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Introduce
about my self.
and announ-
cement of the
topic.

2 min. Introduce
about topic. INTRODUCTION –
The epidemiologic triad is a model for explaining the organism causing the Student
disease and the conditions that allow it to reproduce and spread. teacher
Epidemiological triad model demanded a broader concept of disease introduce the PPT
causation that synthesized the basic concept of agent, host and environment. topic &
This model has been in use for many years. It helped epidemiologist to student listen
focus on different classes of factors, especially with regard to infectious attentively.
disease.

Meaning – Student
1. 1 min. Explain the
Epidemiology is a greek word that mean is : teacher
mean of What is the
Epi means among ; explain the PPT
epidemiology meaning of
Demos means people ; meaning of epi-
Logy means study. epidemiology demiology?
& student
nodding the
head.
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1. The traditional triangle of epidemiology –

4. 15 Explain the This triangle is based on the communicable disease model and is useful in Student PPT What are the
min. traditional showing the interaction and interdependence of agent, host and teacher traditional
triangle of environment, and time as use in the investigation of disease and epidemics. explain the model of epi-
epidemiology The agent is the cause of disease; the host is an organism, usually a human traditional demiological
. or an animal, the environment is those surroundings and conditions external triad of triad ?
to the human or animal that cause or allow disease transmission; and time epidemiology
accounts for incubation periods, life expectancy of the host or the pathogen, .
duration of course of illness.

Agent of infectious disease include bacteria, viruses, parasites, fungi and

molds. With regards to non-infectious disease, disability, injury or death,
agents can include chemicals from dietary foods, tobacco smoke, solvents,
radiation or heat, nutritional deficiencies, or other substances such as
poison. One or several agent may contribute to an illness.

A host offers subsistence and lodging for a pathogen and may or may not
develop the disease. The level of immunity, genetic make-up, level of
exposure, state of health and overall fitness of the host can determine the
effect a disease organism will have on it. The makeup of the host and the
ability of the pathogen to accept the new environment can also be
determining factor because some pathogens thrive only under limited ideal
conditions. For example, many infectious disease agents can exist only in a
limited temperature range.

Environmental factors can include the biological aspects as well as social,

cultural and physical aspects of the environment. The surroundings in which
a pathogen lives and the effect the surroundings have on it are a part of the
environment . Environment can be within a host or external to it in the
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community. Finally, time includes severity of illness in relation to how long

a person is infected or until the condition causes death or passes the
threshold of danger towards recovery. Delay in time from infection to when
symptoms develop, duration of illness and threshold of an epidemic in a
Population are time elements with which the epidemiologist is concerned.

Epidemiological triad that applied for infectious disease -

A traditional model of infectious disease causation, known as

the Epidemiologic Triad is depicted in Figure 2.  The triad consists of an
external agent, a host and an environment in which host and agent are
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brought together, causing the disease to occur in the host. A vector, an

organism which transmits infection by conveying the pathogen from one
host to another without causing disease itself, may be part of the infectious
process.

A classic example of a vector is the Anopheles mosquito. As the mosquito

ingests blood from an infected host,  it  picks up the parasite plasmodium.
The plasmodium are   harmless to the mosquito. However,  after being
stored in the salivary glands and then injected into the next human upon
which the mosquito feeds, the plasmodium can cause malaria in the infected
human. Thus, the Anopheles mosquito serves as a vector for malaria.
Another familiar example of a vector are ticks of the genus Ixodes which
can be  vectors for Lyme disease.

In the traditional epidemiologic triad model, transmission occurs when the

agent leaves its reservoir or host through a portal of exit, is conveyed by
a mode of transmission to enter through an appropriate portal of entry to
infect a susceptible host. Transmission may be direct(direct contact host-
to-host, droplet spread from one host to another) or indirect (the transfer of
an infectious agent from a reservoir to a susceptible host by suspended air
particles, inanimate objects (vehicles or fomites), or animate intermediaries
(vectors)).
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Figure 2: Epidemiologic Triad of Disease Causation (Historical)

Epidemiological triad that applied for non-infectious disease -

Epidemiologic triad can be applied to a disease that not infectious?  For

example, a smoking-related disease (Figure 3).  If smoking (or more
specifically,  a carcinogen in the smoke of the cigarette)  causes the disease,
those who manufacture, sell and distribute cigarettes are vectors,  bringing
the disease-causing agent to the susceptible host.  Diagramming the
epidemiologic triad also indicates potential interventions to reduce disease
in the population. In this example, clean indoor air legislation, advertising
potential harm from smoking or establishing workplace smoking cessation
programs could change the environment and  reduce the exposure of host to
agent.  Conversely, increased advertising from cigarette manufacturers or
increased numbers of vendors would increase exposure of host to agent.
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Fig. 3: Epidemiologic Triad Applied to Smoking-related

Disease

Thus, the traditional model of disease transmission can be useful to identify

areas of potential intervention to reduce disease prevalence, whether
infectious or non-infectious.
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Advanced model of the triangle of epidemiology / Student What are the

5. 5 min. Elloborate the multifactorial causation – teacher advanced
advance elloborate the PPT model of epi-
model of Pettenkofer of Munich (1819-1901) was an early proponent of this advanced demiological
epide- concept. As a result of advance in public health, chemotherapy, antibiotics model of triad ?
miological and vector control communicable disease began to decline- only to be epide-
triad. replaced by new types of disease, so called “modern” disease of miological
civilization, eg. Lung cancer, coronary heart disease, chronic bronchitis, triad.
mental illness etc. it is known that such type of disease are due to multiple
factors. For example, coronary heart disease and cancer due to excess of fat
intake, smoking, lack of physical exercise and obesity are involved in the
pathogenesis of coronary heart disease.

This new model includes all facets of the communicable disease model,
and to make it more relevant and useful with regard to today’s disease,
conditions, disorders, defects, injuries and deaths; it also reflects the causes
of current illness and conditions. Behaviour, life style factors,
environmental causes, ecologic elements, physical factors and chronic
diseases must also be taken into account. The term agent is replaced by
causative factor, which implies the need to identify multiple causes or a
aetiological factors of disease, disability, injury and death.
The multifactorial concept offers multiple approaches for the
prevention/control of disease.
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Student
6. 1 min. List down The epidemiologic triad is made up of three parts: agent, host and teacher list White Which are
the environment. down the board component
component of component of & of epi-
epi- epide- marke demiological
1. Agent
demiological miological r triad ?
2. 2. Host factors (intrinsic) 3. Environmental factors (extrinsic)
triad. triad &
student note
1. AGENT – down.

The first link in the chain of disease transmission is a disease agent. The
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disease agent is defined as a substance, living or non-living, or a force,
tangible or intangible, the excessive presence or relative lack of which may Student
7. 10 Enumerate initiate or perpetuate a disease process. Disease agents may be classified teacher PPT
min. the agent broadly into the following groups : enumerate the
factor in epi- agent factor
demiological i. Biological agents – in epi-
triad. demiological
triad &
These are living agents of disease, viz, viruses, rickettsiae, fungi, bacteria, student listen
protozoa and metazoan. These agents exhibit certain “host-related” attentively.
biological properties such as:

a) Infectivity- This is the ability of an infectious agent to invade and

multiply in a host.
b) Pathogenecity- This is the ability to induce clinically apparent
illness.
c) Virulence- This is the defined as the proportion of clinical cases
resulting in severe clinical manifestation

ii. Nutrient agent –

These are proteins, fats, carbohydrates, vitamins, minerals & water. Any
excess or deficiency of the intake of nutritive elements may result in
nutritional disorders, protein energy malnutrition, anaemia, goitre, obesity
& vitamin deficiencies are some of the nutritional problems in countries.

iii. Physical agent –

Exposure to excessive heat, cold, humidity, pressure, radiation, electricity,

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sound etc may result in illness.

iv. Chemical agent –

Enumerate
a) Endogenous : Some of the chemicals may be produced in the body the agent
as a result of derangement of function, e.g. urea (uremia), serum factor of epi-
billirubin (jaundice), Ketones (ketosis), uric acid (gout), calcium demiological
carbonate (Kidney stone) etc. triad ?
b) Exogenous : Agent arises outside of human host, e.g. allergens,
metals, fumes, dust, gases, insecticides etc. These may be acquired
by inhalation, ingestion or inoculation.

v. Mechanical agents –

Exposure to chronic friction and other mechanical forces may result in

crushing, tearing, sprains, dislocation and even death.

vi. Social agent –

It is also necessary to consider social agents of disease. These are poverty,

smoking, abuse of drugs and alcohol, unhealthy lifestyle, social isolation etc

2. HOST FACTORS ( INTRINSIC ) -

In epidemiological terminology, the human host is referred to as ‘soil’ and

the disease agent as ‘seed’. In some situations, host factors play a major role
in determining the outcome of an individual’s exposure to infection (e.g.
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tuberculosis)

The host factor may be classified as :- Student

teacher
8. 5 min. Explain the explain the PPT Explain the
host factor of I. Demographic characteristic such as age, sex, ethnicity. host factor of host factor of
epi- II. Biological characteristics such as genetic factor ; biochemical level epidemiology epide-
demiological of blood ( e.g. cholesterol) ; blood group & enzymes; cellular & student miological
triad. constituents of the blood; immunological factors and physiological listen triad ?
function of different organ system of the body (e.g. blood pressure) attentively.
III. Social and economic characteristics such as socio-economic status,
education, occupation, stress, marital status, housing etc.
IV. Lifestyle factor such as personality trait, living habit, nutrition,
physical exercise, use of alcohol, drugs & smoking, behaviour etc.

The association of a particular disease with a specific set of host factors

frequently provides an insight into the cause of disease.

3. ENVIRONMENTAL FACTORS ( EXTRINSIC ) –

the study of disease is really the study of man and his environment. For
human being environment is not limited, as it normally is for plants and
animal, for example, For man, social and economic condition are more
important than the mean of annual temperature. Thus the concept of
environment is complex and all embracing. The external or macro
environment is defined as “all that which is external to the individual
human host, living and non-living, and with he is constant interaction”.
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For descriptive purpose, the environment of man has been divided into three
components- physical, biological and psychosocial. They are closely related
9 5 min. Elaborate the to the host factors. Student Name the
min. enviromental teacher PPT enviromental
factor of I. Physical environment – elaborate the factor ?
epide- enviromental
miological factor and
triad. The term ‘physical environment’ is applied to non-living things and student
physical factors (e.g. air, water, soil, housing, climate, geography, heat, verbalize the
light, noise, debrise , radiation etc.) with which man is in constant enviromental
interaction. In most developing countries, defective environment (e.g. lack factor.
of sanitation) continues to be the main health problem.

Physical environment such as air pollution, water pollution, noise pollution,

urbanization, radiation hazard etc. create a man as a host for new health
problem.

The increasing use of electrical and electronic devices, including rapid

growth of telecommunication system (e.g. satellite system), radio-
broadcasting, television transmitters and radar installations have increased
the possibility of human exposure to electromagnetic energy.

So man is living today in a highly complicated environment which is getting

more complicated as man is becoming more ingenious. If these continue, it
is feared that the ‘quality of life’ we want to cherish may soon in danger.

II. Biological environment –

The biological environment is the universe of living things which surrounds

man, including man himself. The living things are viruses and other
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microbial agents, insects, rodents, animals and plants. These are constantly
working for their survival, and in this process, some of them act as disease
producing agent, reservoirs of infection, intermediate host and vectors of
disease. Between the members of the ecological system there is constant
adjustment. For the most parties manage their effective harmonious inter-
relationship, to achieve a state of peaceful co-existence. When for any
reason, this harmonious relationship is disturbed, ill-health results.

In the area of biological environment also, preventive medicine has been

highly successful in protecting the health of the individual and of the
community.

III. Psychosocial environment –

It includes a complex of psychosocial factors which are defined as “those

factors affecting personal health, health care & community well being. They
include cultural values, customs, habits, beliefs, attitudes, morals, religion,
education, lifestyles, community life, health services, social and political
organization. Between the individual and other members of the group, there
can be harmony or disharmony, interest and point of view that are shared or
that are in conflict. The behaviour of one’s individual can affect others more
or less directly. Conflict & tension between the individual & other members
of the group can yield great distress.

The impact of social environment has both positive & negative aspect on
the health of individuals and communities. A favourable social environment
can improve health, provide opportunities for man to achieve a sense of
fulfilment, and add to the quality of life; eg. Community participation.
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Psychosocial factor can also affect negatively man’s health & well being.
For example, poverty, urbanization, migration & exposure to stressful
situations such as bereavement, desertion, loss of employment, birth of a
handicapped child may produce feeling of anxiety, depression, anger,
frustration and so forth; and these feelings may be accompanied by physical
symptoms such as headache, palpitation and sweating.

By john M. Last –
The study of the distribution and determinants of health and disease related
states in populations, and the application of this study to control health
problems.

Epidemiology defines –
 A study of all disease / health events
 Infectious / noninfectiooous
 Acute / chronic
 Communicable / non communicable
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 Science of rates expressed as a probability
 “Anything that happens to the people
2. 5min. Define the Student PPT What is the
epidemiology teacher definition of
defines the epi-
epidemiology demiology?
and student
listen
attentively.
Epidemiological triad model of disease causation has two types-
1. The traditional triangle of epidemiology
2. Advanced model of the triangle of epidemiology

3. 1 min. List down Teacher list PPT What are the

the types of down the types of
epide- types & epide-
miological student note miological
Triad. down. triad?
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9.
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