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epidemiology

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science that evaluates occurence, determinants, distribution and control of health and disease in a defined human population.

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epidemiologist

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one who practices epidemiology

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john snow

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first epidemiologist studied cholera in london

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CDC center for disease control and prevention

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in atlanta, GA national focus for developing and applying disease prevention and control envronmental health health promotion and health education activities designed to improve the health of the people.

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world health organization

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wouldwide counterpart located in geneva, switzerland

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what does epidemiology do?

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determines causative agent, source/ reservoir of disease agent, mechanism of transmission, host and evironmental factors that facilitate development of disease within a defined population, best control measures.

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sporadic disease

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occurs occasionally and at irregular intervals.

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endemic disease

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maintains a relatively steady low-level frequency at a moderately regular interval.

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hyperendemic disease

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gradually increase in occurrence frequency above endemic level but not epidemic level.

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outbreak

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sudden unexpected occurrence of disease, usually focal or in a limited segment of population

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epidemical

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sudden increase in frequency above expected number index case

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index case

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first case in an epidemic

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pandemic

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increase in disease occurrence within large population over wide region (usually worldwide)

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public heath surveillance

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protect populations, improving the health of communities via education, promotion of healthy lifestyles and prevention of disease and injury.

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methodical approach to identify issues

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review of death certificates, field investigation of epidemics, and investigation of actual cases

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measuring the infectious frequency

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to determine if an outbreak, epidemic or pandemic is occuring, epidemiologist mesure the disease frequency at a single time points and over time. -statistics

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statistics

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mathematics dealing with collection, organization and interpretation of numerical data important statistical measures of disease frequency

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morbidity rate prevalence rate mortality rate

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three important statistical measures of disease frequency

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morbidity rate

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incidental rate number of new cases in a specific time period per unit of population # of new cases during specific time/ # of individual in a population

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prevelance rate

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total number of individuals infected at any one time, depends both on incidence rate and duration of illness.

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mortality rate

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number of deaths from a disease per number of cases of the disease # deaths due to given disease/ size of total population with disease

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infectious disease

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disease resulting from an infection by microbial agents such as viruses, bacteria, fungi, protozoa, and helminths.

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communicable disease

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can be transmitted from one host to another.

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two types of epidemics

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common source epidemic propagated epidemic

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common source epidemic

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single common contaminated source (food) faster and kills more but once source is found and iliminated, the disease dies off fast.

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propagated epidemic

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one infected individual into a susceptible group, infection propagated to other slow takes longer time

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how do we recognize and measure infectious disease in a population?

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survelillance methods are used gather information on development and occurrence of a disease collating and analyzing the data summarizing the findings selecting control methods.

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WHO

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Graphic representation of epidemiological data confirmed human cases of avian influenza A (h5n1) from 2003-2012

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herd immunity

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resistance of a population to infection and to spread of an infectious organism because of the immunity of a large percentage of the population -however, levels can be altered by introducing new susceptible individuals into the population public health services recomend at least 70% of population should be immunized against common infectious disease.

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Herd immunity levels

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levels can be altered by changes in pathogen -antigenic shift -antigenic drift

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antigenic shift

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major change in antigenic character of pathogen

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antigenic drift

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smaller antigenic changes

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emerging and reemerging diseases

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infectious disease mortality has increased since 1982 in the us -incidents of infectious disease due to emerging microbial population -some novel or reemerging infectious diseases.

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hot spots of emerging infectious diseases?

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northeast U.S., west europe, japan and southeast Australia.

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systematic epidemiology

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focuses on ecological and social factors that influence development and spread of emerging and reemerging diseases. many factors identified.

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reasons for emerging and reemergind diseases

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world wide population growth increased international travel habitat disruption microbial evolution and development resistance inadequate public infrastructures.

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other reasons for emerging and reemerging of diseases

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changes in ecology and climate social unrest wars and bioterrorism changes in food processing and agricultural practices changes in human behavior, technology and industry medical practices that lead to immunosuppression.

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nosocomial infections

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hospital acquired infections -from pathogens within a hospital or other clinical care facility, acquired by patients in the facility. -10% of all hospital patients acquire a nosocomial infection .often caused by bacteria that are members of normal microbiota many hospital strains are antibiotic resistant

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endogenous pathogen

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brought into hospital by patient or acquired when patient is colonized after admission

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exogeneous pathogen

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microbiota other than the patients

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autogenous infection

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caused by an agent derived from microbiota of patient despite whether it became part of patients microbiota following admission.

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nosocomial infections control

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prolong hospital stays by 4-13 days results in over 4.5 billion costs results in 20k-60k deaths annually must do proper training of personnel in basic infection control measures (handing surgical wounds and hand washing) monitor patient for signs and symptoms of nosocomial infection

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hospital epidemiologist

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accreditation by the joint commision on accreditation of healthcare organization must have designated individual directly responsible for developing and implementing policies to monitor and control infections and communicable diseases. -reports to infection control committee or similar group.

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how to control the infection?

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-reduce/eliminate source or reservoir of infection -break connection between source and susceptible individual -reduce number of susceptible individuals.

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reduce or eliminate source or reservoir infection

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quarantine and isolate of cases and carriers destruct animal reservoir treatment of sewage therapy that reduces or eliminates infectivity of cases.

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break connection between source and susceptible individuals

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chlorination of water supplies pasteruization of milk supervision and inspection of food and food handlers destruction of insect vectors with pesticides.

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Reduce number of susceptible individuals

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-raise herd immunity -passive immunity following exposure -active immunity for protection

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vaccines

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preparation of microbial antigens used to induce protective immunity. -may consist of killed, living, weakened microbes or inactivated bacterial toxins, purified cell material recombinant vectors or dna.

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immunization

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result obtained when vaccine stimulates immunity -vaccine attempt to induce antibodies and activated T cells to protect host from future infection

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vaccinomics

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application of genomics and bioinformatics to vaccine development.

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Adjuvants

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mixed with antigens in vaccines to enhance the rate and degree of immunization -can be any nontoxic material that prolongs antigen interaction with immune cells and stimulates the immune response to the antigen. -several types are available such as oil in water emulsion, alum and beeswax.

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immunized hosts

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vaccination of children shoud begin at 2 months more vaccination depends on relative risk ( living in close communitites, reduced immunity, international travelers, health care workers)

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global health considerations

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500K infectious disase deaths in developed countries 18 mil infectious disease deaths in less developed countries.

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precautions needed for

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global travel, clean water, sanitation, health care infrastructure and vaccination

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whole cell vaccines

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most current vaccines active against bacteria and viruses and they consist of two microbes that are either inactivated (killed) or attenuated (live but avirulent)

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may be problamatic

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may not protect, immunosuppressed at risk of getting disease, and attenuated may revert to virulent.

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Acellular or subunit vaccines

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use of purified moecules from microbes avoids some of the risk of whole cell vaccines. forms of subunit vaccines

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forms of subunit vaccines

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capsular polysaccharides, recombinant surface antigens and inactivated exotoxins. (toxoids)

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recombinant vector vaccines

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pathogen genes that encode major antigens inserted into non-virulent viruses or bacteria which sere as vectors and express inserted gene released gene products (antigens) can elicit cellular (t cells) and humoral immunity (b cells).

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dna vaccines

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dna directly introduced into host cell via air pressure or gene gun -dna is taken into the nucleus and pathogens dna fragment is expressed. host immune system responds to foreign proteins produced. many dna vaccine trials are currently being run.

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epidemiological guardian

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role of public health system -network of health professionals involved in surveillance, diagnosis and control of epidemics -form county, regional, state, national, and international public health organizations.

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bioterrorism preparedness

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intentional or threatened use of viruses, bacteria, fungi or toxins from living organisms to produce death or disease in humans, animals, and plants.

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salmonella typhimurium

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1984 in dalles OR, in 10 restaurant salad bars. intentional use of agents. caused hospitalization

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shigella dsentariae

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intentional relaease of bacteria in a hospital lab break room. caused hospitalization

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bacillus anthracis

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2oo1 in seven easter us states, use of weaponized spores delivered through us portal systems. resulted in 5 deaths

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choosing biological agents as weapons

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biocrime when chosen as a means for a localized attack vs bioterrorism when chosen for mass casualties.

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characters that favor the use of biological agents as weapons

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invisible, odorless, and tasteless difficult to detect take hours or days before awareness that they have been used fear and panic associated with anticipation that they were used.

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U.S. Biological weapons defense initiative

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-procurement of specialized vaccines and medicines for a national civilian protection stockpile. -invigoration of biodefense research including genome sequencing, vaccine, and therapeutic research. -develop improved detecting and diagnostic systems -prepare of health care professional to be member of first responder team.

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Public health security and bioterrorism preparedness and response act

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identified "select" agents whose use is tightly regulated 2005 final rules issued

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department of homeland security

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established to coordinate the defense of the us against terrorist attacks. -responsible for developing/maintaining a national incident management system to monitor large scale hazards.

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partner to protect us population

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CDC partner with academic institutions to educate health care providers. establish centers for public health relatedness established centers for public health preparedness

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Laboratory response network (LRN)

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ensures effective laboratory response to terrorism (improves us public health lab infrastrucutre) -CDC manged program partener with FBI and association of Public health labs (APHL) CDC managed program

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indicator of bioterrorism

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sudden increase numbers of sick people, especially with unusual disease for that place or time of year. sudden increase numbers of zoonoses, diseased animals, or vehicle borne illnesses

chapter 37:Epidemiology and public health microbiology – Flashcards

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