VOCAB Endemic- occurrence of expected number of cases among a group of people

over time incidence- # of new cases in a population Prevalence- # of cases in a

population (per 10,000 or 100,000) Outbreak- more cases of a particular disease
than expected in a given area over a given time Epidemic- large numbers of people
over geographic area distribution affected with the same disease Pandemic- an
epidemic spanning a very wide area Vector- an animal intermediate that transmits a
pathogen to humans Virulence- Degree or intensity of pathogenicity of an organism
Compromised host- host with lowered resistance to infection Infectivity - capacity
to cause infection in a susceptible host Pathogenicity - capacity to cause disease
in a host Case definition- The onset of symptoms in a person at time and place
Cohort Study- used for outbreaks in small, well-defined populations, moves forward
or backward from exposure Suspected- some factors point to diagnosis Reservoir-
site that harbors pathogenic organisms (human, animal, soil) Morbidity rate- # sick
divided by # exposed Mortality rate- # dead per 100000 population Case Fatality
rate- # dead divided by # sick Modes of transmission: droplet (through air, flu,
TB, SARS, hantavirus), blood (sexual or injected, HIV, hepatitis), direct contact
(touching, leprosy, chicken pox), oral-feca(contaminated water, cholera, giardia),
vector (spread by animal, malaria, lyme disease) Malaria- caused by protozoan,
spread by mosquitoes (anopheles), cyclic fever and chills 2 Triads: Person, Place,
Time; Agent, Host, Environment
health Outcome: result of a medical condition that directly affects the length or
quality of a person's life.Virus: Viruses are small, much smaller than bacteria.
They are not composed of cells. Viruses have 2 basic components: DNA or RNA covered
in protein. Viruses can only reproduce inside the cells of other living organisms
(rabies, AIDS, SARS, ebola, measles) Bacteria: Bacteria have 1 cell and no nucleus.
DNA and ribosomes float in the cell. They have no cell organelles. Gram + bacteria
have a strong cell wall with peptidoglycan and a capsule. Bacteria also have pili
that help stick. (E. coli, streptococcus, diphtheria, MRSA, lyme disease) Lines of
defense 1.Skin and secretions- acts as initial barrier, mucus catches pathogens,
enzymes kill pathogens 2.Inflammatory response- injury/tissue damage releases
chemical signal, blood flow increases: heat, redness, pain, swelling
3.Phagocytosis- ingests and destroys microorganisms: neutrophils, macrophages
4.Natural killer cells- kills tumor cells and infected cells with viruses
5.Interferon- infected cell makes protein and releases into bloodstream, interferes
with reproduction Epidemiology Study of health of population Uses scientific method
Studies distribution and causes of disease in human populations Attempts to control
these diseases investigates health concerns in relation to disease STEPS 1.Prepare
for field work- Research disease, prepare to travel, make arrangements with
personal contacts 2.Establish the existence of an outbreak- compare current number
of cases to previous cases, use health records, documents, etc. 3.Verify diagnosis-
Review clinical and laboratory results for the cases, interview patients 4.Define
and identify cases- establish case definition, have clinical info, characteristics
of the people, place, time, etc. 5.Describe and orient the data in terms of person,
place, and time- use epi curve to describe how many cases at what time 6.Develop
hypotheses- consider disease, interview people who are ill, try and notice what
certain characteristics make people have the disease 7.Evaluate hypotheses- compare
with established fact, use statistics, use case-control or cohort studies 8.Refine
Hypotheses- study environment, use data for more insight 9.Control and Prevention
measures- immunization, medicine, isolation, carry out as soon as possible 10.
Communicate findings- Oral briefing for local health authorities, written report
for archives
Attack Rate- exposed A/(A+B) unexposed C/(C+D)
Relative Risk- [A/(A+B)]/[C/(C+D)]
Relative Risk> 1: more likely
Relative Risk<1: possible protective effect
Possible protective effect=More likely Case control Study- used when groups are not
well-defined compares people with the disease to people without, works backward
Odds ratio: (A x D)/(B x C)
A= number of case patients exposed
B= number of control people exposed
C= number of case patients unexposed D= number of control people unexposed
Chicken Pox- varicella zoster (droplet and direct contact) Chlamydia- Chlamydia
trachomatis (sexually) E. coli- Escherichia coli (oral-fecal) Influenza - (virus-
droplet) Malaria-plasmodium (vector, anopheles mosquito) MRSA- staphylococcus
aureus (direct contact)SARS-coronavirus (droplet) Leprosy-mycobacterium leprae
(direct contact)Schistosomiasis- schistosoma (oral/contact with water) Shingles-
herpes zoster (contact, droplet) Strep throat-streptococcus(droplet) Tuberculosis-
mycobacterium tuberculosis (droplet) Salmonella - (infection - oral-fecal- direct
animal contact))Tetanus-clostridium tetani (contact) Ebola-filoviridae
(contact/blood) Athlete’s foot- tinea pedis (contact) Jakob Cruztfelt-
prion(ingestion) Tapeworm- nematode (ingestion) Hepatitis- hepatitis a, b, c virus
(a: oral fecal, b: sexually) Giardia- giardia lamblia (direct contact) Cholera-
Vibrio Cholerae (oral-fecal) Campylobacter Enteritis- campylobacter jejuni (oral-
fecal)
Types of epidemic Point source - An epidemic in which all cases are infected at
the same time, usually from a single source or exposure. Continuous source - An
epidemic in which the causal agent (e.g. polluted drinking water, spoiled food) is
infecting people who come into contact with it, over an extended period of time.
Person-to-Person (a.k.a. Propagated) - An epidemic in which the causal agent is
transmitted from person to person, allowing the epidemic to propagate Path of
infection : Reservoir: Susceptible Host: Portal of Entry: Portal of exit: Koch’s
postulates 1.Collect samples from different people 2.Grow contents on Petri dishes
3. Look for similar organisms from each of the patients 4. Inoculate suspect
organism into healthy animal 5.Wait for symptoms to occur 6. Isolate organism from
diseased animals
Study design
Strength
Weakness
Case-control
Good for rare disease or
long latency, examine multiple exposures from a single outcome; less
expensive and quicker to
conduct than cohort study
Possible error in recalling past exposure (Recall Bias). Possible time-order
confusion
Cohort
Examining multiple outcomes for a single exposure; examine rare
exposures (such as asbestos but not for rare disease); can calculate the incidence
of disease (while case control cannot); best technique for
an outbreak in a small, well defined population; most accurate observational study
Not good for rare diseases; costly in time and resources; possible loss to
follow up over time; factor, which may be many years in the past or may be seen as
socially (un)desirable
Cross-sectional
Relatively short duration; can study several outcomes; least expensive
Since exposure and disease status are measured at the same point in time, it
may
not always be possible to
distinguish whether the
exposure preceded or
followed the disease.
Experimental or
Trial
Most scientifically sound; best measure of exposure
Time consuming and
Expensive; Unethical for Harmful Exposures
Hills Criteria 1. Strength of Association - relationship is clear and risk
estimate is high 2. Consistency - observation of association must be repeatable in
different populations at different times 3. Specificity - a single cause produces a
specific effect 4.Alternative Explanations - consideration of multiple hypotheses
before making conclusions about whether an association is causal or not 5.
Temporality - cause/exposure must precede the effect/outcome 6.Dose-Response
Relationship - an increasing amount of exposure increases the risk 7.Biological
Plausibility - the association agrees with currently accepted understanding of
biological and pathological processes 8.. Experimental Evidence - the condition can
be altered, either prevented or accelerated, by an appropriate experimental process
9. Coherence - the association should be compatible with existing theory and
knowledge, including knowledge of past cases and epidemiological studies Passive
Surveillance: Diseases are reported by health care providers, Simple and
inexpensive, Limited by incompleteness of reporting and variability of quality---
Active Surveillance : health agencies contact health providers seeking reports,
ensures more complete reporting of conditions - used in conjunction with specific
epidemiologic investigation, are most appropriate for epidemics or where a disease
has been targeted for elimination--- Sentinel Surveillance: reporting of health
events by health professionals who are selected to represent a geographic area or a
specific reporting group, is used when high quality data is needed, can be active
or passive, is not that effective for detecting rare diseases or anything that
happens outside of the sentinel sites, it may be a disease, an event, or a
population--- Syndromic Surveillance: Focuses on one or more symptoms rather than a
physician-diagnosed or laboratory-confirmed disease, Is the analysis of medical
data to detect or anticipate disease outbreaks, Has been historically used to
target the investigation of potential cases, Its use for detecting outbreaks
associated with bioterrorism is increasingly being explored by public health
officials Incidence Rate: # of new cases in a specific time period/ # of people at
risk Prevalence: Total # of cases (old and new)/ # of people at risk Counts:
absolute number of persons who have a disease or characteristic of interest risk: -
The probability that an individual will be affected by, or die from, an illness or
injury within a stated time or age span. rate: number of cases occurring during a
specific period; always dependent on the size of the population during that period.
RATE (%): number of cases/population at risk x 100. ratio – value obtained by
dividing one quantity by another – a ratio often compares two rates. Number or rate
of events, items, persons, etc. in one group/ Number or rate of events, items,
persons, etc. in another group proportion – the comparison of a part to the whole
as the number of cases divided by the total population – does not have a time
dimension, It can be expressed as a decimal, a fraction, or a percentage Number of
persons or events with a particular characteristic / Total number of persons or
events, of which the numerator is a subset times 10(power of n)

Control Methods regarding the Reservoir of Infection: o Diagnosis and Treatment o

Screening o Isolation o Reporting o Animal reservoirs Control Methods regarding the
Mode of Transmission o Sanitization, disinfection, sterilization o Water o Food o
Other vehicles o Vector control o Handwashing Control Methods regarding the
Susceptible Host o Vaccination o Chemoprophylaxis – drugs given to exposed and
susceptible hosts o Maintaining a healthy life style o Limiting exposure to sources
of infection o Personal protective equipment Data Collection, Data Interpretation,
Data Analysis, Data dissemination, Link to Action 1. Identify the peak of the
outbreak, which is the time period then the largest number of cases occurred. 2.
Count back from the peak, the average incubation period for disease. Note that
date. 3. Identify the earliest case in the outbreak and count back the minimum
incubation period. Note that date.4. Identify the last case in the outbreak and
count back the maximum incubation period. Note that date.