Nguyen Thi Ngoc Mai

April 18, 2017

2 Contents

Modes of disease transmission

Natural history of disease
Endemic, Epidemic, Pandemic
Attack rate cross-tabulation
Herd Immunity
Exercises
3 Modes of transmission

Direct Indirect
Skin-skin Common vehicle:
Mucous- Food
mucous
Water
Vertical
Air
transmission
Fomites
Vector
4 Direct transmission

Through person-to-person
contact like kissing,
touching, biting, sexual
intercourse.
Skin-skin: Herpes type 1
Mucous-mucous: STI
Vertical transmission:
HIV, Zika
5
6 Indirect transmission
Common vehicle:
Food: Staphylococci, salmonella
Water: Cholera, hepatitis A
Air: Chickenpox, influenza
Fomites: Cooking utensils, bedding,
clothing, surgical, medical instrument
7
Vector: An animal (normally invertebrate) that carries and
spreads infectious agent.
Fleas (plague)
Aedes (zika, dengue fever)
Anopheles (malaria)
9 Natural history of disease
10
11 Subclinical infection

Unapparent, covert,
missed or abortive cases
Disease agent multiply in
the host but dose not
manifest to clinical disease
Contaminates the
environment!!

Carriers
12 Carriers

Harbors the organism but is not infected as measured by

serologic study or evidence of clinical illness

Inadequate treatment
Inadequate immune response
13
14 Latent disease
15 Endemic Epidemic -
Pandemic
Endemic: The habitual presence of a disease within a
geographic area, or usual occurrence of a given of a
given disease.
Epidemic: The number of cases excess of normal
expectancy disease outbreak

Pandemic:
When
epidemics
occur at
several
continents
global
epidemic
16 Disease outbreaks
The occurrence, in a defined community or region, of
cases of an illness with a frequency clearly in excess of
normal expectancy Heymann, D. (2004)
Primary case: The case that bring infection into the
population
Attack rate
Secondary case: Persons who were infected by a
primary case
Secondary attack rate T
S
Susceptible P
S
Immune
S
T
Sub-clinical

Clinical
17 Attack rate

Useful for comparing the risk of disease in groups with

different exposures.
18

Sick Total Attack Rate

Ate egg
135 175 77.1
salad
Did not eat
85 250 34.0
egg salad

Attack rate:
people who ate egg salad: 135/175 x 100 = 77.1%
People who didnt: 85/250 = 34.0%
19 Cross-tabulation

When confronted with several possible causes

Help determining which of the possible agents is likely
to be the cause.
20

Ate tuna Did not eat tuna

Attack Attack
Sick Total Sick Total
rate rate
Ate egg
60 75 80.0 75 100 75.0
salad
Did not
eat egg 70 200 35.0 15 50 30.0
salad
21 Herd immunity

A situation in which a sufficient proportion of a

population is immune to an infectious disease
(through vaccination and/or prior illness) to
make its spread from person to person unlikely.
Even individuals not vaccinated (such as
newborns and those with chronic illnesses) are
offered some protection because the disease
has little opportunity to spread within the
community - CDC
22
23

Epidemic refers to
a. A disease that has a low rate of occurrence but that is
constantly present in a community or region
b. An attack rate in excess of 10 per 1,000 population
c. The occurrence of illness of similar nature clearly in
excess of the normal expectation for that population
at that time
d. Diseases of the respiratory system that occur
seasonally
e. The annual case rate per 100,000 population
 Table 1. Total number of people who ate specified
combination of food items
24
Did not Eat
Ate Pheasant
Pheasant
Ate caviar 100 100
Did not eat caviar 100 100

Table 2. Number of sick people who ate each of the various

specified combinations of the food items

Did not Eat

Ate Pheasant
Pheasant
Ate caviar 50 20
Did not eat caviar 50 25
25

What is the sore throat attack rate in people who ate

both pheasant and caviar?
a. 50/50
b. 50/70
c. 50/75
d. 50/100
e. 50/200
 According to the results shown in Tables 1 and 2,
26 which of the following food items (or combination
of food items) is (are) most likely to be the infective
item(s)?
a. Pheasant only
b. Caviar only
c. Neither pheasant nor caviar
d. Both pheasant and caviar
e. Cannot be calculated from the data given
27