IMPORTANCE OF EPIDEMIOLOGY

EPIDEMIOLOGY (CHS 234)

PUBLIC HEALTH AND EPIDEMIOLOGY:

 Public health:
“All organized measures (whether public or private) to prevent disease,
promote health, and prolong life among the population as a whole".
CONTENT OF PUBLIC HEALTH PRACTICE:

 Concern on disease prevention.

 Community protection through monitoring and
surveillance for infectious & toxic agents.
 Response to outbreaks and unanticipated
natural and human-generated disasters.
 Health promotion through programs to notify
and educate the community about risks and
protective measures.
 Target populations with hard-to-reach clinical
services.
 WHY IS EPIDEMIOLOGY THE BASIC SCIENCE OF PUBLIC
HEALTH?

 It could be clear if we compare the approaches between epidemiologists

and public health workers:
 Epidemiologists Public health workers
1. Determine the extent of disease in the community. 1. Defining a health problem.
2. Study the natural history of the disease. 2. Identifying risk factors associated with the problem.
3. Identify associations and potential causes 3. Developing and testing community-level interventions
(etiologies) and risk factors for the disease. and policies to control or prevent the potential causes
of the problem.
4. Evaluate new preventive and therapeutic measures.
4. Implementing the interventions to improve the health
5. Provide a foundation for developing public policies of the population.
and regulations related to health problems.
5. Monitor those interventions to assess their
effectiveness.
 The primary goal of
epidemiology is to Measure the A basis for interventions and
relationships between Which is policies to protect public health
"exposures" and health
"outcomes"
CORE EPIDEMIOLOGIC FUNCTIONS

 Six major tasks of epidemiology in public health practice were identified:

1. Public health surveillance

2. Field investigation
3. Analytic studies
4. Evaluation
5. Linkages
6. Policy development
1. PUBLIC HEALTH SURVEILLANCE

 Public health surveillance (simply means monitoring change over time) is "the ongoing, systematic
collection, analysis, interpretation, and dissemination of health data to help guide public health
decision making and action".
 Its definition incorporate these elements:
 Ongoing data collection.
 Converting these data into statistics.
 Interpreting these statistics to produce information.
 Dissemination of this information to those who can take appropriate action.
Population-health assessment include:

A. Assess the health levels of the community.

B. Determine whether health services are available, accessible,
effective, and efficient.
To do this, they must find answers too many questions:

1. What are the actual and potential health problems in the

community
2. Where are they? Who is at risk?
3. Which problems are declining over time?
4. Which ones are increasing or have the potential to increase?
2. FIELD INVESTIGATION

As noted above, surveillance provides information for action. One of the first
actions that results from a surveillance case report is investigation by the
public health department.
 The investigation may be as limited as a phone call to the health-care
provider to confirm or clarify the circumstances of the reported case, or it
may involve a field investigation requiring the coordinated efforts of
dozens of people to characterize the extent of an epidemic and to identify
its cause.
The objectives of such investigations also vary:
a. Identification of additional unreported or unrecognized ill
persons who might otherwise continue to spread infection to
others.
b. Identify a source or vehicle of infection that can be controlled or
eliminated.
c. Learn more about the natural history, clinical spectrum,
descriptive epidemiology, and risk factors of the disease before
determining what disease intervention methods might be
appropriate. For example, early investigations of the epidemic of
SARS in 2003 were needed to establish a case definition based
on the clinical presentation, and to characterize the populations at
risk by time, place, and person.
3. ANALYTIC STUDIES

 Both surveillance and field investigations provide clues or hypotheses about causes
and modes of transmission, but analytic studies evaluate the credibility of those
hypotheses.
 The hallmark of an analytic epidemiologic study is the use of a valid comparison
group.
 Epidemiologists must be skilled in all aspects of such studies, including design,
conduct, analysis, interpretation, and communication of findings.
4. EVALUATION

 Evaluation is the process of determining, as systematically and objectively as

possible, the relevance, effectiveness, efficiency, and impact of activities with respect
to established goals.
 Effectiveness refers to the ability of a program to produce the intended or expected
results in the field.
 Efficiency refers to the ability of the program to produce the intended results with a
minimum expenditure of time and resources (under ideal conditions).
5. LINKAGES

 Epidemiologists working in public health settings rarely act in isolation. In fact, field
epidemiology is often said to be a “team sport.”
 During an investigation, an epidemiologist usually participates as either a member or the
leader of a multidisciplinary team.
 Other team members may be laboratorians, sanitarians, infection control personnel, nurses
or other clinical staff, and, increasingly, computer information specialists.
 Many outbreaks cross the geographical and jurisdictional lines, so co-investigators may be
from local or state levels of government, academic institutions, clinical facilities, or the
private sector.
6. POLICY DEVELOPMENT

 Epidemiologists who understand a problem and the population in which it

occurs are often in a uniquely qualified position to recommend
appropriate interventions. As a result, epidemiologists working in public
health regularly provide input, and recommendations regarding disease
control strategies, regulations and health-care policy.
RELATIONSHIP BETWEEN EPIDEMIOLOGY AND
CLINICAL PRACTICE
A) EPIDEMIOLOGIST DEPENDS ON CLINICAL PRACTICE

 When studying a disease outbreak, epidemiologists depend on clinical

physicians and laboratory scientists for the proper diagnosis of individual
patients.
B) CLINICAL PRACTITIONERS USES POPULATION DATA

 Data provided from epidemiology helps physicians to:

1. Identify patients' diagnoses. Completing the clinical picture and understanding
natural history of disease are defined and determined from large groups of patients.
2. Predict patients' disease prognoses. That is based on experience of large groups of
patients with the same disease, stage of disease and treatments.
3. Select of therapy. That is based on results of large treatment studies; such as clinical
trials.
FOR EXAMPLE,

 in New Mexico few patients were diagnosed as having myalgia's (severe

muscle pains in chest or abdomen) and unexplained eosinophilia (an increase
in the number of one type of white blood cell). Their physician could not
identify the cause of their symptoms, or put a name to the disorder.
 Epidemiologists began looking for other cases with similar symptoms, and
within weeks had found enough additional cases of eosinophilia-myalgia
syndrome to describe the illness, its complications, and its rate of mortality
EPIDEMIOLOGY AND INDIVIDUAL HEALTH-DECISIONS

 People may not realize that they use epidemiologic information in their
daily decisions. When they decide to stop smoking, take the stairs instead
of the elevator, order a salad instead of a cheeseburger with French fries,
or choose one method of contraception instead of another, they may be
influenced, consciously or unconsciously, by epidemiologist's assessment
of risk.
PRACTICAL AND ETHICAL ISSUES

 Measures of outcome and exposure occurrence are often not easy to

obtain.
 Many diseases occur infrequently in human population.
 Unlike experimental sciences, investigator cannot manipulate study
variables (i.e. those hypothesized to be causes of diseases).
ETHICAL PRINCIPLES THAT ARISE IN EPIDEMIOLOGIC PRACTICE

1. Informed consent.
2. Confidentiality.
3. Respect for human rights.
4. Scientific integrity.
EXAMPLES OF UNETHICAL RESEARCHES:

 In 1936 – US public health service started study of effects of untreated syphilis on

Tuskegee, Alabama long after effective treatment for the disease was known.
 In 1963 – in Jewish chronic disease hospital, 22 elderly patients injected with cancer
cells without their knowledge to test immunological responses.
 Willowbrook State Hospital, NY: retarded children were deliberately infected with
viral hepatitis to study natural history.
 In 1947 – criminal and unscientific behavior of physicians in concentration camps in
Nazi Germany led to adoption of Nuremberg Code against such behaviors.
ROOTS OF MODERN EPIDEMIOLOGY

1. Acute disease investigation

2. Medicine
3. Statistics
4. Social sciences
5. Computer sciences
6. Managerial sciences
7. Genomics
THE ROLE OF THE EPIDEMIOLOGIST IN THE FUTURE:

 Epidemiologists will continue to respond to emergent events, newly emerging

infections or natural disasters.
 Study public health problems, such as unintentional injuries, environmental
exposures, cardiovascular disease, obesity, tobacco use, and violence domestically
and internationally.
 Public and private partners on the public health team will expand to include new
disciplines.
 The analytic tools and technologies available will increase.
 Maintain a critical role in capacity building.
INFECTIOUS DISEASE EPIDEMIOLOGY
INFECTION

Infection is “the entry and multiplication of an infectious agent (pathogen)

into the tissue of the host”.
INFECTIOUS DISEASES

“Diseases that can be transmitted from one person to another and is caused
by an infectious agent that is transmitted from a source or reservoir to a
susceptible host”
CHAIN OF INFECTION
1. Infectious agent:
 Microorganisms include bacteria, viruses, fungi and protozoa.
 The ability of the microorganisms to cause disease depends on the
following factors:-
1) Number of organisms.
2) Ability to enter and survive in the host.
3) Ability to produce diseases.
4) Susceptibility of the host.
2. Reservoir:

The reservoir of an agent is "the habitat in which an infectious agent

can survive but may or may not multiplies". Reservoirs include
humans, animals, and the environment.

3. Portal of exit:

Portal of exit is the path by which an agent leaves the source host.
The portal of exit usually corresponds to the site at which the agent is
localized.
4. Modes of transmission:

Modes of transmission are classified as:

1. Direct:
a. Direct contact.
b. Droplet spread.

2. Indirect:
c. Airborne (Dust, Droplet nuclei)
d. Vector-borne (Mechanical,Biologic)
e. Vehicle-borne
1. Direct Modes:
a. Direct contact occurs through kissing, skin-to-skin contact, and sexual
intercourse. It refers also to contact with soil or vegetation harboring
infectious organisms.
b. Droplet spread refers to spray with relatively large, short-range aerosols
produced by sneezing, coughing, or even talking. Droplet spread is
classified as direct because transmission is by direct spray over a few feet,
before the droplets fall to the ground.
2. Indirect Modes:
In indirect transmission, an agent is carried from a reservoir to a susceptible host:
A. Airborne transmission is by particles that are suspended in air. There are two types of
these particles: dust and droplet nuclei.
 Airborne dust includes infectious particles blown from the soil by the wind as well as
material that has settled on surfaces and become re-suspended by air currents.
 Droplet nuclei are the residue of dried droplets. The nuclei are less than 5 μ (microns) in
size and may remain suspended in the air for long periods, may be blown over great
distances, and are easily inhaled into the lungs and exhaled.
B. Vectors:
most vectors are arthropods such as mosquitoes, fleas, and ticks or
may be animals such as cows and dogs.
 In mechanical transmission, the agent does not multiply or
undergo physiologic changes in the vector.
 In biologic transmission: an agent undergoes part of its life cycle
inside a vector before being transmitted to a new host.
C. Vehicles that may indirectly transmit an agent include food, water,
biologic products (blood), and fomites (inanimate objects such as
handkerchiefs, bedding, or surgical scalpels).
 As with vectors, vehicles may passively carry an agent—as food or
water may carry hepatitis A virus or may provide an environment in
which the agent grows, multiplies, or produces toxin.
5. Portal of entry
o An agent enters a susceptible host through a portal of entry.
o The portal of entry must provide access to tissues in which the agent
can multiply or a toxin can act. Often, organisms use the same portal
to enter a new host that they use to exit the source host.
Such as:-
- Skin and mucous membrane.
- Respiratory tract such as nose.
- Genitourinary tract such as urine, vaginal secretion.
- Gastrointestinal tract as mouth.
- Blood and placenta.
6. Susceptible Host
• The final link in the chain of infection is a susceptible host.
• Susceptibility of a host depends on genetic factors, specified
acquired immunity, and other general factors, which alter an
individual’s ability to resist infection or to limit pathogenicity.
SPECIFIC INFECTION CONTROL MEASURES

 Choice of appropriate prevention and control measures depends on the knowledge of:
1. Causation and dynamics of disease transmission.
2. Identification of risk factors.
3. Detection of high-risk groups.
4. Availability of tools of intervention.
 Measures directed against the reservoir (cases):

1. Case finding (early diagnosis).

2. Reporting.
3. Isolation.
4. Treatment.
5. Disinfection of contaminated objects.
 Measures applied to carriers:
1. Detection of carriers.
2. Exclusion from work in certain occupations for example:
• Food handler (Typhoid carrier).
• Teacher (Diphtheria carrier).
1. Treatment for the carrier state.
 Measures applied to animal reservoir:
1. Destruction of infected animals (rabies, plague).
2. Inspection or slaughtering (in bovine tuberculosis).
3. Testing and immunization (in brucellosis).
4. Careful husbandry and sterilization of animal products (anthrax).
 Measures that interrupt the transmission of organisms:

1. Purification of water.
2. Pasteurization of milk.
3. Inspection of food handlers and public food places.
4. Improvement in housing condition.
5. Education people in proper personal hygiene and hand washing.
THANK YOU!