DEFINITION

OF EPIDEMIOLOGY
- Fundamental Science of Public Health
- The study of distribution of a disease or physiologic
condition in human populations and of the factors that
influence this distribution.
- Goal:
o Promotion of Health
o Prevention of Disease
o Control of Disease
- Components:
o Population
o Distribution
o Factors
- The study of the distribution and determinants of
health-related states or events in specific populations,
and the application of this study to control of health
problems.

ELEMENTS OF IDEAL EPIDEMIOLOGIC HYPOTHESIS
POPULATION
- to whom hypothesis will apply
CAUSE
- the particular environmental exposure
- suspected risk factor
OUTCOME
- the disease or condition of interest
DOSE-RESPONSE RELATIONSHIP
- the amount of exposure necessary for the disease or
condition to develop
TIME-RESPONSE RELATIONSHIP
- the time period between the exposure and the
development of the outcome
- synonymous with:
o Incubation Period for infectious disease
o Latency Period for non-infectious disease

METHODS OF FORMULATING HYPOTHESIS
- METHOD OF DIFFERENCE
- a DISADVANTAGE of this type of method in
formulating hypothesis is the potentially large
number of hypothesis which are consistent with or
are suggested by the observed difference.

- METHOD OF AGREEMENT
- COMMON FACTOR at a different circumstances
that have been found to be associated with the
presence of the disease may be a CAUSE of the
Disease. (HIV as an example on the book)

- METHOD OF CONCOMITANT VARIATION
- involves identifying a factor whose frequency of
strength varies with frequency of disease.

- METHOD OF ANALOGY:
- suggest that certain causes may be common to
both disease/condition. (ex. Burkitts lymphoma)

STUDY DESIGN
a. DESCRIPTIVE STUDIES
- characterize disease occurrence in a population and
is often the first step in epidemiological investigation.

b. OBSERVATIONAL STUDIES
- simply observes the natural course of events.
*COHORT STUDIES
- the members of the population at risk are
classified in terms of whether they had been
EXPOSED or UNEXPOSED to the factor of
interest and FOLLOWED UP to determine who
will develop the disease/condition being
investigated
*CASE-CONTROL STUDIES
- identify the group of subjects who already
HAVE the disease/condition and a comparison
group who DO NOT HAVE the disease/
condition.

c. EXPERIMENTAL STUDIES
- with various types of intervention trials.

HEALTH
- the state of complete physical, mental, and social well-
being and not merely the absence of disease and infirmity.

WELLNESS
- the quality that the individual enjoys as a positive good,
but only in relation to the broader realities of which he is a
part.

NORMAL HEALTH
- state of well being in which the individual is free from
disabling effects and has sufficient vigor to carry on the
usual requirement of life, with social adaptation that
produces self-gratification and enjoyment.

HOLISTIC HEALTH
- views all persons as whole beings whose individual Psycho-
Physio-Cultural-Spiritual Relationships with the
environment directly affect their state of health.

PRE-PATHOGENESIS
- Phase before man is involved
- the preliminary interaction of potential agent, host, and
enviroment BEFORE disease production.

PATHOGENESIS
- agent become established in the host.

CLINICAL HORIZON
- Stage when diagnosis can be made

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PERIOD OF INCUBATION
- the agent either multiplies, develops, or gets absorbed or
fixed in the tissues.

SURVIVAL TIME
- time from signs and symptoms to final outcome

CONTRIBUTING FACTORS:
I. AGENTS
TYPES OF AGENTS:
A. PHYSICAL AGENTS
- related to material and mechanical properties of
matter.
- Ex. Light, sound, heat, cold, radiation
B. CHEMICAL AGENTS
- this include exogenous substances such as carbon
monoxide from engine combustion, leads, acids,
insecticides.
- also endogenous substances such as cholesterol,
hormones, and others like them.
C. BIOLOGIC AGENTS
- includes parasites like helminthes, protozoans,
fungi, bacteria and viruses.

CHARACTERISTICS OF AGENTS:
- INFECTIVITY
- ability of the agent to gain access and adapt to
the human host to the extent of finding lodgment
and multiplying within the host.
- VIRULENCE
- a measure of the severity of the reaction
- PATHOGENECITY
- is the measure of the ability of an agent when
lodged in the body to set up a specific reaction.

- refers to the Antibodies CONFERRED to the host

through the use of GAMMA GLOBULINS (Tetanus
and Rabies)
III. ENVIRONMENT
- aggregate of all external conditions and influences
affecting the life and development of an organism.
A. PHYSICAL ENVIRONMENT
- this includes the climate, weather, and geography
of the place.
B. SOCIO-ECONOMIC ENVIRONMENT
- this includes the Income of the family, Crowding in
the houses, housing facilities, availability of health
facilities and others.
C. BIOLOGICAL ENVIRONMENT
- this includes the vectors and animals that affect
man (Ex. Mosquitos-Malaria; Snails-Schistosomiasis)

HERD IMMUNITY
- resistance of group or community

LEVELS OF PREVENTION
a. PRIMARY
-HEALTH PROMOTION and SPECIFID PREOTECTION
Examples:
- 4oclock Habit
- Healthy Lifestyle

b. SECONDARY
- EARLY DIAGNOSIS AND PROMPT TREATMENT
Examples:
- Routine BP
- Blood Glucose
- Peak Flow Meter
c. TERTIARY
- TREATMENT and REHABILITATION
- LIMITATION of DISABILITY
Examples:
- OT
- Maintenance Drugs
- Desensitization

II. HOST
- refers to man or group of men and is affected by the
following:
1. NATURAL ACQUIRED IMMUNITY

a. NATURAL ACQUIRED ACTIVE IMMUNITY

- results from previous infection where the host has
produced the antibody himself.

b. NATURAL ACQUIRED PASSIVE IMMUNITY

- ex. Newborn who acquired antibody from the
mothers who have previous exposures to measles
chiefly by TRANSPLACENTAL PASSAGE of maternal
antibodies into the Fetal Circulation.

2. ARTIFICIAL ACQUIRED IMMUNITY

a. ARTIFICIAL ACQUIRED ACTIVE IMMUNITY

- refers to antibodies produced by host AFTER he has
received VACCINES or TOXOIDS.

b. ARTIFICIAL ACQUIRED PASSIVE IMMUNITY

DISEASE or CONDITION DIRECTLY LEADING TO DEATH:

a. Immediate Cause - Post-Op Pneumonia
b. Antecedent Cause - Mastectomy
c. Underlying Cause - Cancer (Breast)
d. Other Significant Condition - Pulmonary Tuberculosis

QUALITIES OF STATISTICAL DATA

a. TIMELINESS
- interval between the data of occurrence of the
different events considered and the time the data is
ready to be used or disseminated
b. COMPLETENESS
- has 2 components: Completeness of coverage and
Completeness in accomplishing all the items in every
form.

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c. ACCURACY
- refers to how the measurement or the data is to its
true value.

II. STATISTICAL ASPECTS

a. Association and Causation
b. Defining Variables in an Association
1. INDEPENDENT and DEPENDENT
VARIABLES
2. CONFOUNDING VARIABLES
- an independent variable that is a risk
factor of the disease and is associated
with but not a consequence of the
exposure
3. INTERMEDIATE / INTERVENING
VARIABLES
- when the effect of the exposure variable
on the disease or study condition is
mediated through a third variable, the
latter is called an INTERMEDIATE.
*Commonly used measures of Association
RATION MEASURES OF ASSOCIATION
a. Rate Ratio
b. Risk Ratio
c. Odds Ratio
DIFFERENT MEASURES OF ASSOCIATION
a. Rate Difference
b. Risk Difference
c. Attribute Fraction

d. PRECISION
- refers to the extent to which similar information is
obtained when a measurement is performed or an
observation is made more than once.

e. RELEVANCE
- refers to the consistency of the data produced with
the needs of the data users.

f. ADEQUACY
- collected data provide all the basic information
needed to meet the requirements of the user.

CAUSE
- something that bring about an effect or a result

CAUSAL ASSOCIATION
- an association between categories of events or
characteristics in which an alternation in the frequency or
quality of one category is followed by a change in the other.

STATISTICAL ASSOCIATION
- simply an association in the scientific sense.

NON-CAUSAL or SECONDARY STATISTICAL ASSOCIATIONS

- Usually results from association of both categories of
events with a Third Category.

CONCEPTS IN DISEASE CAUSATION
I. BIOLOGIC ASPECTS

a. EPIDEMIOLOGIC TRIANGLE
- consists of 3 components
- HOST
- ENVIRONMENT
- AGENT
- considers the AGENT as a SEPARATE
COMPONENT.

b. WEB OF CAUSATION
- effects never depend on a single isolated
cause, but rather develop as the result of
chains of causation in which each link itself is
the result of a complex genealogy and
antecedents.

c. WHEEL
- consists of a hub (the host or man) which
has the genetic make-up as its core.
- surrounding man is the environment,
schematically divided into 3 sectors:
- Biological
- Social
- Physical

III.

EVIDENCE OF CAUSALITY
a. Experimental Evidence not always possible
b. Non-Experimental

NECESSARY CAUSE
- a cause that must be present for the disease to occur
- it must always precede an effect.

SUFFICIENT CAUSE
- a cause that inevitably brings a certain consequence.

RISK FACTOR
- an attribute or exposure that increases the probability of
occurrence of the disease or other specific outcome.

RISK INDICATOR / RISK MARKER

- an attribute that is associated with an increased
probability of occurrence of a disease or other specific
outcome and that can be used as an indicator of these
increased risk. (Not necessarily a causal factor)

PATHOGENIC MECHANISM
1. DIRECT INVASION
- many parasitic diseases such as:
o Amoebiasis
o Giardasis

2. PRODUCTION OF TOXIN
- Ex. Tetanus, Diphteria, and infection by
Enterotoxigenic Escherichia coli.

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3. IMMUNOLOGIC ENHANCEMENT OR ALLERGIC

REACTION LEADING TO THE DAMAGE TO THE HOST
- Ex. Tuberculosis, post-streptococcal
glumerulonephritis, dengue hemorrhagic fever

4. PERSISTENT OR LATENT INFECTION

- Ex. Reyes Syndrome, Varicella, Influenza B virus

5. ENHANCEMENT OF HOSTS SUSCEPTIBILITY TO DRUGS

OF OTHERWISE MINIMAL TOXICITY

6. IMMUNE SUPPRESSION

COLONIZATION
- agent propagate at a rate sufficient to maintain its
numbers without producing identifiable evidence of any
reaction in the host.

INAPPARENT INFECTION
- also known as Sub-clinical Infection
- the organisms not only multiply in the host, but also cause
a measurable reaction that is not clinically detectable.

INFECTIOUS DISEASE
- infection leads to clinical disease with symptoms, physical
findings , or both.

TYPES OF CARRIER
Type of Carrier

Example

Inapparent Throughout
Incubatory Carrier
Convalescent Carrier

Polio virus, Meningococcus,

Hepatitis Virus
Viruses of chickenpos, measles,
and hepatitis
C. Diptheria, Hepatitis B Virus,
and Salmonella Species
S. Typhosa, Hepatitis B Virus

Chronic Carrier

SECONDARY ATTACK RATE
- measures the spread of disease within a group
- defined as the number of cases of a disease developing
during a stated time period among those members of a
closed group who are at risk.

EPIDEMIOLOGY OF NON-COMMUNICABLE DISEASES
I. ENVIRONMENTAL EPIDEMEOLOGY
- the study of environmental factors that influence the
distribution and determinants of disease in human
populations

II. OCCUPATIONAL EPIDEMIOLOGY

- the study of the workplace exposures on the frequency
and distribution of diseases and injuries in the
population.

ENVIRONMENTAL FACTORS THAT MAY AFFECT HEALTH:

1. Physiological Factors
- Stress, Shift Work, Human relationship

2. Biological Factors
- Bacteria, Viruses, Parasites
3. Accident Factors
- Hazards, situation speed influence of alcohol, drugs
4. Physical Factors
- Noise, Climate, Workload, Lighting radiation,
Economics
5. Chemical Factors
- Chemicals, Dust, Drugs, Tobacco, Skin irritants, Food
Additive

INFECTIOUS vs. NON-INFECTIOUS DISEASES

INFECTIOUS DISEASE
Single necessary agent
Specific agent-disease
relationship

NON-INFECTIOUS DISEASES
No single necessary agent
One-to-one correspondence
between agent and disease very
rare
Causes unknown, intervention
usually based on risk factors
Long Latency Period
May require multiple exposure to
same or multiple agents
Most often produce chronic
disease
Acquired immunity unlikely
Diagnosis often dependent on
non-specific symptoms or tests.

Causes are relatively well

understood
Short Incubation Period
Single Exposure usually sufficient
Usually produce acute disease
Acquired Immunity possible
Diagnosis based on tests specific
to disease agent

COMMON SOURCE EPIDEMICS
- these are outbreaks caused by exposure of a group of
persons to a common noxious influence.

PROPAGATED or PROGRESSIVE EPIDEMICS

- result from transmission, either direct or indirect, of an
infectious agent from one susceptible host to another.

VECTOR-BORNE EPIDEMIC
- result of vector-borne disease.
- usually has a small geographic area as a common source
but may have a zoonotic, human or mixed cycle as the
source of the pathogen to the vector.

INVESTIGATION OF EPIDEMICS
(Refer to Page 70 of FCM handouts)
*Define a case: verify the diagnosis
*Data analysis: report the investigation

*etong dalawa lng tinanong eh..

ENDEMIC
-the constant presence of a disease or infectious agent
within a given geographic area.
EPIDEMIC
- the occurrence in a community or region of cases off an
illness (or an outbreak) with a frequency clearly in excess of
normal expectancy
STERILIZATION
- the elimination of microbiological organisms to achieve
asepsis, a sterile microbial environment

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FUMIGATION
- a technology that provides a specific dose of ionizing
radiation from a source such as radioisotope.

INCIDENCE RATE
- the number of new cases of a specified disease diagnosed
or reported during defined period of time, divided by the
number of persons in a stated population the in which the
cases occurred.

ATTACK RATE
- the cumulative incidence of infection in a group of people
observed over a period of time during an epidemic.

INFESTATION
- for persons or animals, the lodgment, development and
reproduction of arthropods on the surface of the body or in
the clothing.

STRICT ISOLATION
- this category is designed to prevent transmission of highly
contagious or virulent infections that may be spread by both
air and contact.
- Private Room + Masks + Gowns + Gloves

AFB ISOLATION
- aka Tuberculosis Isolation
- for patients with pulmonary TB who have a positive
sputum smear or a chest x-ray that strongly suggests active
TB.
- Private Room + Special Ventilation + Closed Door +
Respiratory-type Mask

ABSOLUTE or COMPLETE QUARANTINE

- the limitation of freedom of movement of those exposed
to a communicable disease for a period of time not longer
than the longest usual incubation period of that disease.

METHOD QUARANTINE
- a selective or partial limitation of freedom of movement
of contacts, commonly on the basis of known or presumed
differences in susceptibility and related to the danger of
disease transmission.

1. Sensitivity
2. Specificity
3. Sensitivity: 90%
4. Specificity: 90%
5. Positive predictive value: 8.3%
6. Negative predictive value: 99.9%
7. Feb-march 2010 epidemic in the phils: dengue?
8. Epidemiologic surveillance?
9. Cases: 3+4+4

*I HAVE NO IDEA.. Decode nyo nlng )

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