Chapter Two
The Infectious Disease Cycle
By:
Simegn Alemu(MPHE, Assistant professor of
Epidemiology )
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Objectives:
At the end of this unit, you have to be able to:
Understand the components of infectious disease process
Understand time course of infectious disease
Understand carriers and their role in disease transmission
Understand Individual and herd immunity
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Disease Classification
• Disease is often classified according to its time course, or its
cause
• The time course classifies disease as:
acute (characterized by a rapid onset and short
duration) or
chronic (characterized by a prolonged duration).
• A chronic disease may have both acute and chronic
manifestations.
• The cause of a disease may be classified as
infectious (caused by living organisms which are
transmissible) or
non-infectious. 3
• Infection implies that the agent has achieved entry and begun to
develop or multiply whether or not the process leads to disease.
• The infectious disease process (sometimes called the chain of
transmission or transmission cycle or chain of infection) of a
specific disease is traditionally described by the following
components:
1. The causative agent
2. The reservoir(s)
3. Portal(s) of exit
4. Mode(s) of transmission
5. Portal(s) of entry
6. The susceptible host
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1. The agent
• It includes viral particles to complex multicellular organisms.
Intrinsic properties of infectious agents:
• Many characteristics of infectious agents are agent
determined or intrinsic to the agent itself and do not depend
on any interaction with a host.
Example: Morphology, size, chemical character, genetic
make up etc.
Host-parasite (infectious agent) interactions:
• Many properties that are ascribed to infectious agents are
not actually intrinsic to the agent but are dependent on the
interaction between the agent (parasite) and the host.
• Included in this category are: infectivity, pathogenicity,
virulence and immunogenicity.
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Infectivity:
Is characteristics of the agent that embodies capabilities to enter,
survive and multiply (produce infection) in the host.
The proportion of exposures, in defined circumstance, that
results in infection.
Can be evaluated by techniques such as secondary attack rate.
Pathogenicity:
Is the ability to produce clinically apparent illness.
Is the proportion of infections resulting in clinical illness.
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Virulence:
The proportion of clinical cases resulting in severe clinical
manifestations.
The CFR is one way of measuring virulence.
May depend on dose, route of infection, and host factors such
as age or race.
Immunogenicity:
It is the ability of an infection to produce specific immunity.
Can be affected by host factors such as age, nutrition, dose,
and virulence of infection.
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2. Reservoir
• The reservoir of an agent is the habitat in which an infectious
agent normally lives, grows, and multiplies.
• Thus, reservoirs of infection include human beings, vertebrate
animals, invertebrates (arthropods, molluscs), and
environmental sources (plants, soil, water etc).
• Many infectious diseases have more than one reservoir.
• Agents with a human reservoir include measles, mumps, and
most respiratory pathogens.
• Human reservoirs may be persons with symptomatic illness,
or carriers.
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• A carrier is an infected person without manifestations of
disease, but capable of transmitting the infection to others.
• The importance of carriers in the transmission of disease
depends on their:
1. Number
2. Detectability
3. Mobility, and
4. Chronicity.
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• Four types:
a. Asymptomatic carrier – transmit the infection without ever
showing signs of the disease ( e.g. Poliomyelitis 95%,
amoebiasis 90%, HIV/ AIDS).
b. Incubatory carrier –transmit the infection by shading the agent
before the onset of clinical manifestations.(e.g. Measles 1-
3days, mumps 5-7days, viral hepatitis B up to 3 months, AIDS
≥10years, Rabies 3-10days in dogs and cats).
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c. Convalescent carrier- transmits the infection after the time of
recovery from the disease. ( eg. About 10% of untreated
typhoid fever patients become convalescent carriers for 3
months).
d. Chronic carrier –transmit the disease for a long period
/indefinite transmission.(eg. 0.1-20% Viral hepatitis B
permanently, 2-5% typhoid fever permanently).
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Time course of an infectious agent
i. Prepatent period- time interval between infections
(biological onset) to a point at which the infectious agent starts
to shade.
ii. Incubation period-time interval between infection (biological
onset) and the first clinical manifestation of the disease.
iii. Communicable period-the period during which an infected
host can transmit the infection to others.
iv.Latent period-time interval between recovery and occurrence
of relapse/recrudescence in clinical disease.
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Time Course of a Disease in Relation to Its Clinical Expression and Communicability
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3. Portal of exit
• It is the way the infectious agent leaves the reservoir.
• Possible portal of exit include all body secretions and
discharges (mucus, saliva, tears, breast milk, vaginal, cervical
and urethral secretions, semen, pus, exudates from wound),
excretions (feces and urine), blood, tissues (including
placenta).
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4. Mode of transmission
• Is the mechanism by which the agent escapes from the
reservoir host and enter a susceptible host.
• There are two major modes:
1. Direct transmission – immediate transmission of the agent
from the reservoir to a susceptible host by direct contact or
droplet spread.
1.1. Direct contact- contact of skin, mucosa or conjunctiva with
infectious agents directly transferred from another person or
vertebral animal, via:
Touching( e.g. eye-hand-eye in trachoma, feces-hand-mouth
in shigellosis)
Kissing (e.g. mononucleosis )
Biting (e.g. rabies)
Sexual intercourse (e.g. AIDS, STD)
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1.2. Direct projection-Projection of saliva droplets by
coughing, sneezing, singing, spitting or talking. E.g.
Common cold.
1.3. Transplancental- transmission from mother to fetus
through placenta. ( e.g. Syphilis, Toxoplasmosis, rubella)
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2. Indirect transmission- an agent is carried from reservoir to a
susceptible host by suspended air particles or by animate
( vector, mosquitoes, fleas, ticks ) or inanimate vehicles
( food, water, biologic products, fomites) intermediaries.
2.1. Vehicle borne- through any non-living substance or object.
2.2. Vector borne ( biological or mechanical vectors)
2.3. Airborne
2.4. Non-vector intermediate hosts
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5. Portal of entry
• Is the site where an infectious agent enters a susceptible host.
Example, the required portal of entry for the agent of tetanus
to cause a disease is the site of an injury.
6. Susceptible host
• The susceptible human host is the final link in the infectious
process.
• Host susceptibility can be seen at the individual level and at
the community level.
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• At individual level: The state of the host at any given time is
the interaction of the genetic endowment with the environment
over the entire life span.
Examples: Genetic factors: sex, blood type, ethnicity etc.
Environmental factors: immunity acquired as a result of past
infection.
• At the community level: Host resistance at the community
(population) level is called herd immunity.
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• Conditions under which herd immunity best operates:
i. Single reservoir (the human host)
ii. Direct transmission
iii.Total immunity
iv.No shading of agents by immune hosts
v. Uniform distribution of immunes
vi.No over crowding
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Chain of infection
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Many Thanks!
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