Epidemiology

- Science that study the patterns of health and disease, its

occurrence and distribution for the prevention of disease

Patterns of Disease Occurrence

1. Sporadic - Intermittent

2. Endemic - continuous occurrence

3. Epidemic - sudden inc in no. of cases in a short prd of time - outbreak

4. Pandemic - worldwide occurrence (e.g. SARS)

Communicable Disease

dse caused by an infectious agent acquired from an infected

individual transmitted to a susceptible host either by direct or
indirect contact or by direct inoculation in the broken skin
Two types of Communicable Dse

1. Infectious

- not easily transmitted from one person to another

- malaria, tetanus, dengue

2. Contagious

- easily transmitted form one person to another

- TB, diphtheria, measles

Infection

 The implantation and successful replication of an organism in the

tissue of the host resulting to signs and symptoms as well as
immunologic response

Virulence

 Ability of the microorganism to produce a disease

Pathogenecity

 Virulence and potency of the microorganism

True Pathogen

 Causes disease or infection in a healthy individual

Opportunistic Pathogen

 Causes disease only in susceptible individuals

Carrier

 A person or animal that harbors a specific infectious agent and serves

as a potential source of infection, yet does not manifest any clinical
signs and symptoms of the disease

Asepsis

 Freedom from disease causing microorganisms

Medical Asepsis

 Includes all practices intended to confine a specific microorganism to

a specific area, limiting the number, growth and transmission of
microorganisms.

 Objects are referred to as clean or dirty

Surgical Asepsis

 Practices that keep an area or object free of all microorganism.

 Normal Body Defense

Non-specific Defense

 Protect the person against all microorganism regardless of prior

exposure

 Includes anatomic and physiologic barriers and the inflammatory

response e.g. skin, nasal passages, saliva, tears

Inflammation

 Local and non specific defensive response of the tissues to injury

Manifestations of Inflammation

1. Pain/Dolor

2. Redness/Rubor

3. Swelling/Tumor

4. Heat/Calor

5. Impairment of Function/Functionlysa

Stages of Inflammation

1. Vascular and cellular responses

 Constriction of blood vessels on the site of injury

 followed by rapid dilatation of small blood vessels(hyperemia)

responsible for heat and redness

 Vascular permeability increases

 Releases of chemical mediators(bradykinin, prostaglandin,

serotonin, substance P, Histamine)

 Outpouring of fluids, proteins and leukocytes into interstitial

space(swelling)
 Pain is caused by the stretching of nerve endings

 Blood flow slows

 Margination – leukocytes line up along inner surface of blood

vessel

 Emigration – leukocytes move through the vessel wall of the

affected area

2. Exudate production

 Exudate is produced

 Fibrinogen, thromboplastin and platelets form a barrier(walling

off)

 Major types of exudates

Serous

Purulent

Hemorrhagic(sanguineous)

3. Reparative Phase

 Regeneration – replacement of destroyed tissue by similar

tissue

Granulation tissue Formation

Granulation tissue shrinks(Remodelling)

Fibrous (Scar) tissue is formed

Specific Defense

 Involves the immune system

Immunity

 ability to resist a specific disease

 immunization: process of rendering an individual resistant to a

specific disease

Types of Immunity

1. Natural

a. Passive – maternal Ab-placental transmission (IgG), breast

feeding (IgA) - toxoids

b. Active – exposure and experience

2. Artificial

a. Passive – antibodies

other Ab sources, quick to come, quick to go

b. Active – induction of Ag - stimulate to Ab production

(eg: vaccines)

Own and slow to come, slow to go

3. Sub Clinical – an immunity acquired through constant exposure to a

particular disease or organism

Two components of the immune system

1. Antibody mediated defenses/humoral immunity

 B lymphocytes

Produce antibodies or immunoglobulins

  Can Be ACTIVE or PASSIVE

2. Cell mediated defenses/cellular immunity

 T lymphocytes

Helper T cells

Cytotoxic Tcells

Suppressor Tcells

Normal blood cells

1. Red Blood Cells(Erythrocytes)

2. White Blood Cells(Leukocytes)

A. Granular

A. Neutrophils

B. Eosinophils

C. Basophils

B. Agranular

A. Lymphocytes

A. T-lymphocytes

B. B-lymphocytes

B. Monocytes

3. Platelets
 Chain of Infection

Etiologic
Reservoir
Agent
(source)

Susceptible
Portal of
Host
Exit

Portal of Entry to
the Susceptible
Host Method of
Transmission

Etiologic agent

 Depends on the number, Pathogenecity, ability to enter the body,

susceptibility of the host, and the ability of the microorganism to live
in the host’s body

Types of Microorganisms Causing Infection

1. Bacteria – a simple one celled microbe with double cell membrane

that protect them from harm. Classified according to:
 a. Shape – cocci, bacilli, sprilli

b. Need for oxygen – aerobic or anaerobic

c. Response to staining – gram (+) or (-)

d. Motility – Motile or non motile

e. Tendency to capsulate – encapsulated or non encapsulated

f. Capacity to form spores – spore forming or non sporeforming

2. Spirochete – bacteria with flexible, slender, undulating spiral rods that

has a cell wall. 3 types of spirochetes include

a. Treponema

b. Leptospira

c. Borilia

3. Viruses – smallest known microbe. Cant replicate so they invade the

hosts’ cells and stimulate it for reproduction

4. Rickettsia – small, gram (-) bacteria like microbe that induce life
threatening infections. Like viruses they invade hosts’ cells for
reproduction. Transmitted through arthropods like lice, fleas, ticks as
well as waste products. E.g. Rocky mountain spotted fever, typhus
fever and q fever

5. Chlamydia – smaller than rickettsia, common cause of infection in

urethra, bladder, fallopian tubes and prostate glands. Transmitted
commonly through sexual contact.

6. Fungi – found anywhere on earth. Can be harmful or beneficial.

7. Protozoa – larger than bacteria. Simplest one celled organism of

animal kingdom

8. Parasites – live within other organisms. Don’t kill their hosts but take
only nutrients
Reservoir

 Sources of the microorganism

 environment

 humans:

 frank cases

 subclinically-infected

 carrier

 Incubatory Carrier

• Those who is incubating the illness

 Convalescent carrier

• Recovery stage of illness but continue to shed the

pathogenic organism

 Intermittent carrier

• Occasionally sheds the pathogenic organism

 Chronic/ sustained Carrier

• Always has infectious organism in his system

 animals: dog, cat, cow, chicken

 plants

 soil

 fomites: inedible objects

Portal of Exit from the reservoir

a. Respiratory

b. GIT

c. GUT

d. Wounds and lesions

e. Mechanical escape

 incision and drainage

 needle aspiration

 bites and stings of insects

f. Placenta

Methods of Transmission

 weakest link

 Direct/contact transmission

 Involves direct contact such as touching, kissing, biting and

sexual intercourse

 Indirect transmission

 Vehicle borne transmission

 Vector borne transmission

 Airborne Transmission

 Involves droplets or dust

  > 3 ft or 1 meter

Portal of Entry to the Susceptible Host

 Microorganisms enter the host the same way they have left the
source

a. Respiratory c. GUT e. Blood

b. GIT d. Skin f. placenta

Susceptible Host

 Any person who is at risk of infection

Compromised Host

 A person more likely than others to have an infection

 Have an “increased risk”

Risk Factors for Infection

 Age  Preexisting diseases

process
 Sex
 Fitness
 Heredity/genetic
predisposition  Environment factors

 Level of stress  Absence of or abnormal

antibodies or
 Nutritional status
immunoglobulin
 Current medical therapy

Stages of Infection Process

1. Incubation Period
  time interval from the 1st exposure to the disease to the
appearance of the 1st signs and symptoms

2. Prodromal

 time interval from the appearance of 1st s/s to the appearance

of the characteristic symptoms of the dse

3. Illness

 characteristic symptoms of the dse are manifested

4. Convalescence

 gradually s/s will disappear

Nosocomial infections

 infections that are associated with the delivery of healthcare services

in a health care facility

Iatrogenic Infections

 direct result of diagnostic or therapeutic infection

Cross infection

 an infection of a new type, usually carried from one patient to another

by a break in aseptic technique

Isolation

 The separation of an individual suffering from a communicable

disease from other persons

 Done to confine the infectious agent to a circumscribed area and to

prevent its escape from that area
Isolation precautions accdg to CDC(HICPAC)

1. Standard precautions

2. Transmission Based Precautions

a. Airborne Precautions

b. Droplet Precautions

c. Contact Precautions

Categories recommended in Isolation

1. Strict Isolation

 Prevent highly contagious or virulent infections

i. Wash hands before and after contact with patient

ii. Contaminated articles should be properly disposed

iii. Use of private room

iv. Use of mask

v. Use of gown

vi. Use of gloves

vii. Negative pressure surrounding area is desirable

2. Contact Isolation

 close or direct contact precautions

3. Respiratory Isolation

 Over short distances through air

4. TB Isolation

 For TB patients

5. Enteric Isolation
  For direct contact with feces

6. Drainage/secretion precaution

 For direct/indirect contact withpurulent materials/drainage from

an infected site

7. Universal Precaution

 Blood and Fluid precaution

8. Reverse Isolation

 For immunocompromised patients

Body substance Isolation

 Employs generic infection control for all clients except those with the
few diseases transmitted through air

 Based on 3 premises

o All people have an increased risk for infection from

microorganisms placed on their mucous membranes and non
intact skin

o All people are likely to have potentially infectious

microorganisms in all their moist body sites and substances

o An unknown portion of clients and health care workers will

always be colonized or infected with potentially infectious
microorganisms in their blood and other moist body sites and
substances