IGNACIO, MYKA R. BSMLS 2D -Relevant with regard to: changing 5.

BOTH CHRONIC AND INFECTIOUS:

landscape of infection and bioterrorism
 TB
CLASSICAL EPIDEMIOLOGISTS – interest  AIDS
BIOSTATISTICS AND EPIDEMIOLOGY
in discovering risk factors.
ETIOLOGY – cause of origin of a disease
2. CLINICAL EPIDEMIOLOGY – or abnormal condition.
EPIDEMIOLOGY – study factors that application of principles of
NATURAL HISTORY – the way a disease
determine the occurrence and epidemiology to clinical medicine.
progresses in the absence of medical or
distribution of disease in a population.
GOAL TO IMPROVE: public health intervention.
- basic science of public health
 Prevention GOAL OF INTERVENTION: to alter the
and the practice of clinical practice
 Early detection natural history of a disease in a
EPIDEMICS – a disease spreads quickly  Diagnosis favorable way.
or extensively, leading to more cases  Treatment
than normally seen.  Prognosis
 Care of illness in individual STAGES OF DISEASE:
EPIDEMIOLOGIST – deals with data
patients
from groups of patients or even entire PRE-DISEASE
population. CLINICAL EPIDEMIOLOGISTS – study
 Before the disease process
patients I health care settings rather
begins.
than in the community at large.
 Early intervention may avert
“CLASSIFICATIONS OF EPIDEMIOLOGY”
3. INFECTIOUS DISEASE EPIDEMIOLOGY exposure to the agent of
1. CLASSICAL EPIDEMIOLOGY – studies – depended more heavily on laboratory disease.
the distribution and determinants of support (especially microbiology and
PRIMARY PREVENTION
disease in populations and the serology)
community origins of health problems  Start of preventing the disease
4. CHRONIC DISEASE EPIDEMIOLOGY –
(ex. Infectious agents, nutrition, process
depended on complex sampling and
environment, human behavior,
statistical methods.
psychological)
LATENT STAGE
  When the disease process has OSTEOMALACIA – 2. AGENT – whatever causes the
already begun but is still disease
a) Both social and biological cause
asymptomatic.
b) Observance of PURDAH  Biologic agents
SECONDARY PREVENTION c) Woman’s Diet is Deficient of VIT  Chemical agents
D during rapid growth (puberty)  Physical agents
 Screening for the disease and
 Social and psychological
providing appropriate treatment ANTHEROGENESIS, ELEVATED, LDL,
may prevent progression to HDL, CHO – 3. ENVIRONMENT – influences the
asymptomatic disease. probability and circumstances of
a) Behavioral
contact between the host and the
TERTIARY PREVENTION
EPIDEMIOLOGIC HYPOTHESES – agent.
 During the symptomatic stage, frequently guide laboratory scientists as
4. VECTOR – insects, arachnids,
when disease manifestations are they seek to understand biologic
mammals, human groups, inaminate
evident, intervention may slow, mechanisms of disease, which may
objects.
arrest, or reverse the suggest methods of treatment.
progression of disease. - (environment)

TRIAD OF FACTORS FOR CAUSES OF

MECHANISMS AND CAUSES OF DISEASE: “RISK FACTORS AND PREVENTABLE
DISEASES CAUSES”
1. HOST – the person or organism
harboring the disease.
DIFFERENT ETIOLOGIES OF DISEASE: HOST FACTORS – responsible for degree BEINGS MODEL – mnemonic device for
to which individual is abrupt to adapt the major categories of risk factors for
 Biological mechanism
the stressors produced by the agents. disease
 Social
 Behavioral HOST REISTANCE – INFLUENCED BY: BIOLOGIC FACTORS and BEHAVIORAL
 Environmental cause of disease genotype, nutritional status, body mass FACTORS:
(ex. OSTERMALACIA) index, immune system, behavior.
  Bio: Gender, Age, Weight, Bone NUTRITIONAL FACTORS: EXAMPLE OF UNINSTENDED
Density, Obesity. CONSEQUENCES FROM SOLUTION OF
 1950s Japanese-Americans in the
 Behavioral: Cigarette smoking, EARLIER HEALTH PROBLEMS:
US (prone to heart attack) vs
sharing of infected needles. Japanese in Japan (healthier).
ENVIRONMENTAL FACTORS:
 LEGIONNAIRE’S DISEASE ”ECOLOGIC ISSUES IN EPIDEMIOLOGY”
-1976 American Legion
GENETIC FACTORS:
Conference in Philadelphia,
Pennsylvania  Genetic diseases
- Discovery of LEGIONELLA  Genetic screening
PNEUMOOHILIA (BACTERIA) - important for identifying problems in
newborns.
 LYME DISEASE
 Potential problems.
- 1975, Old Lyme, Connecticut
- 1977: known as LYME DISEASE SERVICES, SOCIAL FACTORS, AND SPIRITIAL
by IXODES TICKS FACTORS: THE DEGREE OF IMMUNITY
-1982: discovered actual  Iatrogenic disease- occurs when a NECESSARILY TO ELIMINATE A DISEASE
causative agent – BORRELIA disease is induces inadvertently by VARIES DEPENDING ON:
BURGDORFERI (ixodes ticks) treatment or during a diagnostic
procedure.
1. Type of Infectious Organism
IMMUNOLOGICAL FACTORS:
2. Time of the Year
 SMALLPOX – first infectious disease
known to have been eradicated 3. Density and Social Patterns of the
from the globe. population.
 HERD IMMUNITY – results when
disease transmission is effectively
reduces.
 IMMUNODEFIENCY – inadequate ECOLOGIC ISSUES IN EPIDEMIOLOGY
immune function.
EXAMPLES OF IMMUNIZATIONS SMALLPOX: c.) Remains endemic in only 3
WHERE CONTROL OF DISEASE IS MORE countries: AFGHANISTAN, PAKISTAN,
a. early attempts at preventing
COMPLES: NIGERIA (not updated).
smallpox: Buddhist nun would grind
scabs from patients with the mild form HUMAN PAPILLOMAVIRUS (HPV):
and blow them into the nose of
DIPTHERIA: a.) Vaccination: protects against
nonimmune individuals.
infection with human papillomaviruses.
1. when diptheria was a more common
TERM: VARIOLATION
disease, people who had beed b.) Types that cause warts and cancer:
vaccinated against it were exposed b. Vaccination: VACA “COW” Cervical, Oropharyngeal, Cancer.
more frequently to the causative agent
- milkmaids SYPHILIS:
– exposure could result in a mild
reinfection. - effective against VARIOLA MINOR a.) caused by an infection with bacteria
and MAJOR. known as SPIROCHETES.
A. Reinfection: produces NATURAL
BOOSTER EFFECT A. VARIOLA MINOR (Alastrism) b.) Stages
- dominant form of smallpox in
2. Became less common – fewer people i. Primary: Production of chancre
the 1970s
exposed – fewer subclinical booster (infectious skim lesion filled with
- relatively mild form
infections. spirochete organism: subside
- provided individual and herd
spontaneously).
3. Russia in 1990s: despite 90% of immunity against Variola Major.
Russian adults being immunized against B. VARIOLA MAJOR (Classis ii. Secondary: Rash or other lesions
diptheria when they were children, an Smallpox) appear and subside spontaneously.
epidemic occurred due to the DECLINE - more disfiguring, often fatal.
iii. Latent: Disappearance of
IN ADULT IMMUNITY LEVELS.
POLIOMYELITIS: symptoms.
A. SINGLE VACCINATION – now
a.) 2000: Officially eradicated in 36 iv. Tertiary: neurosyphilis, gummas.
recommended for adults for booster
Western Pacific Countries.
effect.
b.) 2002: Europe declared polio free.
UNTREATED INFECTION = immunity to and overall rate of population -> Frequent Droughts, Dust
future infection by disease agent. growth. Bowls, Little Vegetation ->
 SANITARY REVOLUTION Famine and Starvation.
 IMMUNITY is not absolute.
- one of the causes of today’s
 Does not protect individuals
worldwide population problem.
from progressive damage to
- fundamental cause of the “RIVER DAM CONSTRUCTION AND
their own body
appearance of epidemic PATTERNS OF DISEASE”
 Provide some herd immunity –
paralytic poliomyelitis.
making infected individual
*3 Polioviruses are enteric ->
unlikely to develop a new
Fecal- Oral Route ASWAN HIGH DAN (Egypt): Increased
infection if reexposed to
- delayed the time when most cases of SCHISTOSOMIASIS.
SYPHILIS.
infant and children were
 PENICILLIN: syphilis infection DAMS FOR SENEGAL RIVER PROJECT
exposed to the poliovirus.
killed so quickly -> chancre- (West Africa):
* most were exposed after they
immunity did not develop ->
were no longer protected by - before dam was erected, sea would
high-risk individuals continued
material immunity. move far inland during the dry season
to repeatedly reacquire and
and mix with fresh river water, making
spread the disease.
the river water too salty to support the
“VECTOR CONTROL AND LAND USE larvae of blood flukes responsible for
PATTERNS” Schisto or the mosquitoes that transmit
“EFFECTS OF SANITATION”
MALARIA, RIFT VALLEY FEVER, AND
DENGUE FEVER.
NEGATIVE SIDE EFFECT RESULTING
19TH CENTURY, ENGLAND: WHERE - Incidence increased until clean water,
FROM POSITIVE INTENTION OF LAND
SANITATION BEGAN sanitation, and other health
USE:
interventions were provided.
 Reduction of infant mortality
 Control of TSETSE FLY in Africa ->
contributed in a major way to
Larger number of Cattles ->
increase the effective birth rate
Overgrazing
“SYNERGISM OF FACTORS “CONTRIBUTION OF EPIDEMIOLOGIST” “STUDYING THE BIOLOGIC SPECTRUM
PREDISPOSING TO DISEASE” OF DISEASE”
BIOLOGIC SPECTRUM OF DISEASE –
variation in the severity of a disease
SYNERGISM – each makes the other
process.
worse or more easily acquired.
ICEBERG PHENOMENON – more
 MALTRUTION AND INFECTION –
appropriate term because most of an
malnutrition makes infections
iceberg remains unseen, below the
worse, infections make
surface, analogous to asymptomatic
malnutrition worse as well.
and mild cases of disease.
 ANTIGENIC SHIFT – result if the
genetic changes in the agent are  Paramount to epidemiology,
major and the new agent because studying only
produces a Pandemic. symptomatic individuals may
 ANTIGENIC DRIFT – result if the produce a misleading picture of
genetic changes in the agent are the disease pattern and severity.
minor. This also applies to viral disease.
 PANDEMIC – widespread
outbreak of agent that could
involve multiple continents. “SURVEILLANCE OS CIMMUNITY
 GLOBAL PANDEMIC – HEALTH INTERVENTIONS”
worldwide epidemic.

FIELD TRAILS – randomized trials of

prevention measures in the field.
 Importance phase of evaluating
a new vaccine before it is given
to the community at large.
“INTRODUCTION OF VACCINE” AFTER 9/11: US developed smallpox “IMPROVING DIAGNOSIS TREATMENT,
response plan in case of future AND PROGNOSIS OF CLINICAL
bioterrorism events. DISEASE: SUPPORTING THE PRACTICE
ONGOING SURVEILLANCE OF DISEASE OF EVIDENCE-BASED MEDICINE”
SYNDROME SURVEILLANCE –
AND SIDE EFFECTS – essential to ensure
surveillance that identify not only
the vaccine’s continued safety and
changes in disease occurrence but also
effectiveness. DIAGNOSIS – process of identifying the
increase in potentially suspicious
nature and cause of a disease, problem
Ex. POLIOMYELITIS symptom patterns.
through evaluation of the clinical
1954: Field Trials of the Salk inactivated history, review of symptoms
Polio Vaccine. examination, or testing.
SETTING DISEASE CONTROL PRIORITIES
1955: Polio surveillance program of the EPIDEMIOLOGIST METHODS ARE USED
Should be based on:
CDC discovered an outbreak of vaccine TO IMPROVE DIAGNOSIS THROUGH:
associated poliomyelitis. 1. Current size of the problem
 Selection of the best diagnostic
 Slight change from the 2. Potential of a disease to spread to test
recommended procedure for others  Determine of the best cutoff
producing the vaccine had points for such tests
3. Likelihood of causing death and
allowed clumping of the  Development of strategies to
disability
poliovirus to occur. use in screening for disease
 People received vaccine 4. Its cost to individuals, families, and
containing live virus. the community
TREATMENT – determined by methods
1972: Routine smallpox vaccination Example: of clinical epidemiology
among the entire American population
• Too much focus on HIV, other disease PROGNOSIS - probable cause and
stopped in 1972 after the eradication of
with same amount of fatality was not outcome of a disease.
the disease.
given same focus, there's also the rise
ALLOW RISK ESTIMATION – describe
of sedentary lifestyle and obesity,
the probability that the hazard will
leading to Type II DM.
cause illness.
“IMPROVING HEALTH SERVICE 3. To improve patient safety. 5. Improving the Diagnosis, Treatment,
RESEARCH” and Prognosis of Clinical Disease
supporting the practice of Evidence-
PROVIDING EXPERT TESTIMONY IN based Medicine
HEALTH PLANNING – Epidemiologic COURTS OF LAW
6. Improving Health Services Research
measures are employed to determine
Types of lawsuits that rely on
present and future community health 7. Providing Expert Testimony in Courts
Epidemiologic Data include:
needs. of Law
1. Clinical of damage from generate
DEMOGRAPHIC PROJECTION
environmental exposures
TECHNIQUE – can estimate the future
size of different age groups. 2. Occupational Illness Claims
ANALYSES OF PATTERNS OF DISEASE 3. Medical Liability
FREQUENCY AND USE OF SERVICES -
4. Product Liability
estimate future service needs.
HEALTH SERVICES RESEARCH –
multidisciplinary scientific field that CONTRIBUTIONS OF EPIDEMIOLOGISTS
examines how people get access to TO MEDICAL SCIENCE:
healthcare and health care services, the
1. Investigating Epidemics and New
costs of such services, and outcomes.
Diseases
2. Studying the Biologic Spectrum of
PRIMARY GOALS: Disease
1. Identify the most effective ways to 3. Instituting Surveillance of Community
manage, finance, and delivery high- Health Interventions
quality care.
4. Suggesting Disease Control Priorities
2. To reduce medical errors.