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Internal Medicine II

Module 6

Descriptive vs Analytical Epidemiology

OBJECTIVES

Understand the basic concepts of epidemiology as applied in


infectious diseases

Know the principles of clinical practice in infectious diseases

Understand the basic concepts of anti-infective agents


Epidemiology

Epidemiology

Study of the distribution and determinants of health and disease


related states in populations, and the application of this study to
control health problems (Last, 1999)

Is a Greek word that means to put people to sleep with charts


and graphs
-

Dr. Mark Johnson

In testimony before the


House Judiciary Committee
On the spread of HIV

Case Definition

A case is defined as a person in the population or study group


identified as having the particular disease, health disorder or
condition under investigation

Clinical criteria and restrictions on persons, place and time

Probable

Crude Death Rate, USA: 1906-996

It is now time to close the book on infectious diseases and declare war
against the pestilence won.
-

Study the risk associated with exposures

Identify, monitor and control epidemics

Confirmed

W.H. Stewart, 1967

The Purpose of Epidemiology

A case that meets the clinical description and that is


epidemiologically linked to a confirmed case
A case that meets the clinical description and at least
one of the criteria for laboratory confirmation as
described above

Descriptive Epidemiology

Basic: Count of cases

Useful for looking at the burden of disease

Classification of Epidemiologic Studies

Descriptive

Analytical

Designed
to
examine
associations,
hypothesized casual relationships

particularly

Solution: Prevalence

The number of affected persons present in the population divided


by the number of people in the population

Observational

Designed to describe only the existing distribution of


case characteristics, without regard to casual or other
hypotheses

Conducted in natural setting where changes in one


characteristic are studied in relation to others without the
intervention of the investigator

Experimental

Condition is under the direct control of the investigator

INTRODUCTION TO INFECTIOUS DISEASE

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Prevalence

Analytic Epidemiology

Useful for assessing the burden of disease within a population

Valuable for planning

Not useful for determining what causes disease

Incidence

The number of new cases of a disease that occur during a


specified period of time divided by the number of persons at risk
of developing the disease during that period of time

Disease is the result of forces within a


dynamic system consisting of:

Agent of infection

Host

Environment

Factors Influencing Disease

Incidence Example

A study is examining related to development of. TB in a


community. During the study period 77,789 adults aged 25-65
were followed, and 110 developed TB.

The one year incidence of TB in adults aged 25-65 is 0.14%

Can be expressed as 14 cases per 10,000 persons aged


25-66

Prevalence and Incidence

Incidence

High incidence represents diseases with high occurrence; low


incidence represents diseases with low occurrence

Can be used to help determine the causes of disease

Can be used to determine the likelihood of developing disease

Prevalence and Incidence


Transmission of Infectious Agents

Any mechanism by which an infectious agents is spread through


the environment or to another person

Two type - direct and indirect

The Chain of Infection


Descriptive vs Analytic Epidemiology

INTRODUCTION TO INFECTIOUS DISEASE

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Routes of Transmission

Laboratory

Direct modes of transmission


1.

Contact - touching, sexual intercourse

2.

Droplet spread to mucous membranes - travel 1-2 m

3.

Animal bite or contact with soil or decaying matter, e.g.


rabies, systemic mycosis

4.

Transplacental transmission

Dynamics of Spread

"Common Vehicle" spread

Ingestion of water or food

Inhalation in air breathed

Laboratory investigation should start as early as possible

Before doing anything explain the procedure to patient and


relatives

When collecting specimens, avoid contamination

Take sufficient quantity of material

Follow safety procedures

Blood

CSF

Upper respiratory infections

e.g. Legionnaires' disease


e.g. Hepatitis B, HIV

Propagation by serial transfer from host to host

Directed toward establishing an etiologic diagnosis in the


shortest possible time, cost-effective, and least possible
discomfort to the patients

Inoculation (intravenous, subcutaneous)

e.g. Salmonellosis

Respiratory route

Ear specimens

Urine
Genital secretions

Anal-oral route

e.g. Shigellosis

Genital route

e.g. Syphilis

Sputum

Semen

Vaginal secretions

Soft tissues
Gastrointestinal secretions

Self-limiting (respiratory infections) to life-threatening


(sepsis)

Asymptomatic (HIV) to frank symptoms (AIDS)

Biopsy

Short-lived (Hepatitis A) to chronic infections (Hepatitis


B)

Bone

Select the anatomic site

Avoid contamination from the indigenous flora

Collection with a swab is least desirable

Collect a sufficient volume of material to enable all requested


tests to be performed satisfactorily

Methods of detection (Reading assignment)

History

Nasal specimens

Lower respiratory infections

e.g. Measles

Infectious diseases broad spectrum

Throat swabs

CLINICAL PRINCIPLES OF INFECTIOUS DISEASE

Details of the present complaint

Fever pattern, abdominal pain pattern, etc

Feces

Occupation

Present geographical location and history oftravel

Microscopy

Medication

Culture

Risk factors for exposure

Nucleic acid detection

Sexual history

Antigen detection

Contact with animals

Detection of antibodies directed against the organism

Food intake pattern

Blood transfusion

Review of organ systems

PE

INTRODUCTION TO INFECTIOUS DISEASE

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TREATING INFECTIOUS DISEASE


Principles of Anti-infective Therapy

Choice of the proper antimicrobial agent

Identity of the organism

Susceptibility of the infecting organism must be accurate

Host factors that would influence the efficacy and toxicity of


antimicrobial agents

History of previous adverse reactions to antimicrobial


agents

Age

Acidity

Renal function diminishes with age

Quinolones and doxycyclines are not gives to


children

Genetic or metabolic abnormalities

G6PD deficiency and drugs can produce fatal hemolysis

HLAB27 is a blockbox warning for Abacavir

Renal and hepatic function

Site of infection

Adequacy of the concentration of the drug

BBB limits drug penetration

Aminoglycosides are inactivated by purulent material

Presence of foreign bodies

~END~

That in all things, God may be glorified

INTRODUCTION TO INFECTIOUS DISEASE

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