Natural History of Disease and Infectious Disease Cycle 2

Natural h istory of disease an d Infectio us disease cycle
Ob jectiv es o f th e session
 Describe Stages in the natural history of diseases
 Discuss Components of infectious disease cycle
 Measure Diseases transmission probability
 Describe levels of diseases prevention
prepared by Delelegn Y (BSc,MPH)

Natural history of diseases
Brain storming(2min)
• What is natural history of diseases?

 It is refers to the progression of a disease process in an

individual over time, in the absence of intervention
 The process begins with exposure to the causative agent

capable of causing disease.
 Without medical intervention, the process might ends with
recovery, disability or death.

Stages in the natural history of diseases
1. Stage of susceptibility
2. Stage of pre-symptomatic disease (sub-clinical stage)
3. The clinical stage
4. Stage of recovery, disability or death


Activity
• A patient with tuberculosis is treated with
drugs. Is it possible to know the natural history
of tuberculosis on this patient?
Yes, why?
No, why?

Time Course of a Disease in Relation to Its Clinical Expression
and Communicability

Epidemiological importance of carriers:
 Number
 Difficult to diagnose
 Mobility
 Chronicity

Outcomes at Each Stage of Infection
.
Exposure Infection Disease Disease Outcome
Infectiousness Pathogenesis Virulence

(Infection rate) (Clinical to sub-clinical ratio) (Case-fatality rate,
Hospitalization rate)

Activity(6min)
• A follow up study was conducted among 500

individuals who live in village ‘’A’’. Among
them 50 individuals screened HIV positive
while 10 individuals diagnosed having sign and
symptoms of HIV/AIDS. After five years 3
individuals died. Calculate
A. infection rate
B. pathogenesis rate
C. case fatality rate

., diseases
Chain of infectious
Causative
agent
Reservoir
Susceptible
host
Portal of
exit
Portal of
entry Mode of
transmission

1. Infectious Agent
• What are the infectious agents?

.
Þ epidemiologic characteristics of an infectious
agent:
 Infectivity
Pathogenicity
Virulence
Immunogenicity
Toxigenecity
§Resistance

2. Reservoir of infection
.
Group discussion(4min)
• What are Reservoirs

.
A. Man as the only reservoir..like measles,
gonorrhea, small pox, typhoid etc.
B. Animal as reservoir of infection- E.g. anthrax-

cattle, Rabies-dog, etc
C. Non-living things as reservoir - soil, water,

food E.G : Tetanus, typhoid fever etc.

.
3. Portal of Exit- this are the site on the reservoir

of infection through which the infectious agent
escapes from the reservoir.
E.g. Respiratory tract

GIT
Urinary tract
Skin
Mucus membrane
4. Mode of Transmission-
. Discursion(4min)
 What are the Types mode of transmission?

.
I. Direct transmission- the immediate transfer of

infectious agent
 Direct contact-:the contact of the skin, mucosa
or conjunctiva with infectious agent directly
transferred from another reservoir.
-
 Direct projection-:of droplets of saliva created
by expiratory activities
 Trans-placental- :direct transmission of an

infectious agent from mother to her fetus in
uterus through the placenta.
Activity(2min)
Categorize correctly
• coughing, syphilis. Touching, HIV, spitting,
kissing, Scabies, TB, sneezing, talking,
passing through the birth canal, singing, sexual
intercourse, biting
• Direct contact-
• Direct projection-
• Trans-placental

.
II. Indirect transmission-

Airborne - particles, dust and droplet nuclei
Vehicle borne - food, water, milk, fomites, or

contaminate objects such as towel, cooking &
eating utensils
 Vector borne transmission- Biological Vs

Mechanical.

.
5. Rout of entry- this is the site on

susceptible host through which an infectious
agent gets in to a susceptible host.
 GI tract
Respiratory tract
Skin and mucus membrane
The manner of entry is one of the factor in
which determines whether or not the agent
will establish infection.

.
6. Susceptible host- in order for transmission to

be completed the existence of susceptible host is
necessary. a susceptible host is one who is highly
likely to acquire infection when exposed to the
agent.
Discussion: on factors host Susceptibility depends on?

Chain of Infection

Disease transmission probability
 There are two common ways of estimating

transmission probability
1. Secondary attack rate
2. Binomial model

1. Secondary attack rate (SAR):
• Refers to number of cases arising from primary case
SAR = number of new cases
number of susceptible individuals
• Secondary cases are those with time of onset b/n the end of
minimum IP (E1) relative to the beginning of the index case
(t=0) and the end of maximum IP (E2) relative to the time of
the maximum infectious period of the primary case, t=I.
.
Time periods for estimating the household secondary attack rate.
Onset of .
. primary
case
Maximum
Maximum
incubation period
infectious period
Definition
of time
intervals Time
Minimum secondary cases
incubation period
Primary Co-Primary Secondary Secondary Tertiary

case case case case case
1 2 3 4 5
Onset of
Cases in
Household
Time
Example
• A study is conducted to assess infection
probability among 400 individuals who were
served meal at the wedding; end of the
minimum and maximum IP were 4th day and
12th day respectively. 100 individuals were
found to have gastroenteritis infection. Among
them 20 individuals infected before the 4 th day
while 10 individuals after 12th day .
A . Calculate SAR

2. Binomial Model of Transmission Probability
Number of susceptible who become infected
Total number of contacts with infective
• The numerator is the same as for secondary
attack rate (SAR).
• Denominator include the total number of
potentially infectious contacts that susceptible
individuals make

.
Example
• Study of HIV transmission was conducted in a
population of 100 steady sexual couples .At
the beginning one couple was already
infected; 25 became infected . The total
number of sexual contacts was 1500.
A. what is the probability of being infected?
B. The probability of escaping infection?

Reproductive Number
• It is a measure of how a disease is infectious
• It is the mean number of secondary cases

caused by each infectious case during infectious
period
• It is required to calculate number of individuals
we need to vaccinate to achieve Herd
immunity

Basic Reproductive Number (Ro)
.
• Ro is the expected number of new infectious
hosts (cases) that one infectious case will
produce during the period of infectiousness.
• Infection will ….. Disappear if R < 1, endemic if

R = 1 and epidemic if R > 1
Example
• If disease X has transmission rate of 0.5,
infectious duration of 2 days. Calculate basic
reproductive number for urban area where
average contact per day is 12?

.
Effective Reproductive Number (R)
• R unlike Ro assumes that all contacts by the
infective case are not with susceptible individuals.
• R= Ro . x (proportion of susceptible population)
• Example: if basic reproductive number of measles

is 12 and 50% of the children are immune; how
many cases effectively a case of the disease will
produce?

Control reproductive number
• is the expected number of new infectious hosts

(cases) that one infectious case will produce
during the period of infectiousness with
presence of intervention
• Rc = Ro x (1-hf)
• h= Vaccine efficacy
• f=proportion of vaccinated individuals

Level of Diseases prevention
• Goals of diseases prevention and control
Prevention
Control
Elimination
Eradication

levels of disease prevention
 The important tasks of health workers are preventing people

from getting sick, preventing sick people from getting worse,
becoming disabled or becoming chronically sick or dying.
 levels of prevention:
1. primary
2. secondary and
3. Tertiary prevention

Methods for prevention. and control of
infectious diseases
1. Increasing host resistance
2. Breaking the chain of transmission of infection
3. Inactivating the infectious agents

1. Action on the reservoir of the infection
Early detection & treatment,. Isolation, Quarantine
2. Interruption of transmission-
E.g. control of vectors, improvement of personal

hygiene, and environmental sanitation.
3. Protection of a susceptible host:
=>Individual level- active & passive immunization and
chemoprophylaxis.
What are vaccines under Ethiopian EPI ?
=> Community level- Herd immunity.
Prerequisite for herd immunity
 Single reservoir
 Direct transmission
 Total immunity
 no carrier state
 Uniform distribution of immunes
 No overcrowding

What proportion of population needed to
vaccinate to attain herd immunity?
• f > (1-1/Ro)/h

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Natural h istory of disease an d Infectio us disease cycle

 Describe Stages in the natural history of diseases

 Discuss Components of infectious disease cycle

 Measure Diseases transmission probability

 Describe levels of diseases prevention

prepared by Delelegn Y (BSc,MPH)

• What is natural history of diseases?

prepared by Delelegn Y (BSc,MPH)

 It is refers to the progression of a disease process in an

 The process begins with exposure to the causative agent

prepared by Delelegn Y (BSc,MPH)

3. The clinical stage

4. Stage of recovery, disability or death

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

Exposure Infection Disease Disease Outcome

Infectiousness Pathogenesis Virulence

prepared by Delelegn Y (BSc,MPH)

• A follow up study was conducted among 500

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

• What are the infectious agents?

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

• What are Reservoirs

prepared by Delelegn Y (BSc,MPH)

B. Animal as reservoir of infection- E.g. anthrax-

C. Non-living things as reservoir - soil, water,

prepared by Delelegn Y (BSc,MPH)

3. Portal of Exit- this are the site on the reservoir

E.g. Respiratory tract

 What are the Types mode of transmission?

prepared by Delelegn Y (BSc,MPH)

I. Direct transmission- the immediate transfer of

 Trans-placental- :direct transmission of an

prepared by Delelegn Y (BSc,MPH)

II. Indirect transmission-

Vehicle borne - food, water, milk, fomites, or

 Vector borne transmission- Biological Vs

prepared by Delelegn Y (BSc,MPH)

5. Rout of entry- this is the site on

prepared by Delelegn Y (BSc,MPH)

6. Susceptible host- in order for transmission to

Discussion: on factors host Susceptibility depends on?

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

 There are two common ways of estimating

prepared by Delelegn Y (BSc,MPH)

Primary Co-Primary Secondary Secondary Tertiary

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

prepared by Delelegn Y (BSc,MPH)

• It is the mean number of secondary cases

prepared by Delelegn Y (BSc,MPH)

• Infection will ….. Disappear if R < 1, endemic if