Kapita Selekta Epidemiologi

Dr. Efyluk Garianto, M.Kes

Epidemiology
Comes from Greek words
epi, meaning on or upon
demos,meaning people
logos, meaning the study of

Study of distribution and determinants of

health-related conditions or events in
populations
Ilmu yang mempelajari distribusi dan faktorfaktor penentu dari suatu kondisi atau kejadian
yg berkaitan dengan kesehatan pd suatu populasi

Distribusi penyakit/masalah kesehatan

Menurut orang (umur, jenis kelamin, ras,
status sosial, dll
Menurut tempat (Desa, kota, pesisir,
pegunungan, sekolah, asrama, LP, tempat
lahir, RS, dll)
Menurut waktu (hari, bulan, tahun, musim,
dll)

Common Terms

Descriptive Epidemiology
organize and summarize data according to time,
place, and person
Time disease rates change over time the
seasonal increase in influenza with the onset of
cold weather
time data is usually shown on a graph

 Place - describe a health event by place to

gain insight into the geographical extent of
the problem.
Residence
Birthplace
place of employment
school district
hospital unit, etc

Person

inherent characteristics of people

Age
Race
Sex

Causation

 cause of disease is a factor

(characteristic, behavior, event, etc.) that
influences the occurrence of disease
An increase in the factors leads to an
increase in disease.
Reduction of the factors leads to a reduction
in disease

Epidemiologic triangle
traditional model of infectious disease
causation.
Agent

Host

Environment

Agent
Infectious microorganism - must be
present for disease to occur
Virus
Bacterium
Parasite
other microbe

Host

Agent

Environment

Host factors
Intrinsic factors that influence an
individuals exposure, susceptibility, or
response to a causative agent.
Agent
Age
Race
Sex
socioeconomic status
behaviors

Host

Environment

Environmental factors

Extrinsic factors which affect the agent

and the opportunity for exposure

physical factors
biologic factors
socioeconomic factors

Host

Agent

Environment

Epidemiology and Disease

Chain of Infection
Mode of
Transmission
Susceptible
Host

Reservoir
Mode of
Transmission

Chain of Infection
reservoir of an agent is the habitat in
which an infectious agent normally lives,
grows, and multiplies.
Portal of Entry is the path by which an
agent enters a susceptible host
Portal of exit is the path by which an
agent leaves the source host

Pathogen Reservoirs

Humans are
the most
important
reservoir of
human
infectious
disease.

Portals of Exit

Portals of Entry

Portals of Entry

Many
organisms that
cause one
disease if they
enter one
body site are
harmless if
they enter
another, e.g.,
various enteric
urinary-tract
pathogens.

Chain of Infection
Modes of transmission
Direct immediate transfer of the agent from a reservoir to
a susceptible host by direct contact or droplet spread
Direct contact
Droplet spread
Indirect an agent is carried from a reservoir to a
susceptible host by suspended air particles or by animate
(vector) or inanimate (vehicle) intermediaries
Airborne
Vehicleborne
Vectorborne
Mechanical
Biologic

Modes of Transmission

Chain of Infection
Portal of entry means by which an agent
enters a susceptible host
Host individual infected with the agent

Epidemic Disease Occurrence

Level of Disease - amount of a particular
disease that is usually present in a
community
Increasing amount of disease
Pandemic
Epidemic
Endemic
Sporadic

 Sporadic - irregular pattern of occurrence, with

occasional cases occurring at irregular intervals
Endemic - persistent level of occurrence with a
low to moderate disease level
Epidemic or Outbreak- occurrence of a disease
within an area is clearly in excess of the expected
level for a given time period
Pandemic - an epidemic spreads over several
countries or continents, affecting a large number
of people

Pathogen Transmission

Zoonoses are
Human Diseases
with Animal
Reservoirs.

Zoonoses

Toxoplasmosis

Zoonoses

Contact Transmission

Rhinovirus?

Direct-Contact Transmission

Direct Fecal-Oral Transmission

Giardiasis in
daycare
centers.

Indirect-Contact Transmission
Methicillinresistant
Staphylococcus
aurius
(MRSA)?

Beddings are an example of a

Fomite, an inanimate object
that can transmit pathogens
between people.

Indirect-Contact Transmission
Influenza
virus?

Door knobs are

another good
example of a
fomite.

Droplet Transmission

Measles?

Airborne Transmission

Mycobacterium
tuberculosis?

Airborne Transmission

Contact with air from clean,

empty room.

Contact with air from small

room containing 12 people.

Waterborne Transmission

Cryptosporidium
parvum?

Waterborne Transmission

Giardiasis
from
water.

Foodborne Transmission
Hepatitis A

Foodborne Transmission
Balantidium coli

Types of Epidemiological Studies

Types of Epidemiologcal Studies

q Descriptive studies are simply those that describe the

events and rates of disease. They tend to be the first
sets of studies done.

Quoted or paraphrased from http://dante.med.utoronto.ca/doch/Year1/EPIModule/Part6a.htm

q Observational/Analytical studies then look towards

finding out the causes of the observed rates. They are
called "observational" since the epidemiologist does
not intervene in the assignment of exposure.
q Experimental studies are formal research experiments.
The classic example is the randomized control trial
where one group is randomly assigned a treatment and
a control group gets the placebo or "usual" treatment.
q Experimental studies are expensive and test a very
specific question. Usually a great deal of descriptive and
observational studies are done first.