Siklus Infeksi dan

Transmisi Penyakit
Menular
dr. Yudhi Wibowo, MPH
Department of Public Health & Community Medicine,
Faculty Medicine, Jenderal Soedirman University
[email protected]
Teori epidemiologik klasik
 Digambarkan dengan Triad epidemiologik
 Penyakit adalah hasil dari kekuatan dalam
suatu sistem dinamik yang terdiri dari
 Agen infeksi
Agen
 Manusia (host)
 Lingkungan
Penyakit

Pejamu (host) Lingkungan

2
3
4
What is infectious disease
epidemiology?

A case is a risk factor …

 Infection in one person can be transmitted to others

(www)
5
 What is infectious disease
epidemiology?

The cause often known

 An infectious agent is a necessary cause

What is infectious disease epidemiology then used for?

 Identification of causes of new emerging infections, e.g. HIV, SARS, Covid-
19, Hepatitis misterius
 Surveillence of infectious disease
 Identification of source of outbreaks
 Studies of routes of transmission and natural history of infections
 Identification of new interventions

(www)
6
Konsep Penyebab Penyakit 7
 Infectious Disease

Definitions Tetanus Measles vCJD

 Infectious diseases
 Caused by an infectious agent
 Communicable diseases
 Transmission – directly or indirectly – from an infected person
 Transmissible diseases
 Transmission – through unnatural routes – from an infected person

Note
 Infections are often subclinical – infections vs infectious diseases!
 Antonyms not well-defined
 Non-communicable diseases – virus involved in pathogenesis of diabetes?
 Chronic diseases – HIV?

(www)
8
Routes of transmission
Direct
Indirect
 Skin-skin
 Food-borne
 Herpes type 1
 Mucous-mucous  Salmonella
 Water-borne
 STI
 Across placenta  Hepatitis A
 Vector-borne
 toxoplasmosis
 Through breast milk  Malaria
 Air-borne
 HIV
 Sneeze-cough  Chickenpox
 Ting-borne
 Influenza,covid-19
 Scarlatina
Exposure
 A relevant contact – depends on the agent
Skin, sexual intercourse, water contact, etc
Konsep Penyebab Penyakit (www)
10
Some Pathogens that Cross the Placenta

11
Modes of Disease Transmission

12
 Exposure to Infectious Agents

No infection Clinical Sub-clinical Carrier

Death Carrier Immunity No immunity

Outcome

(www)
13
 Timeline for Infection

Dynamics of Latent Infectious Non-infectious

infectiousness period period

Susceptible
Time

Dynamics of Incubation Symptomatic Non-diseased

disease period period

Susceptible
Time

14
 Transmission
Cases
 Index – the first case identified
 Primary – the case that brings the infection into a population
 Secondary – infected by a primary case
 Tertiary – infected by a secondary case

T
S
Susceptible P
S
Immune S
T
Sub-clinical
Clinical

(www)
15
 Person-to-Person Transmission

Data from Dr. Simpson’s studies in England (1952)

Measles Chickenpox Rubella
Children exposed 251 238 218
Children ill 201 172 82

attack rate 0.80 0.72 0.38

Attack rate = ill

exposed

(www)
16
 Perkembangan proses penyakit menular

Rantai penularan
1. Agen penyebab
2. Reservoir agen
3. Portal dari agen untuk meninggalkan penjamu
4. Cara penularan (mode transmisi) dari agen ke
pejamu yang baru
5. Portal dari agen masuk ke pejamu yang baru
6. Kerentanan pejamu

17 Page 17
 Mata Rantai Infeksi

Reservoir agent Port d’ exit Mode of Port d’ entry ke Menetap

transmission host baru penyakit

Page 18
 Chain of Infection

Konsep Penyebab
Horton Penyakit
& Parker: Informed Infection Control Practice 19
(www)
Page 19
 Factors Influencing Disease
Transmission

Agent Environment
• Weather
• Infectivity
• Housing
• Pathogenicity
• Geography
• Virulence
• Occupational setting
• Immunogenicity
• Air quality
• Antigenic stability
• Food
• Survival

• Age
• Sex
• Genotype
Host
• Behaviour
• Nutritional status
• Health status
20 Page 20
(www)
Infectious Agents

Bacteria
Viruses
Fungi
Protoctists / Protozoa
Helminths

21
 Epidemiologic Triad-Related Concepts

Infectivity (ability to infect)

(number infected / number susceptible) x 100

Pathogenicity (ability to cause disease)

(number with clinical disease / number infected) x 100

Virulence (ability to cause death)

(number of deaths / number with disease) x 100

All are dependent on host factors

22
Predisposition to Infections
(Host Factors)

Gender
Genetics
Climate and Weather
Nutrition, Stress, Sleep
Smoking
Stomach Acidity
Hygiene

23
24
 Reservoirs

Humans
{hepatitis}

Other Vertebrates
{zoonoses}

Birds & Bats

{histoplasmosis}

NOT vectors

Konsep Penyebab Penyakit 25

 Vectors

A host that carries a pathogen without

injury to itself and spreads the
pathogen to susceptible organisms

(asymptomatic carriers of pathogens)

Konsep Penyebab Penyakit 26

 Vectors

Other parasites have life cycles that involve

intermediate organisms, or vectors, which carry
disease-causing microorganisms from one host to
another. The protozoan blood parasite that causes
sleeping sickness, or trypanosomiasis, infects humans,
cattle, and other animals. It uses the tsetse fly as a
vector to carry it from one host to the next. When a
tsetse fly bites an infected animal, it picks up the
parasite when it sucks blood. When an infected fly bites
another animal, the parasite enters the bloodstream and
begins to reproduce in the new host.

Konsep Penyebab Penyakit 27

 Arthropod Vectors

Pathogen - Vector
Viruses (Arbovirus) - Mosquitoes

Bacteria (Yersinia) - Fleas

Bacteria (Borrelia) - Ticks

Rickettsias (R. prowazeki) - Lice, ticks

Protozoa (Plasmodium) - Mosquitoes

Protozoa (Trypanozoma) -Tsetse flies

Helminths (Onchocerca) - Simulium flies

Konsep Penyebab Penyakit 28

 Ecological Factors in Infections

Altered environment
{Air conditioning}
Changes in food production & handling
{intensive husbandry with antibiotic
protection; deep-freeze; fast food industry}
Climate changes
{Global warming}
Deforestation
Ownership of (exotic) pets
Air travel & Exotic journeys / Global movements
Increased use of immunosuppressives/ antibiotics
American Museum of Natural History Exhibition:
Epidemic! The World of Infectious Disease (www)
Konsep Penyebab Penyakit 29
 Ecological Factors in Infections

Altered environment
{Air conditioning}
Changes in food production & handling
{intensive husbandry with antibiotic protection; deep-
freeze; fast food industry}
Climate changes
{Global warming}
Deforestation
Ownership of (exotic) pets
Air travel & Exotic journeys / Global movements
Increased use of immunosuppressives/ antibiotics
American Museum of Natural History Exhibition:
Epidemic! The World of Infectious Disease (www)

Konsep Penyebab Penyakit 30

REFERENSI
 DR.M.N BUSTAN,PENGANTAR
EPIDEMIOLOGI
 AHLBOM & NORELL S, PENGANTAR
EPIDEMIOLOGI MODERN.
 MAUSNER JUDITH & BAHN. ANITA K,
EPIDEMIOLOGY AN INTRODUCTORY TEXT
 BEAGLEHOLE & BONITA, DASAR-DASAR
EPIDEMIOLOGI.
 BUDIARTO EKO & ANGGRAENI
DEWI,PENGANTAR EPIDEMIOLOGI