Burton’s Microbiology for the
Health Sciences
Chapter 11.
Epidemiology and Public Health
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Chapter 11 Outline
Epidemiology
Interactions between Pathogens, Hosts, and Environments
Chain of Infection
Strategies for Breaking the Chain of Infection
Reservoirs of Infection
Modes of Transmission
Public Health Agencies
Bioterrorism and Biological Warfare Agents
Water Supplies and Sewage Disposal
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Epidemiology
• Introduction
– Epidemiology can be loosely defined as the study of
disease.
– Epidemiologists study the factors that determine the
frequency, distribution, and determinants of diseases
in human populations.
– Epidemiologists also develop ways to prevent,
control, or eradicate diseases in populations.
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Epidemiologic Terminology
• A communicable disease is an infectious disease that can
be transmitted from one person to another.
• A contagious disease is a communicable disease that is
easily transmitted from person to person.
• Zoonotic diseases are diseases that humans acquire from
animal sources.
• The incidence of a particular disease is the number of
new cases of that disease in a defined population during
a specific time period.
• The morbidity rate is the number of new cases of a
particular disease that occurred during a specified time
period per a specifically defined population (usually
per 1,000, 10,000, or 100,000 population).
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Epidemiologic Terminology (cont.)
• Prevalence
– Period prevalence is the number of cases of a
disease existing in a given population during a
specific time period (e.g., during the year 2010).
– Point prevalence is the number of cases of a disease
existing in a given population at a particular moment
in time (e.g., right now).
• Mortality rate is the ratio of the number of people who
died of a particular disease during a specified time
period per a specified population.
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Epidemiologic Terminology (cont.)
• A sporadic disease is one that occurs only occasionally
within the population of a particular geographic area
(e.g., tetanus).
• An endemic disease is one that is always present within
the population of a particular geographic area (e.g.,
staphylococcal and streptococcal infections).
• An epidemic disease is defined as a greater than usual
number of cases of a disease in a particular region,
usually within a short period of time (e.g., the
cryptosporidiosis epidemic of 1993).
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Epidemiologic Terminology (cont.)
• A pandemic is a disease that is occurring in epidemic
proportions in many countries simultaneously. Examples
include:
– Influenza
• Examples: (1) the Spanish flu pandemic of 1918
during which more than 20 million people were killed
worldwide (500,000 in the United States);
(2) the H1N1 (swine flu) pandemic of 2009 to
2010.
– HIV/AIDS
– Tuberculosis
– Malaria
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Interactions between Pathogens,
Hosts, and the Environment
• Whether an infectious disease occurs depends on:
– Factors pertaining to the pathogen (virulence of
pathogen, mode of entry, and number of organisms)
– Factors pertaining to the host (health status,
nutritional status, hygiene, age, travel, lifestyle, etc.)
– Factors pertaining to the environment (physical
factors such as climate, season, and geographic
location; availability of appropriate reservoirs;
sanitary and housing conditions; and availability of
potable water)
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The Chain of Infection
There are six components in the infectious disease process:
• a pathogen
• a source of the pathogen (a reservoir)
• a portal of exit
• a mode of transmission
• a portal of entry
• a susceptible host
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The Chain of Infection (cont.)
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Reservoirs of Infection
• The sources of microbes that cause infectious
diseases are many and varied; they are known as
reservoirs of infection or simply reservoirs.
– Living reservoirs⎯humans, pets, farm animals,
insects, and arachnids (e.g., ticks and mites)
– Human carriers:
• Passive carriers
• Incubatory carriers
• Convalescent carriers
• Active carriers
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Reservoirs of Infection (cont.)
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Reservoirs of Infection (cont.)
• Animals
– Infectious diseases that humans acquire from animal
sources are called zoonotic diseases or zoonoses.
– Zoonoses may be acquired by direct contact with an
animal, inhalation or ingestion of the pathogen, or
injection of the pathogen by an arthropod (e.g.,
rabies, Lyme disease, and many others).
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Reservoirs of Infection (cont.)
• Arthropods
– Many different types of arthropods serve as
reservoirs of infection, including insects (e.g.,
fleas, mosquitoes, lice) and arachnids (e.g., mites
and ticks).
– When arthropods are involved in the transmission of
infectious diseases, they are referred to as vectors.
• Examples of arthropod-borne diseases include
Lyme disease and malaria.
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Transmission of Lyme Disease
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Reservoirs of Infection (cont.)
• Nonliving reservoirs
– Air, soil, dust, contaminated water and foods,
and fomites
– Fomites = inanimate objects capable of
transmitting pathogens (e.g., bedding, towels,
eating and drinking utensils, hospital
equipment, telephones, computer keyboards,
etc.)
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Inanimate Vectors of Infection (Fomites)
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Most Common Modes of
Transmission of Infectious Diseases
• Direct skin-to-skin contact
• Direct mucous membrane-to-mucous membrane contact by
kissing or sexual intercourse
• Indirect contact via airborne droplets of respiratory secretions,
usually produced by sneezing or coughing
• Indirect contact via food and water contaminated by fecal
matter
• Indirect contact via arthropod vectors
• Indirect contact via fomites
• Indirect contact via transfusion of contaminated blood or blood
products or by parenteral injection using nonsterile syringes or
needles
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Modes of Disease Transmission
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Public Health Agencies
• World Health Organization (WHO)
– A specialized agency of the United Nations founded in
1948 (www.who.org)
– Missions: to promote technical cooperation for health
among nations; to carry out programs to control and
eradicate diseases; and to improve the quality of
human life
• Investigates outbreaks of Ebola virus, etc.
• Eradicated smallpox
• Attempting to eradicate polio and dracunculiasis
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Public Health Agencies (cont.)
• Centers for Disease Control and Prevention (CDC)
– A federal agency administered by the U.S.
Department of Health and Human Services; located
in Atlanta, Georgia; established in 1946
(www.cdc.gov )
– Mission: “to collaborate to create the expertise,
information, and tools that people and communities
need to protect their health …”
– Certain infectious diseases, known as nationally
notifiable diseases, must be reported to the CDC.
– Publishes Morbidity and Mortality Weekly Report
(MMWR).
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Public Health Agencies (cont.)
• Measures for prevention and control of epidemics:
– Increase host resistance through the development
and administration of vaccines that induce active
immunity and maintain it in susceptible persons
– Ensure that persons exposed to a pathogen are
protected against the disease
– Segregate, isolate, and treat those who have
contracted a contagious infection to prevent the
spread of the pathogen to others
– Identify and control potential reservoirs and vectors
of infectious diseases
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Bioterrorism and
Biological Warfare Agents
• Microbes purposely used to harm others in wartime are
called biological warfare (BW) agents.
• Pathogens used to create fear, chaos, illness, and death
in situations other than war are called bioterrorism
agents.
• Examples:
– Bacillus anthracis (the cause of anthrax)
– Clostridium botulinum (the cause of botulism)
– Smallpox virus (Variola major)
– Yersinia pestis (the cause of plague)
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Modes of Anthrax Transmission
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Black Anthrax Lesion (Eschar)
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Child with Smallpox
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Epidemiology and Pathology of Plague
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Gangrenous Hand (A) and Foot (B) of
Patients with Plague
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Water Supplies and Sewage Disposal
• Water is the most essential resource necessary for
the survival of humanity!
• The two general types of water pollution:
– Chemical pollution
– Biological pollution (e.g., fecal material and
garbage)
• The 1993 cryptosporidiosis epidemic in Milwaukee,
Wisconsin, was the largest waterborne epidemic in
the United States.
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Water Supplies and Sewage
Disposal (cont.)
Sources of Water Contamination
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Water Supplies and Sewage
Disposal (cont.)
• Water treatment
– The major steps in water treatment are sedimentation,
coagulation, filtration, and chlorination.
– Water is tested for fecal contamination by checking for the
presence of coliform bacteria (coliforms), such as E. coli
and other members of the family Enterobacteriaceae.
• Sewage treatment
– Raw sewage consists mainly of water, fecal material,
garbage, and bacteria.
– This treatment includes primary, secondary, and tertiary
sewage treatments.
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Water Supplies and Sewage
Disposal (cont.)
Steps in Water Treatment
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