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 Endemic- occurrence of expected number of cases among a group of 1) Prepare for field work- Research disease, prepare to travel,

are to travel, make

people over time arrangements with personal contacts
 Incidence- # of new cases in a population 2) Establish the existence of an outbreak- compare current number of
 Prevalence- # of cases in a population (per 10,000 or 100,000) cases to previous cases, use health records, documents, etc.
 Outbreak- more cases of a particular disease than expected in a given 3) Verify diagnosis- Review clinical and laboratory results for the cases,
area over a given time interview patients
 Epidemic- large numbers of people over geographic area distribution 4) Define and identify cases- establish case definition, have clinical info,
affected with the same disease characteristics of the people, place, time, etc.
 Pandemic- an epidemic spanning a very wide area 5) Describe and orient the data in terms of person, place, and time- use
 Vector- an animal intermediate that transmits a pathogen to humans epi curve to describe how many cases at what time
6) Develop hypotheses- consider disease, interview people who are ill,
 Virulence- Degree or intensity of pathogenicity of an organism
try and notice what certain characteristics make people have the
 Compromised host- host with lowered resistance to infection
 Nosocomial infection- an infection that is traced back to a hospital 7) Evaluate hypotheses- compare with established fact, use statistics, use
 Infectivity - capacity to cause infection in a susceptible host case-control or cohort studies
 Pathogenicity - capacity to cause disease in a host 8) Refine Hypotheses- study environment, use data for more insight
 Virulence - severity of disease that the agent causes to host 9) Control and Prevention measures- immunization, medicine, isolation,
 Case definition- The onset of ____ (symptoms) in a _____ (person) at carry out as soon as possible
____ (time and place) 10) Communicate findings- Oral briefing for local health authorities,
 Confirmed- diagnosis by lab verification written report for archives
 Probable- many factors point to diagnosis, but no lab verification
 Suspected- some factors point to diagnosis ____________________________________________________________
 Reservoir- site that harbors pathogenic organisms (human, animal, soil) Cohort Study- used for outbreaks in small, well-defined populations, moves
 Morbidity rate- # sick divided by # exposed forward or backward from exposure
 Mortality rate- # dead per 100000 population
 Case Fatality rate- # dead divided by # sick Disease? Yes No
 Modes of transmission: droplet (through air, flu, TB, SARS, Exposed (A) (B)
hantavirus), blood (sexual or injected, HIV, hepatitis), direct contact Unexposed (C) (D)
(touching, leprosy, chicken pox), oral-fecal (contaminated water, Attack Rate- exposed A/(A+B)
cholera, giardia), vector (spread by animal, malaria, lyme disease) unexposed C/(C+D)
 AIDS- acquired immunodeficiency syndrome, spread by blood/ Relative Risk- [A/(A+B)]/[C/(C+D)]
sexually, attacks immune system Relative Risk> 1: more likely
 Tuberculosis- caused by bacteria, cough, fever, fatigue, weight loss, Relative Risk<1: possible protective effect
treated by antibiotics, attacks respiratory system or other parts of body 0-----------------------1------------------------
 Malaria- caused by protozoan, spread by mosquitoes (anopheles), Possible protective effect More likely
Case control Study- used when groups are not well-defined compares
cyclic fever and chills
people with the disease to people without, works backward
 2 Triads: Person, Place, Time; Agent, Host, Environment
Exposed Case Controls
 Index Case: The first case in an outbreak
↓ Patients
 Virus: Viruses are small, much smaller than bacteria. They are not
Yes (A) (B)
composed of cells. Viruses have 2 basic components: DNA or RNA
No (C) (D)
covered in protein. Viruses can only reproduce inside the cells of
other living organisms (rabies, AIDS, SARS, ebola, measles) Odds ratio: (A x D)/(B x C)
A= number of case patients exposed
 Bacteria: Bacteria have 1 cell and no nucleus. DNA and ribosomes
B= number of control people exposed
float in the cell. They have flagella to help them swim. They have no
C= number of case patients unexposed
cell organelles. Gram + bacteria have a strong cell wall with
D= number of control people unexposed
peptidoglycan and a capsule. Bacteria also have pili that help stick. (E.
coli, streptococcus, diptheria, MRSA, lyme disease)
 Cholera- Vibrio Cholerae (oral-fecal)
Shapes: spherical (cocci) Arrangements: staph (clumps)
 Campylobacter Enteritis- campylobacter jejuni (oral- fecal)
Rod (bacilli) Strep (chain)
 Chicken Pox- varicella zoster (droplet and direct contact)
Spiral (spirilla or spirochete)
 Chlamydia- Chlamydia trachomatis (sexually)
 E. coli- Escherichia coli (oral-fecal)
Immunity Inherited-develops before birth, inborn
 Malaria-plasmodium (vector, anopheles mosquito)
Acquired-Active/natural-exposed to antigen naturally
 MRSA- staphylococcus aureus (direct contact)
 Passive/natural-milk, placenta
 SARS-coronavirus (droplet)
 Active/artificial-injections, vaccines of antigens
 Leprosy-mycobacterium leprae (direct contact)
 Passive/artificial-injections of antibodies
 Schistosomiasis- schistosoma (oral/contact with water)
Lines of defense
 Shingles-herpes zoster (contact, droplet)
1. Skin and secretions- acts as initial barrier, mucus catches pathogens,
 Strep throat-streptococcus(droplet)
enzymes kill pathogens
 Tuberculosis- mycobacterium tuberculosis (droplet)
2. Inflammatory response- injury/tissue damage releases chemical signal,
 Tetanus-clostridium tetani (contact)
blood flow increases: heat, redness, pain, swelling
 Ebola-filoviridae (contact/blood)
3. Phagocytosis- ingests and destroys microorganisms: neutrophils,
 Athlete’s foot- tinea pedis (contact)
 Jakob- Cruztfelt- prion(ingestion)
4. Natural killer cells- kills tumor cells and infected cells with viruses
 Tapeworm- nematode (ingestion)
5. Interferon- infected cell makes protein and releases into bloodstream,
 Hepatitis- hepatitis a, b, c virus (a: oral fecal, b: sexually)
interferes with reproduction
 Giardia- giardia lamblia (direct contact)
 Study of health of population
 Uses scientific method
 Studies distribution and causes of disease in human populations
 Attempts to control these diseases investigates health concerns in
relation to disease
Study design Strength Weakness
Case-control Good for rare disease or Possible error in
long latency, examine recalling past exposure
multiple exposures from a (Recall Bias). Possible
single outcome; less time-order confusion
expensive and quicker to
conduct than cohort study
Cohort Examining multiple Not good for rare
outcomes for a single diseases; costly in time
exposure; examine rare and resources; possible
exposures (such as asbestos loss to follow up over
but not for rare disease); can time; factor, which may
calculate the incidence of be many years in the past
disease (while case control or may be seen as
cannot); best technique for socially (un)desirable
an outbreak in a small, well
defined population; most
accurate observational study
Cross- Relatively short duration; Since exposure and
sectional can study several outcomes; disease status are
least expensive measured at the same
point in time, it may
not always be possible to
distinguish whether the
exposure preceded or
followed the disease.
Experimental Most scientifically sound; Time consuming and
or best measure of exposure Expensive; Unethical for
Trial Harmful Exposures

Hill’s criteria

1. Strength of Association - relationship is clear and risk

estimate is high
2. Consistency - observation of association must be repeatable in
different populations at different times
3. Specificity - a single cause produces a specific effect
4. Alternative Explanations - consideration of multiple
hypotheses before making conclusions about whether an
Types of epidemic association is causal or not
 Point source - An epidemic in which all cases are infected 5. Temporality - cause/exposure must precede the effect/outcome
at the same time, usually from a single source or exposure. 6. Dose-Response Relationship - an increasing amount of
 Continuous source - An epidemic in which the causal exposure increases the risk
agent (e.g. polluted drinking water, spoiled food) is 7. Biological Plausibility - the association agrees with currently
infecting people who come into contact with it, over an accepted understanding of biological and pathological processes
extended period of time. 8. Experimental Evidence - the condition can be altered, either
 Person-to-Person (a.k.a. Propagated) - An epidemic in prevented or accelerated, by an appropriate experimental process
which the causal agent is transmitted from person to 9. Coherence - the association should be compatible with
person, allowing the epidemic to propagate
existing theory and knowledge, including knowledge of past
Path of infection
Reservoir: cases and epidemiological studies
Susceptible Host:
Portal of Entry:
Portal of exit:

Koch’s postulates

1) Collect samples from different people

2) Grow contents on Petri dishes
3) Look for similar organisms from each of the patients
4) Inoculate suspect organism into healthy animal
5) Wait for symptoms to occur
6) Isolate organism from diseased animals