EPIDEMICS

Epidemic
(in Greek epi- upon + demos people)

Is the occurrence of a new cases of a

disease or situation in a given human
population, during a given period, at a rate that
substantially exceeds what is "expected," based
on recent experience.
Causes of
Epidemics
flare up of an old or existing
disease
increased virulence of existing
strain
introduction of a new strain of the
existing agent
decreased resistance of the
population
dilution of herd resistance in the
population
changes in the environment
favoring disease transmission, e.g.
new disease
introduction of a disease not
previously present in the community
disease previously affecting lower
animals affecting man for the first
time
recognition for the first time of
previously occurring disease known
by another name
Diseases requiring investigations
1. Endemic diseases with epidemic
potential malaria, cholera, measles,
hepatitis, meningitis

2. Even a single case of diseases has

eradication goals polio

3. Rare but internationally important

diseases with high case fatality rates
yellow fever

4. Outbreaks of unknown etiology

Investigation of Epidemics
1- Definition of the problem
* verify the diagnosis
* establish (Confirm) existence of
an epidemic
* Check initial information

2- Appraisal of existing facts

* characterize the distribution of
cases by person, place and time
* Identify & count cases / exposed
persons ( at risk )
* Describe data on a SPOT MAP
* Construct an epidemic curve
3- Formulation of hypothesis
* as to source of infection, mode of transmission, factors
that may led to the epidemic

4- Testing of hypothesis
* Choose a study design(case control)
* conduct an epidemiological investigation
* Collect specimens for lab analysis
* Conduct environmental investigations

5- Conclusion and recommendations for

control and prevention
6- Communicate the findings with a
written report
Time:
The epi-curve gives the magnitude of outbreak,
its mode of spread & the possible duration of
the epidemic.

Place:
Spot maps show a pattern of distribution
of cases.

Person:
Examine characters such as age, sex, race,
occupation or any other character that helps in
identifying the population at risk.
 Types of
Classification of Epidemics
1. Onset (of epidemic)
explosive, abrupt, sudden
majority of cases occurring
within one incubation period

staggering, insidious, gradual

2. Exposure (of cases)

mass or simultaneous exposure
occurred about the same time

progressive cases were

exposed one after the other
after 1ry case
3. Transmission
common vehicle single or
multiple exposure

propagated
contact-transmitted:

person to
person
vector-transmitted
4. Epidemic Curve
classical short ascending,
long descending limbs;
e.g.- water-borne

inverted long ascending,

short descending limbs;
e.g.- vector-borne
 bell-shaped ascending and
descending limbs about
equal, peak is rounded;
contact-transmitted

point - ascending and

descending limbs about
equal, peak is pointed; food
poisoning
Types of Epidemics
1- Common-source
* infection or intoxication of many
people from a single
contaminated source
* It can be point source, common
exposure
* characterized by rapid onset,
"sharp" peak and rapid decline in
incidence
2- Propagated
* introduction of an infected person
into a susceptible population
leads to transfer of the etiologic
agent to others, who transfer it to
many others
* characterized by slow onset,
"blunted" peak and slow decline
in incidence
epidemic curve

Traditionally, an epidemic can be

presented by drawing a histogram in
which the number of cases of a
disease are plotted by date or time of
onset to describe an outbreak.

This graph, gives a visual

representation of an outbreak's
magnitude over a specific time period
Interpreting an epidemic curve

it is useful to look at the overall shape of

the curve as it is proved to be helpful in:

determining the source of the

outbreak.
Hypothesizing on how an epidemic
spread throughout a population
establishing the potential incubation
period which helps in the diagnosis of
the disease
Point source epidemic,

All persons are exposed to the same

exposure over a limited, defined
period of time, usually less than one
incubation period.

The shape of the curve commonly

rises rapidly and contains a definite
peak at the top, followed by a gradual
decline.
Point Source

The shape of the curve in the graph below

illustrates an outbreak of gastrointestinal
illness from a single exposure.
is characteristic of one source of
exposure.
Continuous common source epidemic,

The shape of the curve commonly contains one

primary peak .
Because the exposure to the source is
prolonged over an extended period of time,
the curve may occur over more than one
incubation period.
The down slope of the curve may be
very sharp if the common source is removed
gradual if the outbreak affect all the susceptible
persons.
Continuous Common Source

The data from the well-known outbreak of

cholera in London that was investigated by the
"father of epidemiology," John Snow.
Cholera spread from a water source for an
extended period of time.
A propagated (progressive source)

occurs when a case of disease serves as a

source of infection for subsequent cases and
whom, in turn, serve as sources for later
cases.
The shape of the curve usually contains a
series of successively larger peaks,
reflective of the increasing number of cases
caused by person-to-person contact, until
the pool of susceptible is exhausted or
control measures are implemented.
Case studies are in-depth
descriptions of the factors related to
an illness or injury of an individual in
which a possible relationships or
causes are found, by history,
Case series
physical examination, or testing.
are a group of
individuals
with the same, or similar, illness or
injury and factors that may be
closely related to it.
The five chest x-rays of young
homosexual men in a San
Francisco hospital , showed an
unusual type of pneumonia, the
first description of Pneumocystis
Carinii (Pneumonia and AIDS).
Cross-sectional/ Prevalence
studies/Surveys
A cross sectional study measures

the prevalence of health outcomes,

determinants of health and other

characteristics,

in a defined population at a point in

time or over a short period.

 Snapshot of a population, a
still life

Can measure attitudes, beliefs,

behaviors, personal or family
history, genetic factors, existing
or past health conditions.

The source of most of what we

know about the population
interview surveys.
A large number of questions are
asked both about illnesses , social
circumstances & demographic
details.
Then some matching are done
between each illness and each
factor to try to see if there is a
relationship to be found.
those with the illness have the
factor and those without the illness
do not.
This is sometimes called a fishing
Uses
determination of prevalence
of risk factors
determination of frequency
of prevalent cases
determination of health
status and health needs
formulation of hypothesis
about etiology. cataract and
vitamin status
in planning health care.
physician , a coronary prevention program , prevalence
of different risk factors in his community, tailor his
intervention accordingly.
 Population census

A cross-sectional study of an entire

population

Provides the denominator data for

many purposes (estimation of rates,
assessing generalizability,
projecting from smaller studies)

A huge effort people can be

difficult to find, to count or may be
not cooperative
 Advantages
quick and easy to perform
carried out repeatedly in the
same population(s), so
changes can be observed &
compared across time.
does not require follow-up to
assess.
Disadvantages
Difficult to determine whether the
cause preceded the effect or not.
Temporality cannot be
ascertained

(genetic factors)
Selects for survivors, longer-
lasting
& indolent cases.
Rapidly fatal conditions & conditions or
characteristics associated with
PREVALENCE/CROSS-
SECTIONAL/ SURVEYS
.,e.g

or anything else that does not require,

follow-up to assess
 EPIDEMICS
IV. Termination of Epidemics
eradication / killing of disease agents
at the source or reservoirs
interruption or closure of transmission
exhaustion of susceptibles
 Step 13 Control measures
Simultaneous to data collection &
hypothesis formation, steps should be
taken to contain the epidemic. These
measures depend upon knowledge of
etiologic agent, mode of transmission &
other contributing factors. Protective
measures are necessary for patients
(isolation & disinfection), their contacts
(quarantine) and the community