Mod 1 Student Outline
Mod 1 Student Outline
This outline is provided as an aid to the student. It contains only the basic content of
the module. To view the supporting material such as graphics, examples, etc. please
see the module itself.
I. INTRODUCTION
A. What is the Purpose of Epidemiology:
• to better understand the burden and causes of health problems in human
populations, and
• to make changes that decrease risk and improve health.
D. Epidemiology has been used to study these conditions and many more:
• West Nile Virus infections
• Sexually transmitted diseases and HIV
• Surgical wound infections
• Hip fractures
• Childhood malnutrition
• Pertussis (whooping cough)
• Schizophrenia
E. Epidemiology can help us identify and understand the factors that influence
the emergence, severity, and consequences of health problems. Examples
include:
• tobacco use and lung cancer
• physical activity and heart disease
• diet and longevity
• lead exposure and developmental disabilities
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• seat belt use and motor vehicle injuries/deaths
• childhood vaccine initiatives and child mortality
• statin drugs and outcomes of atherosclerotic heart disease
F. Infectious diseases:
• Are caused by micro-organisms
• Are transmitted to humans from other humans, animals or the environment
• Usually follow recognizable patterns of symptoms, timing, etc.
• Evolve over time as new organisms emerge and human behavior and
environments change
Epidemiology is, thus, the study of what is upon the people. In modern terms, it is the
science of the distribution of disease and its determinants (causes).
Epidemiology is also a process that uses the facts at hand as clues to point to new
knowledge and solutions. Epidemiologists have been called “disease detectives” and
“medical sleuths” for this reason.
B. Three key terms are used to describe basic patterns of infectious disease
occurrence. The terms are defined by the American Public Health Association (APHA)
as:
Endemic: The habitual presence of a disease within a given geographic area; may also
refer to the usual prevalence of a given disease within such an area.
Epidemic: The occurrence in a community or region of a group of illnesses of similar
nature, clearly in excess of normal expectancy, and derived from a common or from a
propagated source.
Pandemic: A worldwide epidemic.
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Endemic disease levels are measured by ongoing surveillance systems. Some
fluctuations usually occur.
The transition from endemic to epidemic can happen in days, weeks, months, or
even years, depending on the disease. It may be hard to tell when the shift begins.
There are parallel terms referring to disease patterns in animals that may affect
humans:
Zoonosis: An infection or an infectious disease transmissible under natural conditions
between vertebrate animals and man (APHA).
Enzootic: “Endemic” among animal populations
Epizootic: “Epidemic” among animal populations
The natural history of a disease is a description of how that disease “behaves” and what
factors affect its incidence and distribution. Here is a partial list of such factors:
1. Biological
2. Geographic
3. Nutritional
4. Meteorological
5. Social
6. Cultural
7. Religious
8. Behavioral
9. Economic
10. Historical
11. Political
12. Technological
Example:
“The Epidemiology of Measles” includes:
Factor Example
Causative organism Measles virus
Host Humans
Mode of transmission Airborne droplets and direct contact with secretions
Incubation period About 10 days, range 7-18 days from exposure
Period of From a few days before onset of illness to 4 days after the
communicability appearance of the rash
Usual symptoms Fever, conjunctivitis, coryza, cough and blotchy red rash
Complications Otitis media, pneumonia, croup, diarrhea and encephalitis
Mortality rate 2-3 per 1,000 cases in USA; 3-5% in developing countries
Epidemiologic methods were used to compile most of this information.
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III. EVOLUTION OF EPIDEMIOLOGY
Human beings have always sought to understand and explain the occurrence of
disease and death.
A. Supernatural Causation
• Throughout most of human history, people believed in the supernatural as the cause
of illness.
• Individuals and communities who became ill were thought to have angered the gods
or spirits, or to be victims of their enemies’ magic.
• Such beliefs are still held today, even in otherwise modern societies.
B. Environmental Explanations
• Hippocrates was the first to suggest that disease is caused by environmental
elements, around 400 B.C.E.
• From 400 B.C.E. until the mid-19th century, many theories were developed to explain
infection.
• Most of these theories were based on the concept of miasmas. Contagious matter
was thought to create a gaseous form, a miasma, which spread infection through the
atmosphere.
C. Host Factors
• Edward Jenner, in 1796, introduced the idea of host resistance to explain why some
people were immune to smallpox.
• Peter Panum, in 1846, took this idea further when he studied measles in the Faroe
Islands. The islanders had not been exposed to measles in 70 years, and many
otherwise healthy adults died.
• By contrast, in mainland Denmark all were exposed to measles in childhood, and
adult deaths from this disease were rare.
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• Snow’s first step was to gather information about the cholera patients
in the area, and record their residence or place of work.
• He developed a spot map that showed the distribution of cases in
relation to the water pumps.
• Snow investigated all the pumps in the area.
• One pump was so grossly contaminated that people had
avoided its use.
• One pump was in an out-of-the way location, and therefore not
used much.
• Many of the cholera cases were clustered around the Broad
Street Pump.
• When Snow checked with the families of the cholera victims, he
confirmed that they all used the Broad Street Pump.
• Snow showed that by studying the distribution of cases, a source of
infection could be found that explained the pattern. He then took
action to stop the epidemic, by having the pump handle removed.
b. Snow did more pioneering work during another cholera outbreak in 1854.
• This outbreak affected several areas of London that depended on
water hauled in by wagon.
• Two companies, the Southwark and Vauxhall (S&V) Company and
the Lambeth Company, did the hauling.
• Some districts were served mostly by S&V, other districts mostly by
Lambeth, and some districts were served by both.
• Snow compared the number of cholera deaths in the various districts.
• Snow realized that the raw numbers of deaths could not tell him
much.
• If some districts had many more people than others, they couldn’t
really be compared.
• So he collected population figures from the most recent census and
calculated cholera death rates per 1,000 people.
• The rates paint a very clear picture.
• The death rate was 22 times higher in the districts served only by
S&V, compared with those served only by Lambeth.
• Further investigation showed that both companies were drawing their
water from the Thames River.
• However, S&V pulled water from a point just downstream from a
major sewer outlet, while Lambeth drew theirs upstream from the
outlet.
• Snow had shown conclusively that water could serve as a vehicle for
transmitting infection. He also showed that humans could intervene, in
this case by changing the location of the S&V water intake.
2. William Farr, the father of modern vital records, was another important figure
in the development of epidemiology. His contributions include:
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• establishing the first registry of births and deaths in the 1830s.
• advancing population-based surveillance.
• distributing reports that led to public health interventions.
Example: Mortality in Liverpool, 1843. The median age of survival in Liverpool in 1843
was 6 years, compared with an average of 45 in the rest of England. This revelation led
to policy and law changes to improve sanitation.
4. Modern Epidemiology
b. The disease agent, the host, and the environment interact dynamically to produce
disease. All three of these are constantly changing:
• Disease agent: Microorganisms adapt to changing conditions, including
human control efforts such as antibiotics.
• Host: Human populations are constantly growing and moving as people
age, travel, and migrate into new environments.
• Environment: Changes occur locally and globally, both naturally and
through human intervention.
(i) Disease Agents: There are many “agents” of disease and disabilities,
including:
• nutritional components such as vitamin deficiency diseases and obesity.
• physical forces such as fire, radiation, and chemicals.
• biological agents such as bacteria and viruses.
In this course, however, we will be focusing on biological agents that will be
covered more fully in other segments of the course.
(ii) Host Factors: Some host factors that influence susceptibility to disease are:
Sex
Race
Age
Occupation
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Nutrition
Heredity
Marital status
Socioeconomic status
Religious and social customs
Immunization history
Previous history of disease
Examples:
1) Some foodborne diseases, such as salmonella, are highly dependent on
environmental factors such as cross-contamination and cooking/holding temperatures.
2) The spread of measles is influenced by immunization status, but also by housing
conditions and nutritional status.
3) Disease history is a big factor with some diseases, such as hepatitis A, that confer
lifetime immunity after infection.
4) Many other diseases can cause repeated infections in the same individual, for
example gonorrhea, shigellosis and malaria.
5) Some diseases are transmitted to humans only through arthropod vectors such as
mosquitoes, ticks or lice.
• These disease organisms may have complex lifecycles that pass through
several different hosts.
• For example, the spirochete that causes Lyme Disease is transmitted to
humans from certain ticks, but its lifecycle includes rodents and large
mammals such as deer.
• Vectors are subject to agent, host and environmental factors too.
Epidemiology gives us tools to learn about how these factors interact to produce a
particular disease in a particular population. Good epidemiology is most critical when
investigating an outbreak or the emergence of a new disease - some of the most
important tasks of the field epidemiologist.
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A team approach is almost always used in epidemiologic investigations. The range of
experts needed depends on the disease and the setting, but usually includes:
• Epidemiologists
• Medical professionals (physicians, nurses)
• Laboratory scientists
• Statisticians
• Environmental specialists
Summary
Epidemiology is a set of tools for understanding the burden and causes of health
problems in human populations, so that we can make changes that decrease risk and
improve health.
Epidemiology can help us identify and understand the factors that influence the
emergence, severity, and consequences of health problems.
Human beings have always sought to understand and explain the occurrence of
disease and death. The modern approach to epidemiology has developed within the
past 150 years.