Epidemiology

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Epidemiology

"The study of how disease is distributed in populations and the factors that influence or determine this distribution."

Leading Causes of Death

1900's death from micro organism, 2004-death cancer, heart attack-old or suffer because study of epidemiology

Public health & clinical practice today is influenced by population data:

Diagnosis is population based
Prognosis is population based
Therapy is population based

Hippocrates (460-377 BC)

described course of different illnesses & related them to season, geographic area and types of people

John Snow

1813- 1858
Incidence of cholera in London
father of epidimiology, pregerm thory disease, cholera how spread, relate location, social economy, economy status, published

Florence Nightingale

use statistics,infectious disease, cause control study,"First example of someone using healthcare data to affect government reforms in the interest of of preventing death and disease"

Objectives of Epidemiology

Identify cause & risk factors
What is the extent of disease in community
Study natural history of disease
Evaluate existing & new preventive measures
Provide a foundation for developing public policy

Classifying Infectious Diseases A. Behavior

1) Communicable

2)Noncommunicable
3) Highly communicable

Classifying Infectious Diseases B. Freq of Occurence

1) Sporadic
2) Endemic - constantly pres in low nos in population
3) Epidemic - many people, defined area, short period of time
4) Pandemic

Classifying Infectious Diseases C. Severity/Duration

1) Acute

2) Chronic

3) Latent

Spread of Infection A. Reservoirs

1) Human

2) Animal - 150 known zoonoses

3) Non-living - soil & water

Common source epidemic

Result-where they coming from, this disease high 4,5 days, rise sharp, drop sharp, classical bell shape, short of time, selective, large of case, contract ill same thing common source, cluse couple days, case of food poison, potato salad, illness from same place

Propagated epidemic

come and goes, took couple of month, case of Ebola, case death, desease from different source, people get sick, contact person to person, propagate epidemic

Spread of Infection B. Transmission 1. Contact
Direct -

physical contact

Indirect - fomite

Droplet

Spread of Infection B. Transmission 2. Vehicle

Waterborne
Foodborne
Airborne

Spread of Infection B. Transmission 3. Vector (living)

Mechanical

Biological

Spread of Infection C. Portals of exit

Resp tract
GI tract
Urogenital tract
Skin or wound

Language of Epidemiology

Mortality - incidence of ? in a pop

Morbidity - incidence of ? in a pop

Mortality -

incidence of ? in a pop-death of population

Morbidity -

incidence of ? in a pop-# of case and diseases

Patterns of Disease

Predisposing Factors-ITG
Immune health
terms of age
Genetics-Ex) HLA/MHC-haploid from parents, HLA. Sickle cell anemia-genetic mutation of hemoglobin gene, malaria,

Development/Progression of Disease

1) Incubation - infection & first sign of symptoms
2) Prodromal period- early, mild symptoms
3) Illness period
4) Decline period
5) Convalescence period

Outbreak Investigations

Worst waterborne disease-1986-94,1993-400,000 case

Reporting Outbreaks

CDC - pg 459,table 20.1
MMWR

Epidemiological Investigation Handout

Gather data
Graph & analyze -
Source
Prevention

Nosocomial Infections

Def? delivered hospital
Acquired by 5-15% of patients/year
20,000
deaths/year
including extensive use antimicrobial drugs and invasive theraputic procedures, 3 factors, have come together for perfect indicate nosocomial

Results from the interaction of 3 factors:

Nosocomial Infections
1) Microorganisms in
the hospital-Sep. coccus, E.coli, ..,..
2) Compromised host-for sick, elderly sugergical process, immune stystem
3) Chain of transmission-only one we can control, wash hands frequently

Nosocomial Infections

#1 urinary track,
#2 surgical respiratory track
#3 surgical

Emerging Infectious Diseases

Any new, re-emerging or drug-resistant( MARSA, TB, BRE)infection whose incidence as increased in the past two decades.
CDC

drug-resistant

Antimicrobial resistance is the ability of certain microorganisms to withstand attack by antimicrobials, and the uncontrolled rise in resistant pathogens threatens lives and wastes limited healthcare resources.misuse, over use

Emerging Infectious Diseases

Infectious diseases have been around as long as we have.Lamasis II, small pox,3-4000 yrs ago

Emerging Infectious Diseases Predictions - 1960s

Polio vaccine
WHO's smallpox eradication program
Decline in incidence of TB
1967- "War against infectious disease
has been won"

Emerging Infectious Diseases keeping eye,

HIV
H5N1 Influenza

Emerging Infectious Diseases

38 of these are novel human pathogens arising within the past 25 years.
2/3 of these are biral diseas shown up past 25 yrs.
Most are zoonotic-predictable, most virus came from animal

Emerging Infectious Diseases
Human pathogens making the jump

Ebola - ?
HIV-1 - chimps
HIV-2 - monkey
SARS- civet
H5N1 - birds
happen constently, do virus jump animal to human, factor cause germ jump 2 things ability capacity make that jump 1- share recepter viral recepter, carry animal virus for flus virus2- oppotunity- to make jump maybe we can control, ex) HIV what gave oppotunity eating consuming fresh meat viral, lyme disease jump deer to human-hunting, going out house...

1407 recognized human pathogens

538 - bacteria
317 - fungi
287 - helminths
208 - viruses
57 - protozoa

Infectious Disease Mortality Rate 1980-1996

By graphic-increased each yr

Emerging Infectious Diseases
Profile of likely emerging pathogen:

RNA virus
Broad host range
Genetically conserved receptor
Transmissable between humans
Occurs in region undergoing changes

Our role in Prevention of EIDs

Prevention
Education
Detection

Your role in the prevention of emerging infectious diseases

best practices
antibiotic use
food preparation
control exposure
awareness of risk
behavior change

Your role in education about emerging infectious diseases

-stay informed
---CDC Web pages
---MMWR on Web
---EID journal
-educate patients/ family /friend
know resources -who to call

your role in detection of
emerging infectious diseases

Participate in surveillance activities within your clinical settings
-be alert for "clues"; assess risk
know your resources-who to call for consltaion,
report to local health depatment.

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