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DYNAMICS OF DISEASE TRANSMISSION

THEORIES AND MODELS OF DISEASE CAUSATION

GERM TEORY THEORY OF EPIDEMIOLOGICAL TRIAD MULTI FACTORIAL CAUSATION THEORY WEB OF CAUSATION DEVERS EPIDEMIOLOGICAL MODEL

1. GERM THEORY

It becomes popular during the 19th and early part of 2Qth century. This theory attributes micro-organisms as the only cause of disease.

attributes micro-organisms as the only cause of disease. cause causative agent man effect disease THEORY OF

cause

causative

agent

as the only cause of disease. cause causative agent man effect disease THEORY OF EPIDEMIOLOGICAL TRIAD

man

as the only cause of disease. cause causative agent man effect disease THEORY OF EPIDEMIOLOGICAL TRIAD

effect

only cause of disease. cause causative agent man effect disease THEORY OF EPIDEMIOLOGICAL TRIAD  This

disease

THEORY OF EPIDEMIOLOGICAL TRIAD

This model is also called as ecological model and evolved through the study of infectious disease. Acc.

To this model there are three elements or major factors which are responsible for a particular disease causation. i.e. agent, host & environment.

The agent refers to primary factor, without which a particular disease can not occur.

The host refers to human beings who come in contact with the agent.

The environment includes all, that is external to the host and agent but that may influence interaction between them.

agent host environment
agent
host
environment

MULTI FACTORIAL CAUSATION THEORY

4. WEB OF CAUSATION Given by macmohan and pugh. according to him disease never depends
4. WEB OF CAUSATION Given by macmohan and pugh. according to him disease never depends

4. WEB OF CAUSATION

Given by macmohan and pugh. according to him disease never depends upon single isolated cause rather it develops from a chain of causation in which each link itself is a result of complex interaction of preceding events these chain of causation which may be the fraction of the whole complex is known as web of causation.

fraction of the whole complex is known as web of causation. DEVERS EPIDEMIOLOGICAL MODEL This model

DEVERS EPIDEMIOLOGICAL MODEL

This model is composed of four major categories of factors

human biology

lifestyle

environment and

health system

all these factors influence health status positively or negatively.

Human biological --- epidemiological triad and include genetic inheritance, complex physiological systems, factors related to maturation and ageing

Life style factors include daily living activities, customs, traditions, health habits etc

Environmental factors include physical, biological, social and spiritual components

D Health care system factors include availability, accessibility, adequacy and use of health care services at all levels.

Communicable diseases are transmitted from the reservoir/ source of infection to susceptible host.

DYNAMICS OF DISEASE TRANSMISSION

There are three links in the chain of transmission

1. Reservoir

2. Mode of transmission

3. Susceptible host

SOURCE OF MODE OF SUSCEPTIBLE RESERVOIR TRANSMISSON HOST
SOURCE OF
MODE OF
SUSCEPTIBLE
RESERVOIR
TRANSMISSON
HOST

1. SOURCE & RESERVOIR

SOURCE -The source defined as the "person, animal, object or substance from which an infectious agent passes or disseminated to the host". RESERVOIR -A reservoir is defined as "any person, animal, arthropod, plant, soil or substance in which an infectious agent lives and multiplies , on which it depends primarily for survival, and where it reproduces itself in such manner that it can be transmitted to a susceptible host".

Eg:- In hookworm infection, the reservoir is man and the source of infection is soil contaminated with infective larvae.

In typhoid fever the reservoir is a case or carrier and the source of infection is faeces or urine of patient or contaminated food and water.

Types of reservoir

1. Human reservoir

2. Animal reservoir

3. Reservoir in non living things

1. HUMAN RESERVOIR

The most important source or reservoir of infection for human is man himself.

Human may be

o

o

Case

Carrier

CASES -A case is defined as " a person in the population having the particular disease, health disorder or condition under investigation".

The presence of infection in host may be:-

o

Clinical

o

Sub clinical

o

Latent

1. Clinical illness:-

Clinical illness may be mild or moderate, typical or atypical, severe or fatal.

Mild cases may be more important source of infection than severe cases.

2. Sub clinical cases

Sub clinical cases are also known as in apparent, missed or abortive cases.

The disease agent may multiply in the host but does not manifest itself by signs and symptoms.

Sub clinical infection may be detected only by laboratory tests.

3.Latent infection

Infectious agent lies dormant within the host without symptoms.

1. Primary case:- first case of a communicable disease introduced into the population.

2. Secondary case:- develops from contact with primary cases.

3. Index case:-first case which comes to the attention of investigator

CARRIERS

In some diseases, either due to inadequate treatment or immune response, the disease agent is not completely eliminated, leading to a carrier state.

A carrier is defined as an infected person or animal that harbours a specific infectious agent and serves as a potential source of infection for others.

The elements in a carrier state are

o

The presence of disease agent in the body.

o

The absence of recognizable signs and symptoms

o

Spread of disease agent in the discharges or excretions.

A.

TYPE

o

lncubatory

o

Convalescent

o

Healthy

B.

DURATION

o

Temporary

o

Chronic

C.

PORTAL OF EXIT

o

Urinary

o

Intestinal

o

Respiratory

o

Others

A. TYPE

a. lncubatorv carriers

o

Carriers which spread the infectious agent during the incubation period of disease.

o

This usually occurs during the last few days of incubation period.

o

Eg:- measles, mumps, polio, influenza, hepatitis B

b. Convalescent carriers

o

Carriers which continue to spread disease during the period of convalescence.

o

Eg ;-Typhoid, Dysentery, Cholera, Diptheria

c.

Healthy carriers

o

They are victims of sub clinical infection who have developed carrier state without suffering from overt disease.

o

A person whose infection remains subclinical may or may not be a carrier.

B.DURATION

a. Temporary carriers

o Carriers which spread infectious agent for short period of time

b. Chronic carriers

o Carriers which spread infectious agent for indefinite period

C.PORTAL LOF EXIT

a. Urinary

b. Intestinal

c. Respiratory

d. Others -(skin eruptions, open wounds, blood)

2. Animal reservoir

The source of infection may sometimes be animals and birds.

The diseases and infections which are transmissible to man from vertebrate are called zoonoses.

Eg :- Rabies, Yellow Fever, Influenza

3. Reservoir in non living things

Soil and inanimate matter can also act as reservoir of infection

MODE OF TRANSMISSION

Communicable diseases are transmitted from reservoir to host in many different ways

SOURCE OF MODE OF SUSCEPTIBLE RESERVOIR TRANSMISSON HOST
SOURCE OF
MODE OF
SUSCEPTIBLE
RESERVOIR
TRANSMISSON
HOST

DIRECT

TRANSMISSION

1 .Droplet contact 2. Droplet infection 3. Contact with soil 4. Inoculation into skin or
1 .Droplet contact
2. Droplet infection
3. Contact with soil
4. Inoculation into skin or mucosa
5. Transplacental

INDIRECT

TRANSMISSION

1. Vehicle borne 2. Vector borne 3. Air borne 4. Fomite borne 5. Unclean hands
1. Vehicle borne
2. Vector borne
3. Air borne
4. Fomite borne
5. Unclean hands and fingers

DIRECT TRANSMISSION

1. Direct contact Infection may be transmitted by direct contact from skin to skin, mucosa to mucosa, or mucosa to skin. Eg :- STD, AIDS, leprosy, leptospirosis, skin and eye infections

2. Droplet infection This is direct projection of spray of droplets of saliva and nasopharyngeal secretions during coughing, sneezing, talking or spitting. The droplet spread is usually limited to a distance of 30-60 cm between source and host Eg :-Respiratory Infections, Common Cold, Tuberculosis, Diphtheria

3. Contact with soil:-

The disease agent may be acquired by direct exposure to the disease agent in the soil Eg :- hook worm, tetanus, mycosis

4. Inoculation into skin:-

Disease agent may be inoculated directly into the skin or mucosa Eg:-rabies virus by dog bite, Hepatitis B by contaminated needles

5. Transelacental transmissin:-

Disease agents can be transmitted transplacentally.

o

S-Syphilis

o

T-Toxoplasma

o

0-0ther infections(AIDS, varicella, Hepatitis B)

o

R-Rubella virus

o

C-Cytomegalo virus

o

H-Herpes virus

INDIRECT TRANSMISSION

1. VEHICLE BORNE Vehicle borne transmission implies transmission of the infectious agent through the agency of water, food, raw vegetables, fruits, milk, blood etc.

2. VECTOR BORNE

Classification of vector borne disease

a. By vector

o Invertebrate Eg-arthropods( flies, mosquitoes, cockroach, ticks, mites, bugs)

o Vertebrate Eg-mice, rodents

b. By transmission chain

o

Man and a non vertebrate host (man-mosquitoe- man in malaria)

o

Man , another vertebrate host and a non vertebrate host (bird-arthropod-man)

o

Man and 2 intermediate host (man-cyclops-fish-man)

c. By methods in which vectors transmit agent

o

Biting

o

Scratching

d. By methods in which vectors are involved in the transmission of parasite

o

Mechanical transmission

o

Biological transmission

3. AIR BORNE Droplet nuclei Dust

4. FOMITE BORNE Fomites are inanimate articles or substances other than water or food contaminated by infectious agents. Eg-soiled clothes, syringes, instruments etc.

5. UNCLEAN HANDS

Lack of personal hygiene favour personperson transmission of infection.

SUSCEPTIBLE HOST

SOURCE OF MODE OF SUSCEPTIBLE RESERVOIR TRANSMISSON HOST
SOURCE OF
MODE OF
SUSCEPTIBLE
RESERVOIR
TRANSMISSON
HOST

SUCESSFUL PARASITISM

4 stages are there in successful parasitism SURVIVAL IN PORTAL OF SITE OF PORTAL OF
4 stages are there in successful parasitism
SURVIVAL IN
PORTAL OF
SITE OF
PORTAL OF EXIT
THE
ENTRY
SELECTION
ENVIRONMENT

1. PORTAL OF ENTRY

Infectious agent enter the host Eg-

o

Respiratory tract

o

Alimentary tract

o

Genito urinary tract

o

Skin

2. SITE OF ELECTION In the body the disease agent finds appropriate tissue for multiplication and survival

3. PORTAL OF EXIT

The disease agent finds a way out of the body

4. SURVIVAL OUTSIDE After leaving the human body the organism must survive in the external environment for sufficient period till a new host is found

Diseases prevention and control

Prevention of source or reservoir

Early diagnosis

Notification

Epidemiological Investigation

Isolation

Treatment

Quarantine

Interruption of the disease transmission

Prevention of susceptible host

Immunization

Health education