Definitions

Communicable Disease Concepts

A communicable disease is one that can be

transmitted from one human to another or from
animals to humans
Many, but not all are reportable diseases
Measles is reportable
Head colds are not

Dona Schneider, PhD, MPH, FACE

Zoonoses

Definitions
A zoonosis is a type of communicable disease
that is transmissible from a vertebrate animal to
man. Normally it is a disease of animals

Communicable Disease Concepts

Rabies
Plague
West Nile Virus
Eastern Equine
Encephalitis
Brucellosis
Anthrax
Trichinosis

Rocky Mountain
Spotted Fever
Lyme Disease
Typhus
Leptospirosis
Q Fever
Tularemia
Hantavirus

9Epidemiologic Triad

9 Epidemiologic Triad
AGENT

Agent, host, environment

Chain of Infection
Modes of Transmission

Characteristics of Infectious Agents

Infectivity, pathogenicity, virulence

Spectrum of Disease
Herd Immunity
Terminology: Incubation, Latency, and Infectious Periods
Levels of Disease

HOST

ENVIRONMENT

Endemic, Epidemic, Cluster, Pandemic

Definition: Agent
A microorganism,
chemical, nutritive
element or physical
factor whose
presence or absence
is essential for a
particular disease or
condition to occur

Host Factors
Age, sex, ethnic group, nutritional status,
socioeconomic status

Types of Agents

Bacteria
Virus
Protozoa
Parasite
Fungi
Diet deficiency
Diet excess

Radiation
Chemicals
endogenous
exogenous

Heat, cold
Genetic traits
Stress

Host Factors
Personal behaviors: smoking, diet, drinking,
sexual practices, exercise

Host Factors

Host Factors

Immunization status: vaccinated or

unvaccinated

Physiologic states: pregnancy, puberty,

fatigue, immunocompromised, preexisting disease

Environmental Factors

Environmental Factors

Physical Weather, climate and geology

Biological - Sources of food, water, and air;

presence of vectors, flora and fauna

Environmental Factors

Communicable Disease Concepts

Social and cultural - Density, crowding,

adequate housing, war, sanitation,
availability of health care

Epidemiologic Triad
Agent, host, environment

9 Chain of Infection

Modes of Transmission

Characteristics of Infectious Agents

Infectivity, pathogenicity, virulence

Spectrum of Disease
Herd Immunity
Terminology: Incubation, Latency, and Infectious Periods
Levels of Disease
Endemic, Epidemic, Cluster, Pandemic

9Chain of Infection

Chain of Infection
Agent leaves the reservoir/host
Portal of exit
Mode of transmission
Portal of entry
Infects the new susceptible host

Chain of Infection

Chain of Infection
Reservoir - the natural habitat in which an
agent lives, grows and multiplies
Human - persons with symptomatic illness,
or may be inapparent or chronic carriers
Animal - cows, pigs, sheep, raccoons, bats,
dogs, cats, birds, rodents, etc.
Environmental - plants, water, soil

Portal of Exit - path by which an agent

leaves its human or animal source host

Examples of Portal of Exit

Respiratory

Tuberculosis
Diphtheria
Pneumonia
Influenza
Measles
Chicken Pox
Smallpox
Mumps

Examples of Portal of Exit

Fecal (Alvine diseases)

Examples of Portal of Exit

Skin Lesions

Syphilis
Gonorrhea
Herpes
Smallpox
HIV
Chlamydia

Respiratory tract
Urine
Feces
Conjunctiva
Skin lesions
Percutaneous
Placental

Typhoid fever
Hepatitis
Shigellosis
Salmonellosis
Cholera
Amebic Dysentery
Giardiasis

Communicable Disease Concepts

Epidemiologic Triad
Agent, host, environment

Chain of Infection

9 Modes of Transmission

Characteristics of Infectious Agents

Infectivity, pathogenicity, virulence

Spectrum of Disease
Herd Immunity
Terminology: Incubation, Latency, and Infectious Periods
Levels of Disease
Endemic, Epidemic, Cluster Pandemic

Chain of Infection
Examples of Direct Transmission

9Modes of Transmission the way in

which the agent is transferred to a new

host
Direct

Direct contact
Droplet spread

Indirect

Air borne
Vehicle borne
Vector borne

Direct contact kissing, skin

to skin contact and sexual
intercourse. Also refers to
direct contact with plants or
soil harboring infectious
agents
Droplet spread spray by
short range aerosol, large
droplets from coughing
sneezing, talking or singing

Examples of Indirect Transmission

Air borne Microbes,
particles of droplet nuclei and
dust suspend in the air
Vehicle borne food, water,
blood, tissues, organs and
fomites
Vector borne Disease
transmission by a
nonvertebrate host

Fomites
Inanimate objects capable of transferring
infectious material
Examples: bedding, toys, doorknobs,
combs, clothing, drinking glasses,
cooking utensils, pencils, straws, or
surgical instruments

Vector Borne Transmission

Agent is carried by a live non-human
carrier (vector)
Most vectors are arthropods (insects)
such as mosquitoes, flies, ticks or fleas,
but they may be animals
Vector-borne transmission may be
mechanical and/or biological

Vector borne Diseases

Malaria
Yellow Fever
WNV
Plague
Typhus
Tularemia
Lyme
Rabies

Salmonellosis
EEE
Filariasis
RMSF
Erlichiosis
Dengue Fever
Hantavirus
Sleeping Sickness

Mechanical Vector borne Transmission

Mechanical Vector borne Transmission

The vector is contaminated through

mechanical means
Example: The fly lands on Shigella-contaminated items,
carries the agent on its legs, antennae, etc. to a new
location

Biological Vector borne Transmission

There is no multiplication of the agent within

the vector

Examples of Biological Transmission

The agent undergoes

part of its life cycle
within the vector,
multiplying or
undergoing
physiologic change

Malaria Life Cycle

WNV Life Cycle

Other Examples Include

Rabies

Lassa Fever
Hanta Virus

Chain of Infection
Portal of Entry - the route the agent uses to
get into the new host

Back to the Chain of Infection

Respiratory tract
Ingestion
Dermal
Blood borne
Mucous membranes

9Characteristics of the Infectious

Agent

Infectivity ability of an organism to

invade and infect a host
Pathogenicity ability to cause disease
Virulence ability to cause serious
complications and/or death

Infection of a New Host Depends on

9Characteristics of the Agent

Infectivity, pathogenicity, virulence

9Herd Immunity

Ability of the agent to reach a susceptible host

9Spectrum of Disease

Host reaction to the disease

Dose
Immunologic status

9Incubation, latency, and infectious periods

9Herd Immunity
The decreased
possibility of a group
or community
developing an
epidemic because
there is a specific
level of immunity or
resistance to that
disease in the
population

Herd Immunity
Immunized persons act as a barrier to
spread
The entire population does not have to be
immunized to prevent the occurrence of an
epidemic

9Spectrum of Disease
The progress of a disease with no intervention:
Exposure

Pathological changes

Clinical illness

Symptoms

Recovery, Disability or Death

9Terminology
Incubation period
Time between infection and the onset of
clinical illness

Latency period
Time between infection and when the
individual becomes infectious to others

Infectious period
Time during which the infectious agent may be
shed (host need not be symptomatic)

More About the Incubation Period

Each infectious disease has a characteristic
incubation period dependent upon:

Portal of entry
Dosage of the agent
Immune response of the host
Rate of growth of the agent in the host

Example: Measles
Incubation period
Latency period
Infectious period

13-18 days
6-7 days*
6-9 days*

*An individual becomes infectious and stays

infectious BEFORE they have clinical
disease

Food borne Disease

Incubation Periods
Intoxications shorter
incubation periods,
upper gastrointestinal
symptoms
Infections longer
incubation periods,
typically lower
gastrointestinal
symptoms

Example Staphylococcus aureus

to 8 hours, usually 2 to 4 hours
Causes severe nausea, vomiting, cramps,
often diarrhea
No significant fever; body temperature
often drops
INTOXICATION

Example Plague (zoonosis)

In 1-6 days after an
infected flea bite, the
subject gets
lymphadenopathy
The bite gets
gangrenous and
necrotic turning
black
The resultant infection
causes septicemia
and death

Plague took a hefty toll over the

centuries
13th Century Europe
25 million died
1855-96 China/India
12 million died
1910-11 Manchuria
60,000 died of pneumonic plague

Example - Salmonella
6 to 72 hours, usually 12 to 36 hours
Causes gastroenteritis with cramping,
diarrhea, abdominal tenderness,
vomiting, and fever
The diarrhea is usually watery, but may
contain blood or mucus
INFECTION

As it rages through a population

Plague can change to a more virulent form and
enter the lungs
Victims cough up blood-spotted mucus and then
graduate to coughing bloody froth
The cough spreads the PNEUMONIC PLAGUE
through airborne droplets (no longer a zoonosis)

Remember This?
Ring around the rosies,
A pocket full of posies,
Ashes, ashes!
A Tchoo, A Tchoo!
We all fall down.

Bubonic plague suspected in

NYC visitors
Friday, November 8, 2002 Posted: 12:14 PM EST
(1714 GMT)
NEW YORK (CNN) -- A New Mexico couple who
traveled to New York have been hospitalized with
what is believed to be the first case of bubonic
plague in the city in a century, said health officials.

In Contrast, Tuberculosis is a slow

plague
TB has killed more people than any other disease
in history
In 1800, one out of every three people died from
the "white plague
King Tutankhamen (1340 BCE)
Cardinal Richelieu (1640)
Robert Louis Stevenson (1894)
Eleanor Roosevelt (1962)
billions of others and

Tuberculosis Today
Approximately 1.86
billion people worldwide are infected with
TB, including

Nelson Mandela
Desmond Tutu
Tina Turner
Tom Jones

One person dies of TB

every 15 seconds
WHO 2003

The Entire Bronte Family

Mother Bronte
Reverend Bronte
Maria
Elizabeth
Branwell
Emily
Ann
Charlotte

1821
Carrier chronic infection
1825
1825
1948
1848 (Wuthering Heights)
1849 (Agnes Grey)
1855 (Jane Eyre)

Communicable Disease Concepts

Epidemiologic Triad
Agent, host, environment

Chain of Infection
Modes of Transmission
Characteristics of Infectious Agents
Infectivity, pathogenicity, virulence

Spectrum of Disease
Herd Immunity
Terminology: Incubation, Latency, and Infectious Periods
9 Levels of Disease
Endemic, Epidemic, Cluster, Pandemic

10

9Levels of Disease

Levels of Disease

Endemic
A disease or condition persists within a
certain geographical area
The baseline or expected level of disease
in a community
Does not reflect the preferred level of
disease, which is zero

Endemic vs. Epidemic

Epidemic or Outbreak
When the level of disease rises
significantly above the normal endemic
level

Types of Epidemics

Epidemic

30

CASES

25
20
15
10
5

Endemic

0
TIME

Levels of Disease
Cluster
An aggregation of cases that are more than
expected
Clusters may be based on space (geographical
area) or time
A cluster may or may not be an outbreak

Levels of Disease
Pandemic
A widespread epidemic, usually affecting several
countries or continents affecting large numbers
of people and sometimes the entire globe

11

A pandemic occurs because

Entire populations are
susceptible
There are no effective
treatments for the
outbreak

Ever Heard This?

I had a little bird
Its name was Enza
I opened up the
window
And in-flu-Enza
1918

Influenza is Serious
Hippocrates
documented the first
influenza pandemic in
412 BCE
Since 1580, there have
been 31 influenza
pandemics recorded

It started at Fort Riley

On Saturday, March 9, 1918, a threatening
black sky forecast the coming of a
significant dust storm. The dust,
combining with the ash of burning
manure, kicked up a stinging, stinking
yellow haze. The sun was said to have
gone dead black in Kansas that day.
PBS Influenza 1918

Where Does It Come From?

Type A influenza viruses infect birds, pigs,
horses and humans
A novel virus is created
When an intermediate host (pig) is infected by
both human and bird strains at the same time
or
When an avian strain jumps the species
barrier, moving from chickens or ducks to
humans

Our soldiers shipped out

They carried the virus
to the trenches of
Europe where it
mutated into a killer
They brought it home
again, where it killed
hundreds of
thousands almost
instantly

12

My Grandma died of influenza

People would suddenly develop the flu on their
way to work and die within hours (Henig,
1998)
Patients "died struggling to clear their airways
of a blood-tinged froth that sometimes gushed
from their nose and mouth" (Starr, 1976)

1918-1919 Influenza Pandemic

Was the most rapid and devastating epidemic
in recorded history
1/2 the worlds population was infected and
40 million people died
The strain was incredibly virulent
Mortality was so great that the average life
span in the United States was depressed by
10 years

Disease
(2000)

U.S.
Mortality

U.S.
Prevalence

U.S.
Incidence

The world was in shock

It happened so fast
that we ran out of
coffins

A Perspective on Communicable
Disease U.S. and Global Statistics

9Prevalence is

9Incidence is the

the the number of

existing cases (old
and new)

Disease
(2000)
Lower respiratory
infections

Lung Cancer

160,288

179,400

COPD

119,000

24 million

COPD

Asthma

4,487

31 million

Tuberculosis

Tuberculosis

2,460

12,942

Influenza

1,765

>10,000 cultured
specimens

Pertussis

6,755

Measles

81

SARS (2003)

192

SARS
(1 Nov 2002 to 30 July 03)

number of new cases

(usually on an annual
or seasonal basis)

Global
Mortality

Global
Prevalence

Global
Incidence

4.1 million

248.3 million

3 million

600 million

2.7 million

1.86 BILLION

10.2 million

Asthma

180,000

150 million

Influenza

500,000

>100 million
(5 M severe)

Pertussis

400,000

43.1 million

Measles

777,000

40 million

774

8,098

13

Questions?

Lunch

14