true population prevalence.
Example
End of Lect-1

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Introduction to Basic epidemiology and

❖ It starts with Hippocrates in 400 BC.

❖ In his book, Of the Epidemics he provided information about

❖ In another book, On Airs, Waters and Places, concepts in this

❖ Ibn An-Nafis A commentary on Hippocrates’ "Of the Epidemics"

❖ Ibn An-Nafis tries to provide biological plausibility for this notion

❖ John Graunt the founding father

❖ He estimated age and rate of

❖ John Snow conducted studies in 1854 when an

• Gordis, L., 2014. Epidemiology.

• Macera, C.A., Shaffer, R. and Shaffer, P.M., 2013. Introduction to

• Bailey L, Vardulaki K, Langham J, Chandramohan D., 2005.

• Pearce N., 2005. A Short Introduction to Epidemiology.

• Describing disease variation

❑ The study of the distribution of disease in human populations

❑ Epidemiology is deﬁned as the “study of the frequency, distribution

❑ Main objective is to understand the etiology (causes) of

❑ Look for diﬀerences and similarities ('compare and contrast') in

• Human diseases are not distributed randomly in the

•Clinical medicine is concerned with cases of disease and the

•Epidemiology is concerned with disease rates and the burden of

- Worldwide life expectancy has increased from 50 to 67 years

Health issues are not conﬁned within national or regional borders:

1. Identify causes and/or risk factors for diseases.

2. Determining the extent of a disease in a community.

3. Studying natural history (from start to end) and prognosis (outcomes) of a

4. Conducting surveillance of a disease and heath related events in populations.

5. Investigating outbreaks (e.g. Food poisoning).

1 – Observational rather than experimental (intervention).

2 – Dealing with populations rather than individuals.

3 – Quantitative rather than qualitative.

4 – Focusing on free living populations rather than a group of highly-selected

6 – Take multidisciplinary approach to understand or solve a problem (statistics,

Patterns of disease refers to occurrence of health-related events by:

▪ Distribution of a disease (there is increase or decrease),

Time distributions may take on of the following forms:

A – International variations (Cancer, Breast cancer).

B – National variations (Malaria).

C – Urban and rural variations (Accidents, zoonotic disease).

D – Local variations (Rheumatic fever).

3 – Personal characteristics (who):

A – Demographic (age, gender, race, religion, culture).

C – Socio-economic (class, education, income, marital status).

No Data <10% 10%–14%

No Data <10% 10%–14%

No Data <10% 10%–14% 15%–19%

No Data <10% 10%–14% 15%–19%

No Data <10% 10%–14% 15%–19% ≥20%

No Data <10% 10%–14% 15%–19% ≥20%

No Data <10% 10%–14% 15%–19% ≥20% ≥25%

No Data <10% 10%–14% 15%–19% ≥20% ≥25%

No Data <10% 10%–14% 15%–19% ≥20% 25%–29% ≥30%

• An important aspect of epidemiology is to identify,

• If we ﬁnd out that a particular factor or exposure

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