 2 Triads: Person, Place, Time; Agent, Host, Environment 1) Prepare for field work- Research disease, prepare to travel,

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