EPIDEMIOLOGY

INTODUCTION

The branch of medicine which deals with the incidence, distribution, and possible control of diseases and
other factors relating to health. Epidemiology is the study of how often diseases occur in different groups of
people and why. Epidemiological information is used to plan and evaluate strategies to prevent illness and as
a guide to the management of patients in whom disease has already developed.

Like the clinical findings and pathology, the epidemiology of a disease is an integral part of its basic
description. The subject has its special techniques of data collection and interpretation, and its necessary
jargon for technical terms. This short book aims to provide an ABC of the epidemiological approach, its
terminology, and its methods. Our only assumption will be that readers already believe that epidemiological
questions are worth answering. This introduction will indicate some of the distinctive characteristics of the
epidemiological approach.

Definition of Epidemiology:-

Epidemiology is the study of the distribution and determinants of health-related states or events in
specified populations, and the application of this study to the control of health problems.

Epidemiology is the study and analysis of the distribution, patterns and determinants of health and
disease conditions in defined populations. It is a cornerstone of public health, and shapes policy decisions
and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare.

Objectives-in the mid-1980s, five major tasks of epidemiology in public health practice were
identified: public health surveillance, field investigation, analytic studies, evaluation, and linkages. (17) A
sixth task, policy development, was recently added.

Characteristics-It extracts six types of epidemiological characteristic: design of the study, population that has
been studied, exposure, outcome, covariates and effect size.

Components:-

The epidemiologic triangle is made up of three parts: agent, host and environment.

Types-Three major types of epidemiologic studies are cohort, case-control, and cross-sectional studies
(study designs are discussed in more detail in IOM, 2000). A cohort, or longitudinal, study follows a defined
group over time.

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Process of epidemiology:-

1. Identify investigation team and resources.

2. Establish existence of an outbreak.

3. Verify the diagnosis.

4. Construct case definition.

5. Find cases systematically and develop line listing.

6. Perform descriptive epidemiology/develop hypotheses.

7. Evaluate hypotheses/perform additional studies as necessary.

8. Implement control measures.

Epidemiology is the study of the distribution and determinants of health-related states or events in
specified populations, and the application of this study to the control of health problems.

Every public health worker should be familiar with the basic principles in this definition and how they
are useful Distribution - Epidemiology is concerned with the frequency and pattern of health events in a
population. Frequency includes not only the number of events in a population, but also the rate or risk of
disease in the population. Determining the rate of disease occurrences (number of events divided by size of
the population) is critical for making valid comparisons across different populations.

Determinants:-

Epidemiology is also used to search for causes and other factors that influence the occurrence of
health-related events. The occurrence of a health-related event is usually related to multiple determinants
that should be considered. Examples of determinants include host susceptibility to a disease, and opportunity
for exposure to a microorganism, environmental toxin, insect vector or other infected individual that may
pose a risk for acquiring disease.

Specified populations:-

Epidemiologists are concerned with the collective health of people in a community or other area and
the impact of health events on that population.

Application:-

Epidemiology provides data for directing public health action. An epidemiologist uses the scientific
methods of descriptive and analytic epidemiology in "diagnosing" the health of a community, but also must
call upon experience and creativity when planning how to control and prevent disease in the community.
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 Disease surveillance usually begins with descriptive epidemiology -- defining the what, who, when
and where of health-related events.

What - Define the disease events and/or its determinants:-

Who:- Descriptions of demographic characteristics are helpful in determining which groups are at risk for
some outcome. The demographic characteristics usually include age, sex and race/ethnicity. Other categories
include socioeconomic status, history of occupation, or smoking habits, which provide useful information
about exposures that may present a risk. A history of underlying diseases may be useful for determining
susceptibility to certain conditions.

When:- Following changes in disease rates over time, following long-term disease trends and knowledge of
the seasonality of certain diseases helps identify unusual occurrences that may define epidemics. Temporal
associations between particular exposures on illness give information about incubation periods and
exposures posing a risk to others.

Where:- Insight into the geographical extent of health-related events gives an idea of where the agent that
causes a disease normally lives and multiplies, what may carry or transmit it and how it spreads.

The Primary Applications of Epidemiology in Public Health:-

To set policy and plan programs, public health officials must assess the health of the population they
serve and must determine whether health services are available, accessible, effective and efficient.
Epidemiology provides data for directing public health action. The information is used when planning how
to control and prevent disease in the community. Through public health surveillance, a health systematically
collects, analyzes, interprets and disseminates health data on an ongoing basis. By knowing the ongoing
pattern of disease occurrence and disease potential, a health agency can effectively and efficiently
investigate, prevent and control disease in the community.

Uses of Epidemiology:-

 Count health-related events.

 Describe the distribution of health-related events in the population.

 Describe clinical patterns.

 Identify risk factors for developing diseases.

 Identify causes or determinants of disease.

 Identify control and/or preventive measures.

 Establish priorities for allocating resources.

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 Select interventions for prevention and control.

 Evaluate programs.

 Conduct research.

 risk factors and causes.

 drug trials / vaccine trials.

Operational research:-

Purposes of Communicable Disease Investigation and General Principles of Preventing Transmission

Introduction:-

These guidelines have been written to assist public health staff engaged in investigating communicable
diseases. Their intent is to provide basic, practical, up-to-date and easy-to-understand information which has
been coalesced and interpreted from a variety of sources. These guidelines have been written as carefully as
possible to balance the amount of work necessary to follow up a reported case against the probability of
controlling spread of the disease.

Only certain diseases are included in these guidelines. This is based upon their frequency and complexity.
For further information about these and other diseases, consult Control of Communicable Diseases in Man.

Remember, these are only guidelines. All situations differ and best judgment should prevail. Some
situations require a more stringent approach. Some require a less stringent approach.

Purposes of Communicable Disease Investigation:-

Nothing is less self-fulfilling than going through the motions of a task without understanding its
purpose. When investigating a report of communicable disease, always keep in mind the purposes are to:

Prevent Transmission from Cases to Contacts:-

A full discussion of this topic begins below. Identify the Source of the Disease: The source may be in
the environment, a food, or another person. Its identification can lead to control. Identify Other Cases: Each
reported case should be regarded as a sentinel health event. Efforts to identify other cases which are not
diagnosed and/or reported may uncover outbreaks and common sources. It is important to question the
reported case about others who have been exposed or who have similar symptoms.

Conduct Surveillance:-

Information collected when investigating a reported disease can be examined on a state or regional
basis to identify outbreaks or trends and to formulate policy. This information is collected on standardized
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forms and often is sent to the Centers for Disease Control and Prevention for surveillance on a national
basis.

Ensure that the Patient has Adequate Medical Supervision:-

Our responsibilities include making sure the patient is well cared for and understands the
consequences of his illness. Where medical care is inadequate, appropriate referrals should be made.

General Principles of Preventing Transmission:-

This section describes how cases and contacts can be managed to prevent transmission.

Case Management:-

Verify the Diagnosis: It is very important to promptly establish or verify the etiologic agent
responsible for the disease. For many diseases reported by physicians or others, there are often little or no
laboratory data initially available to verify the diagnosis. Since control efforts depend on the exact diagnosis,
it is important to: (a) determine if this information exists; (b) arrange for laboratory tests if the information
does not otherwise exist; or (c) make the best guess about diagnosis if it cannot be obtained.

Determine if the Case is Infectious or Possibly Infectious:-

If the case is still infectious, you must identify available measures for preventing transmission. There
are two ways to assess the case's infectivity:

Estimation-

Uses the date of onset of illness, dates of known treatment, and known periods of infectiousness for
an illness. For example, hepatitis A is no longer infectious after 1 week of the onset of symptoms. Strep
throat is no longer infectious after 24 hours of treatment. verification--requires laboratory testing of
specimens for the case (for example, a stool specimen for a foodhandler with salmonellosis). Which method
you use depends upon the disease (the period of communicability for some diseases is precise; for others it is
not precise), the quality of information about the case (e.g., is date of onset known?), and the need to know
definitely whether the case is infectious.

In practice, because of delays in diagnosis and reporting, many cases will have passed the infectious
stage by the time they are reported. In this instance, the opportunity to prevent transmission is lost, but
preventive efforts can be directed to the case's contacts, and other purposes of case investigation can be
fulfilled. You may need to contact the physician to fill in information about the case, determine results of
laboratory tests, or arrange for tests. Also ask about similar cases for which a report may be pending.

Minimize the Duration of the Case's Infectivity: Drugs (antimicrobials) are the most important means
to shorten the duration of infectivity for many diseases. Usually, decisions about drug treatment will be

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made by the time you investigate. However, sometimes it may be necessary to work with the patient and
physician to ensure the patient is appropriately treated.

Put into Effect Practices for Preventing Transmission: These practices depend upon the disease and other
circumstances. If the disease warrants, the case may have to employ these practices while ill and for a period
after recovery during which (s)he is still infectious:

Disinfect and dispose of contaminated material (e.g., blood, saliva, feces, urine, eating utensils,
bedding, clothes, toys, etc.)

Disinfect the case, clothing, bedding, etc. (e.g., lice):-

Encourage behavioral practices of the case (e.g., handwashing, covering the nose and mouth when
coughing/sneezing, protecting lesions from contact with another person. Also, there may be a need for
changes if individual is a foodhandler.) Isolate the case - the duration and degree depends upon the illness.

Contact Management:-

Determine the risk of infection to contacts: What is the frequency, duration and dosage of the
exposure? Often, these characteristics can only be described vaguely. It is usually reasonable to assume
persons living in the same household had opportunity for exposure.

Is the contact susceptible? Has the person been vaccinated, or previously infected? Is there evidence
of a compromised immune system (surgery, steroids, etc.)? Does the disease result in immunity or are
people generally susceptible?

Determine if the contact is ill or infected:-

Look for clinical signs or symptoms. It is important to know if the contact is in the early stages of an
illness or asymptomatic infected, you must rely on the laboratory. If you determine that a contact is ill or
infected, manage him/her as a case.

Prevent illness in susceptibles: It may be useful for you to think of contacts in two ways: Those who have
been exposed, and those who might yet be exposed, either to the original source or to a contact who
subsequently acquires an infection.

Uses of epidemiology:-

Epidemiology is the only way of asking some questions in medicine, one way of asking others (and
no way at all to ask many). Seven ‘uses' of epidemiology have been described:

 In historical study of the health of the community and of the rise and fall of diseases in the
population; useful ‘projections' into the future may also be possible.

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  For community diagnosis of the presence, nature and distribution of health and disease among the
population, and the dimensions of these in incidence, prevalence, and mortality; taking into account
that society is changing and health problems are changing.

 To study the workings of health services. This begins with the determination of needs and resources,
proceeds to analysis of services in action and, finally, attempts to appraise. Such studies can be
comparative between various populations.

To estimate, from the common experience, the individual's chances and risks of disease.

 To help complete the clinical picture by including all types of cases in proportion; by relating clinical
disease to the subclinical; by observing secular changes in the character of disease, and its picture in
other countries.

In identifying syndromes from the distribution of clinical phenomena among sections of the
population.

In the search for causes of health and disease, starting with the discovery of groups with high and
low rates, studying these differences in relation to differences in ways of living; and, where possible, testing
these notions in the actual practice among populations.

Role of a nurse in epidemiology -Role of a nurse in epidemiology can be explained in 4 aspects. These are:

 Preventive role

 Promotive role

 Curative role

 Rehabilitative role

 Role in Prevention

Epidemiology is one of the basic sciences applicable to nursing. The nurses working in a community
deal with people in various settings and help them solve their health problems. They make the nursing
process. They identify and investigate the problem, formulate and test the hypothesis regarding the causal
factors, formulate alternative interventions and implement to prevent and control the problem and evaluate
effectiveness of intervention.

They have an active role in the prevention and control of communicable diseases which include:

 Identify sources of infection and methods of spread of infection.

 Health education of people in general.

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  Having an important role in the prevention and control of chronic and noninfectious problems, such
as cardiovascular conditions, accident, cancer, etc.

 Notification of certain diseases like measles, diphtheria, tetanus, etc. to health authority.

They can also teach and supervise other workers in surveillance activities.

Role in Promotion of Health:-

Using knowledge of epidemiology, the community health nurses can set priorities for health
programs according to the immediate health needs.

Using knowledge of epidemiology, they establish the health resources more effectively, by giving
more emphasis to urgent health problems needing attention.

Plan the strategies to meet the new health needs. Nurses in the community as a member to health
team participate in surveillance at all levels, which will depend on the existing situation, their preparation,
and the level at which they work.n be explained in 4 aspects. These are:

 Preventive role

 Promotive role

 Curative role

 Rehabilitative role

 Role in Prevention

Epidemiology is one of the basic sciences applicable to nursing. The nurses working in a community
deal with people in various settings and help them solve their health problems. They make the nursing
process. They identify and investigate the problem, formulate and test the hypothesis regarding the causal
factors, formulate alternative interventions and implement to prevent and control the problem and evaluate
effectiveness of intervention.

They have an active role in the prevention and control of communicable diseases which include:

 Identify sources of infection and methods of spread of infection.

 Health education of people in general.

 Having an important role in the prevention and control of chronic and noninfectious problems, such
as cardiovascular conditions, accident, cancer, etc.

 Notification of certain diseases like measles, diphtheria, tetanus, etc. to health authority.

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They can also teach and supervise other workers in surveillance activities.

Curative Role:-

 They may deal with the problem independently, especially when these are the nursing problems,
minor ailments or simply health conditions and they are only the health workers in a healthcare
setting.

 They may participate as them members, especially when it is large scale investigation, e.g.
occurrence of any epidemic.

 They may participate in data collection, data analysis, planning, implementation and evaluation.

 They may early diagnosis and treatment.

 They traces the contacts and keep them under surveillance.

 They identify sources of infection and methods of spread of infection.

 Using knowledge of epidemiology, the community health nurses can set priorities for health
programs according to the immediate health needs.

 Using knowledge of epidemiology, they establish the health resources more effectively, by giving
more emphasis to urgent health problems needing attention.

 Plan the strategies to meet the new health needs. Nurses in the community as a member to health
team participate in surveillance at all levels, which will depend on the existing situation, their
preparation, and the level at which they work.

Role in Rehabilitation:-

 They evaluate the effectiveness of measures used to control specific disease or disorder.

 They can help people in the restoration of family and social life.

 They can also play a role in psychological rehabilitation by helping in restoring personal dignity and
confidence of a person.

 Conclusion-is the basic science of public health, epidemiology includes the study of the frequency,
patterns, and causes of health-related states or events in populations, and the application of that study
to address public health issues. Two essential concepts of epidemiology are population and
comparison.

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CONCLUSION:-

Here I state my topic epidemiology branch of medicine which deals with the incidence, distribution, and
possible control of diseases and other factors relating to health. Epidemiology is the study of how often
diseases occur in different groups of people and why. Epidemiological information is used to plan and
evaluate strategies to prevent illness and as a guide to the management of patients in whom disease has
already developed.

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BIBLIOGRAPHY:-

 Basheer Shebeer.P, khan [Link], “a concise textbook of advance nursing practice” published by
emmess, first edition, page number- 60-68.

 Masih shabnam, “essentials of nursing management in service andeducation” published by lotus

 [Link]
 [Link] .COM
 [Link]

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