Chapter III

Determinants of Disease

Objective

•Identify the types of disease determinants

•Definition, importance & classification

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 2.1. Determinants
Definition and generalities:

• A determinant is any factor that affects the health of the

population.

• Determinants of disease include any factor or variable, which can

affect the frequency of disease occurrence in a population.

• Include both the etiologic agents directly responsible for disease

and other factors that facilitate exposure, multiplication and spread
in the population.

• Health represents a dynamic balance between host-agents and

environment.
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 Generalities
• When this balance is disturbed against the host resulting in
disease

• Determinants may be identified by contrasting the;

 healthy vs diseased individuals or

 groups having high frequency of the disease vs groups

having either none or low frequency of the disease.

Determinants: when altered produce a change in the frequency or

character of a disease and affect the health of a population.

• Few diseases have a single cause.

• Multiple factors do exist

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 Generalities…
• Population: Any group, herd/ flock in
which the disease occurs;
– It’s collection of individuals having
particular characteristic in common.
• Population at risk: the total number of
individuals in a population considered
capable of acquiring the particular
disease.
– Eg. Only cows are at risk of
experiencing mastitis

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 Generalities…

• Putative (likely) causes of a disease - are referred to

as exposure or risk factors (independent, predicator or
explanatory variables).

• Outcome: The presumed effect, either health

(productivity) or disease occurrence is known as the
outcome (response, dependent variable).

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 Cont…
• From healthy to the disease state
due to exposure to risk factors -
infection rates
• From diseased to healthy state -
recovery rates due to therapeutic
intervention or spontaneous
recovery

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 2.1.2. Classification of determinants
• Determinants can be classified in three ways;
1. Primary (necessary) and secondary (predisposing)
2. Intrinsic (internal/endogenous) and extrinsic
(external/exogenous)
3. Associated with host, agent or environment
• The knowledge of determinants facilitates;
Identification of groups of animals in the population at risk
of developing a disease.
It is essential for control and prevention and deferential
diagnosis of a disease.
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 1. Primary and secondary

Primary determinants: are factors whose variations

exert a major effect in inducing disease.

• They are usually necessary causes of disease(etiologic

agent). E.g.

– M. organisms , Metabolic disorder,

– Nutritional disorder, Genetic disorder,

– Allergens etc

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 …
Secondary determinants: they are predisposing,
aggravating and reinforcing factors.

• Factor associated with an increased occurrence of a

disease is risk factor for the exposed group

– E.g. Sex, breed, climate, husbandry (mgt’), age

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 2. Intrinsic and extrinsic determinants

 Intrinsic: are determinants which could be primary

or secondary that are internal to the host

• E.g. Genetic constitution (sex, Spp, breed), Age, size

& conformation, Hormonal status, Immunological
status, Functional status (Pregnant, lactating…),
Behavior

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 Cont…
 Extrinsic: are determinants which could be primary or

secondary that are external to the host

• Host and the env’t facilitate introduction and spread of

etiologic agent in animal population.

E.g. Environmental factors

 Stressors, concurrent diseases

 Location/geography

 Climate

 Management

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 3. Determinants associated with host, agent
and environment
• Most infectious agents enter the host as challenges from the
environment.

• Determinants commonly classified into those associated with

the host, the agent and the environment called as the
Epidemiological Triad model.

• In this model the environment influences the agent, the host,

and the route of transmission of the agent from a source to the
host.

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 Epidemiologic triad

Many of the diseases

occur as a result of these
interactions
Disease

E.g. Environmental
mastitis
Agent factor- E.coli
Host factor-lactating cow
Ent/mgt factor-poor
hygiene
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 Host, agent and environmental det.. Cont…
• In simple diseases, an infectious agent is the main determinant,
and host and environmental factors are of minor importance. eg.
FMD, RP
• In complex diseases, multifactorial nature predominates & a clear
interaction between host, agent and environment can be
identified.
– Eg. Environmental mastitis involves interaction between E
coli or Str. uberis (agent), milking machine faults & poor
environmental hygiene. The cows (hosts) are most
susceptible in early lactation
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 Epidemiological triads
- Age
- Gender
- Species
Host - Breed
- Genotype
Non- infectious - Immunity
- Physical
- Chemical - Geography/
- Nutritious location
- Toxic Agent - Climate
Infectious Environment - Husbandry
- Infectivity Housing
- Pathogenicity Diet
- Virulence
Management
- Stress

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 3.1. Host determinants

a. Genetic
– species, breed, sex d. Size, body conformation
– physical type and coat color
– hereditary defects
– resistance
b. Age
c. Physiological state

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 Cont…

a. Genotype:

• The genetic constitution of a host is its genotype.

• Diseases, in which abnormal genes are primary determinants.

• Genetic diseases belong to;

• Chromosomal disorders totally genetic

• Mendelian (Simply inherited) - haemophilia A and B in dogs

• Multi-factorial disorders – have variable, complex, genetic

component
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 b. Age
• Variations of disease with age is due to:

1. Physiological activities and changes: - e.g. newborns are very

resistant to many infections for some time due to maternal
antibody protection.

2. Pathological State: - during the aging process tissues lose

some of the defensive mechanisms and become under attack.

3. Exposure potentials: - refers to the risk of being exposed to an

infectious disease agent throughout life.

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 Cont…
• Exposure potential could be used as an indicator in disease
control and prevention.

– e.g. when and what ages to vaccinate

– to provide sanitary & clean surroundings to prevent

transmission

4. Exposure experience: - refers to the past history of an

individual in relation to disease.

• Many bacterial and viral diseases are more likely to occur in

young than old animals due to absence of acquired immunity.

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 c. Sex
• Sexual differences may be attributed to hormonal and genetically
determinants.

Eg. Metritis

Hormonal determinants

• The effects of sex hormones may predispose animals to disease.

• E.g. Bitches are more likely to develop diabetes mellitus than male
dogs and signs often develop after oestrus, possibly related to the
increased insulin requirements of diabetic bitches during oestrus.

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 Cont…
Genetic determinants

• Genetic differences in disease incidence may be inherited either

by being sex-linked, sex-limited, or sex-influenced.

• Some diseases are sex-associated with other determinants that are

related to gender.

• Eg. Increased mortality rate in male dairy calves can be sex

associated.

• Sex-limited traits are traits that are visible only within one sex

• Sex linked traits are more occur in one sex- sickle cell anemia

• Sex-influenced traits are autosomal traits that are influenced by

sex- baldness
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 d. Species and breed
• Susceptibility and response to infectious agents varies among
species & breeds;
• The Susceptibility variation is due to efficiency of immune
mechanism, genetic factor and cell surface receptor. Eg.
FMD (in horse), heart water( not affect dog)
• New diseases can develop when a spp/breed is placed in a new
ecosystem with a pathogen.
– Local spp develop inapparent infection without clinical signs.
– New exotic spp develop clinical disease.( B. indicus vs
B.taurus)

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Bophilus tick
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 Cont…

E. Size and conformation- Hip dysplasia and osteosarcoma are

more common in large than small breeds of dog

• Cows with a small pelvic outlet relative to their size are

predisposed to dystokia

F. Coat color: white cats have a high risk of developing

cutaneous squamous cell carcinoma related to the lack of
pigment, which protects the skin from the carcinogenic effects
of the sun's ultraviolet radiation.

• Canine melanoma-in deeply pigmented dogs

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 3.2. Agent factors as determinant
3.2.1. Non-infectious agents:
a. Physical agents c. Nutritional (deficiency,
- Mechanical: trauma and excess -obesity
pressure d. Physiological – abnormal
- Thermal: heat and cold pregnancy, aging
- Radiation: x-rays, gamma e. Genetic – chromosomes:
rays
alopecia, hemophilia
b. Chemical agents
f. Social – crowding
• Exogenous: lead and other
chemicals
• Endogenous: uric acid, gout
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 3.2.2. Infectious agents
• Infection can be defined as the invasion of a living
organism, the host, by another living organism, the
agent.

• Disease can be defined as a derangement in the

function of the whole body of the host or any of its
parts.

• Incubation period: the period of time that elapses

from the infection of the host by the agent to the
appearance of clinical
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symptoms.
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 Cont…

• Prepatent period: the period between the infection

of the host by the agent and the detection of the agent
in the tissues or secretions of the host.

• Period of communicability: the period of time

during which an infected host remains capable of
transmitting the infective agent.

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 Cont…
Characteristics of infectious agent
1. Morphology
• Morphology may influence epidemiology of a disease
Spores /capsule– increase viability (clostridia) – increase
endemicity
Flagella – antigenecity (salmonella)
• 2. Viability/stability

Viability is ability of the antigens to persist in the environment

as infectious

Influences mode of transmission – indirect versus direct

Physical factors: temperature, pH, or oxygen, moisture, organic

matter affects viability.
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 …
• Some organisms survive for short period of time(i.e. labile )

Eg. Leptospira in dry environment

• Others are resistant/ stable. Eg. Anthrax bacillus can survive

longer

• Stability is frequently facilitated by protective capsules, such

as those forming the outer layer of bacterial spores(e.g.,

Bacillus anthracis).

3. Antigenic character

- depends upon chemical composition & molecular

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configuration.
 Infectious agents…
4. Infectivity: is a measure of the ability of a disease
causing agent to establish itself in the host.
• Agents’ ability to penetrate, multiply and produce
change in host.
• It is the amount of organism (dose) required to initiate
infection in a particular host.
• Infectivity can vary between different strains of the
same organism & depend upon route of infection, age
of host & innate resistance.
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 ….

• Attempts to quantify infectivity normally involve the

use of a statistic known as ID50

• This refers to the dose or numbers of agents required to

infect 50% of a specified population of susceptible
animals under controlled condition.

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 Infectious agents…
5. Pathogenecity and Virulence:
 Pathogenecity:

• Refers to the quality of disease induction or agent’s

ability to produce clinical disease.

• It’s quantified as the ratio of:

the number of animals developing clinical illness

number of animals exposed to infection

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 Infectious agents…
 Virulence:
• Can be defined as a measure of the severity of a disease
once produced.
• Is the ability of an infectious agent to cause disease in a
particular host, in terms of severity.
• Case fatality is an indicator of virulence when death is the
outcome.
– quantified by a statistic known as LD50 which refers
numbers of agent which will kill 50% of a specified
population of susceptible animals under controlled
environmental conditions.
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 6. Genetic variability
Gradient infection

• It refers to the variety of responses of an animal to challenge

by an infectious agent,

• It represents the combined effect of agent’s pathogenecity

and virulence, and host characteristics such as susceptibility,
pathological and clinical reactions.

• If an animal is either non-susceptible or immune, the animal

is not important in the transmission of infection to others.

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 Gradient infection
Increase severity of disease
Signs in No signs No signs (sub Clinical sign Death
animals clinical Mild Severe
disease) disease disease
Types of No infection Inapparent
infection (silent) Overt infection
infection
Status of Insusceptible Susceptible
animal or immune
Generation time: is defined as the interval of time between receipt
of infection by a host and maximal infectivity of that host.
•Inapparent infection: infection without clinical signs.
• Subclinical infection: occurs without overt clinical signs but cause
production
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 Gradient infection….
Clinical infection: produces clinical signs.

• Severe reactions results in death.

Outcome of infection: clinical disease may result in chronic clinical

infection, recovery or death.

Chronically infected cases are potential sources of an infectious

agent.

Death - removes an animal as a source of infection exceptions such as

infection with T. spiralis, and anthrax

Recovery may result in sterile immunity ,which removes the entire

infectious agent from the body; not a threat to the susceptible
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population.
 7. Immunogenecity

• It is the ability of an agent to cause a detectable antibody

response in a host.

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 Host/agent relationships
• The r/n b/n infection and disease are frequently dynamic in nature.

• Health is a balance b/n agent infectivity, pathogenecity and host

susceptibility

• There are many mechanisms by which infectious agents can avoid

or overcome the defenses of the host. For example:

– the carrier state and antigenic variation

 Carrier is used to describe an individual that is infected by a

disease agent and is capable of disseminating that disease agent
but shows no sign of clinical disease..

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 Cont…
Three types of carrier state are recognized:

• The true carrier, which is an infected individual capable of

disseminating the infectious agent but which never exhibits
clinical signs of disease.

• Eg salmonellosis, maedvisna

• The incubatory carrier, which is an infected individual

capable of disseminating the infectious agent while the disease
is still in the incubatory stage.

• Ex: FMD infected animals are most infectious 12 to

24 hrs before the clinical signs of the disease appear.

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 Cont…
• The convalescent carrier, which is an individual that
continues to disseminate the infectious agent after the clinical
signs of the disease have disappeared. Eg. CBPP.

 Antigenic variation: Some species of disease agent seek to

evade the hosts' defense mechanisms by altering their
antigenic characteristics.

• The most extreme case of antigenic variation occurs in

trypanosomiasis, where infection in the host usually takes the
form of a series of parasitaemias each one of which involves a
form of trypanosome antigenically different from the
preceding one.
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 3. Environmental Determinants

• The environment may weaken the host and increase its

susceptibility to disease or provide conditions that favour the
survival of the agent.

• The environment includes location, climate, husbandry.

• Environmental factors - are all external conditions that

surround, act upon and influence an individual.

– Influences host susceptibility

– Influences exposure to agent

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 Cont…
A. Geography/location:

• Local geographical formations, vegetation and climate affect the

spatial distribution of both animals and disease.

• The temporal distribution of disease is affected by location &

season.

• Vectors has inverse relationship with altitude.

• Poor drainage increases occurrence with;

• eg. Schistosomiasis, Fashiolosis (Marshy area)

• Area with lush green pasture-bloat

• Water associated vectors – vector borne diseases

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 Cont…

• Air currents:

• May spread disease in direction of prevailing winds (FMD,

Histoplasmosis)

• B. Soil characteristics: E.g.

 pH: alkaline  anthrax, clostridial disease
Neutral  listeriosis
Acid  histoplasmosis
 By interacting with climate, soil determine vegetation and the
environment in which the livestock are kept low
vegetation starvation disease
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 C. Climate
1. Macroclimate
• Comprises the normal components of weather to which
animals are exposed: temperature, solar radiation, rainfall,
humidity and wind, all of which can affect health.

• Act as disease agents in their own right, either individually or

in combinations

• Affect the stability of infectious agents

• Affect the ability of intermediate host or vector, to survive in

the environment.

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 Climate …

• Temperature: influence survival, stability and viability of

infectious agent

• If the rise is great and sudden the animals will pant, salivate
excessively, become restless and then prostrate.

• Lowered ambient temperature;

• Increases susceptibility to respiratory disease-new born can’t

maintain their temperature during cold stress

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 …
• Humidity: favors survival, development of
infectious agent

– Increased humidity - increases respiratory disease,

airborne transmission

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Precipitation:

• High precipitation: increases rodent activity  increase

leptospirosis

• Low precipitation: summer animal disease  anthrax, rabies

• Wind:

– Can carry infectious agents (eg. FMD virus) and arthropod

vectors (Culcoides with blue tongue virus) over long
distances.

• Solar radiation: carcinogenic effect(photosesitization)

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 2. Micro-climate
• A climate that occurs in a small, defined space.
• This may be a plant's or an animal's surface or a piggery or
calf house. Microclimate can be:
• Terrestrial microclimate - affects the dev’t of arthropods &
helminthes.
• Biological microclimate (over the surface of the host) - can
change during the course of a disease, assisting in its spread.
• Macroclimatic conditions unsuitable for the transmission of a
disease may contain limited areas where the microclimatic
conditions are suitable for the survival of the disease agent and
its vector or intermediate host.
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 Cont…

• Eg: water hole or an irrigated pasture in an arid

environment)

• In this area the transmission of such diseases as

helminthiasis and trypanosomiasis and contagious
diseases take place during the dry season when the
hosts, the agent and the vector are all concentrated
around permanent water sources/irrigated land.
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 Cont…
• The microclimate in intensive animal production units is an
important determinant of disease. Eg.

• Stable dust is associated with respiratory hypersensitivity and

non-allergic pulmonary disease, and can act as a vehicle for
microorganisms.

• High levels of ammonia are associated with

keratoconjunctivitis in hens.

• Poor ventilation is associated precipitation of respiratory

disease
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 D. Husbandry
• It includes Housing, feeding, animal use and management and
stress factors;

 Housing (ventilation, floor structure, bedding material,

drainage system)- well designed and ventilation of house is
important

• Limb and hoof lesions are common in pigs reared on concrete

floors.

 Diet(Excess, deficiency, or imalance): deficiency of energy,

protein, vitamin and minerals have serious effects in disease.

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 …..
 Management(production system/ animal use,
stocking density, replacement)
• Increased stocking densities increase the challenge of
microbial pathogens
• An internal replacement policy (closed population) is
less likely to introduce pathogens than a policy
involving buying animals from outside(open).

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 Stress
• Adverse condition associated with weaning, overcrowding,
transportation, changes in diet, and other environmental
factors.
• Stress as a primary determinant: capture of wild animals
can produce post-capture myopathy syndrome.
• Porcine stress syndrome- inability of pigs to tolerate the
usual environmental stressors (castration, vaccination,
movement, high temperature).
• Stress as a secondary determinant: immune system can be
suppressed by stressors.
Eg. Shipping fever associated with transportation, dehorning,
and castration.
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