UNIVERSITY OF MEDICAL
SCIENCES ONDO DEPARTMENT
OF COMMUNITY HEALTH
NURSING
EPIDEMIOLOGY NSC 318
LECTURER: DR MARGARET M. OLADAPO
EPIDEMIOLOGY NSC 318
• UNIT II: EPIDEMIOLOGY AND CONTROL OF COMMUNICALE DISEASES
Objectives
• At the end of the lecture students should be able to :
• Discuss the concept of health and disease
• Explain the theories of disease causation
• Define terms in infectious disease epidemiology
• Discuss the general principles of prevention and control of
communicable diseases
• Analyse the protection of susceptible host
• Discuss the concept of universal precaution and transmission-based
precautions
Definitions
Communicable diseases:
• Communicable diseases are characterised by the existence of a
living infectious agent which are transmissible. Apart from this
infectious agent, two other factors which are the host and the
environment affect the epidemiology of infection.
• It is sometimes defined as a subset of infectious diseases that can
spread from person to person
Definitions
Endemic disease:
• When the epidemic becomes static and refuse to go, it is called endemic.
• It is the constant presence of a disease or infectious agent within a given
geographic area or population group; It may also refer to the usual prevalence of
a given disease within such area or group
Epidemic:
• This is a widespread occurrence of an infectious disease in a community at
a particular time
• It is the occurrence of a disease in a magnitude that is far in excess of what
it use to be in that locality.
Definitions
Pandemic:
• It is found all over the world. e.g Tuberculosis (TB), COVID-19, Yellow
fever, Lassa fever
• Zoonoses : Transmission of diseases by animals e.g. Rabies by dogs
• Infectious disease:
Epidemiological triad
• The epidemiological triad or triangle is a model to explain how
infectious diseases are caused and transmitted.
• This is known as the Agent, Host and Environment.
• The three are used to draw the epidemiological triangle with the apices
representing the Agent, Host and Environment.
• It is a modification to the germ theory of disease.
• The germ is the Agent, the person is the host living in the environment
Spectrum of health and illness
• Both health and illness are dynamic processes and each person is
located on a graduated scale or continuous spectrum (continuum)
ranging from wellness and optimal functioning in every aspect of
one's life, at one end, to illness culminating in death, at the other.
• The spectrum of disease refers to the range of manifestations and
severities of illness associated with a given diseases, illnesses, or
injury.
• For example, HIV infection has broad clinical spectrum, from
inapparent to severe and fulminating.
Spectrum of health and illness
• An individual can be free from illness and progress to better health,
ant continue to progress to positive health, while on the continuum
an individual can have mild illness which can progress to moderate
illness, to severe illness which may later result in death.
Iceberg phenomenon of disease:
• For every disease that affect human being, the tip of iceberg that
you see because the majority of cases are not reported to the
appropriate quarters. Local government report to state government,
state to federal and federal to WHO.
Spectrum of health and illness
• Iceberg phenomenon describe a situation in which a large percentage
of a problem is subclinical, unreported, or otherwise hidden from
view.
• Uncovering disease that might otherwise be below "sea-level" by
screening and early detection often allows for better disease control.
• Some diseases are asymptomatic, treated by traditional healers,
chemists or even self medication which do not come to the health
care facilities
Theory of causation of disease
• 1. The supernatural theory- This states that disease is developed as a result
of sin against God
• 2. The theory of spontaneous generation: Disease occurs spontaneously by
chance
• 3. The theory of miasma: according to this theory, there are some unseen
objects flying in the air, and when you come in contact with these objects
flying in the air you contact illness
• 4. Theory of vital humors: The air is very bad, when you inhale bad air you
develop disease. It is scientific
• 5. The germ theory of disease: According to the theory, there are some
microorganisms that come in contact with human and they cause disease
CONCEPT OF HEALTH AND
DISEASE
• Health according to WHO IN 1948 was defined as state of complete
physical, mental and social wellbeing not merely the absence of
disease or infirmity.
• In 1978, Health was defined as a state of physical, mental and social
wellbeing not merely the absence of disease or infirmity in order for
all citizens of the world to live a socially, economically and productive
life. It is the best definition.
CONCEPT OF HEALTH AND
DISEASE
• Criticism of the definition by who:
• -Health is not usually static but dynamic
• - It is not a measurable definition
• - It was silent on the importance of the environment.
Concept of health and illness
• There are four concepts of health and illness:
• 1. Biomedical concept- Health means absence of disease
• 2. Environmental concept- you are healthy when you are in
equilibrium with your environment.
• 3. You are healthy when you can afford everything you need
• 4. Holistic concept- It comprises the three (3) other concepts. It is
the most reliable concept
Ways the microorganism takes
to affect the man
• Infectivity: it is the ability of a microorganism to affect the host and
cause infection
• Pathogenicity: This refers to the ability of the organism to cause
disease
• Virulence: this is the ability to cause serious threatening disease
Human Immunodeficiency Virus (HIV):
• There are four clinical stages which are
Ways the microorganism takes
to affect the man
Human Immunodeficiency Virus (HIV):
There are four clinical stages which are
• a. Asymptomatic – no symptom shown after the infection
• b. Pathogenicity – it starts showing symptoms
• c. Virulence – The ability of the virus to cause damage to its host. It
moves from HIV to AIDS
• d. - AIDS- this is the fourth (4th) stage.
Categories of disease
transmission
• There are four categories of disease transmission.
• 1. Disease transmitted through the gastrointestinal tract (GIT) e.g.
cholera and typhoid
• 2. Disease transmitted through the respiratory tract e.g. coronavirus
• 3. Disease transmitted through the skin and mucous membrane e.g.
chicken pox and conjunctivitis
• 4. Vector borne disease e,g. malaria
General principles of prevention
and control of infectious
diseases
• The main objective of microorganism is to kill the man. Therefore
action should be taken to ward off infecting microorganisms.
• i The organism can hide in a reservoir
• ii Multiply, replicate 2-4-8-16-32 - - - -
• iii Become infective
General principles of prevention
and control of infectious
diseases
• 1. Eliminate reservoir of infection
• Reservoir may be living or non-living. If living either man or animal.
You don’t eleminate man but instead:
• - Notification- you notify the local government
• - Isolation
• - quarantine
• - Treatment
General principles of prevention
and control of infectious
diseases
Differences between isolation and quarantine:
• - You isolate the sick and quarantine the suspect
• - Quarantine is for the incubation period of the disease while you isolate for
a period of maximum communicability
• - Treatment : you give drug. Chemotherapy
• 2. Interrupt transmission.
Disease of G.I.T:
• - Good toilet system
• - Good water system
General principles of prevention
and control of infectious
diseases
• - Prevention of flies along your food
• - Personal hygiene
• - Hand washing
• Good housing
Disease of respiratory tract:
• - Avoid overcrowding
• - Good ventilation
• - Personal hygiene
• - use face mask
• - social distancing
General principles of prevention
and control of infectious
diseases
Disease of vector:
• Kill the vector using physical or chemical means
• 3. Reduce host susceptibility/protection of susceptible host
• The host can either be man or animal
• - Chemotherapy- Treatment of cases
• - Chemoprophylaxis- using drugs to prevent the disease
• - Immunization-
• - Mass campaigns are sometimes indicated for dealing with acute
epidemics
General principles of prevention
and control of infectious
diseases
• Any vaccine or drug for mass campaign must be effective, safe,
cheap and simple to apply.
• Following the emergency operation of mass campaign, the
programme must be integrated into the basic health services of the
community.
Concept of standard
precautions
Standard Precautions:
• Standard precautions are used in the care of all hospitalised individuals
regardless of their diagnosis or possible infection status.
• The premise of standard precautions is that all patients are colonised or
infected with microorganisms, whether or not there are signs or symptoms
and that a uniform level of caution should be used in the care of all patients
• The Centre for Disease Control and Prevention (CDC) developed standard
precautions to help protect both HCWs and patients from infection with
blood-borne pathogens in the healthcare setting.
Concept of standard
precautions
• These recommendations stress that blood is the most important
source of HIV, HBV, and other blood-borne pathogens and that
infection control efforts should focus on the prevention of exposures
to blood as well as the receipt of HBV immunizations.
• In 1995, the CDC's Hospital Infection Control Practices Advisory
Committee (HICPAC) introduced the concept of standard precautions,
which synthesizes the major features of universal precautions and
body substance isolation into a single set of precautions to be used
for the care of all patients in hospitals regardless of their presumed
infection status.
Concept of standard
precautions
• Blood, certain other body fluids (e.g., semen; vaginal secretions; and
amniotic, cerebrospinal, pericardial, peritoneal, and synovial fluids), and
tissues of all patients should be considered potentially infectious.
• Standard precautions apply to blood; all body fluids, secretions, and
excretions (except sweat); non-intact skin; and mucous membranes.
• The core elements of standard precautions comprise (i) hand washing after
patient contact, (ii) the use of barrier precautions (e.g., gloves, gowns, and
facial protection) to prevent mucotaneous contact, and (iii) minimal manual
manipulation of sharp instruments and devices and disposal of these items
in puncture-resistant containers.
Transmission-based precautions
• Some microbes are so contagious or epidemiologically significant that in
addition to standard precautions, a second tier of precautions –
transmission-bases precautions – should be used when such organisms
had been identified.
• The isolation categories are airborne, droplet, and contact precautions.
• Airborne precautions – are required for patients with presumed or proven
patients with pulmonary TB, varisella, or other airborne pathogens.
• When admitted, patient should be in airborne infection isolation rooms
engineered to provide negative air pressure, rapid turnover of air, and air
either highly filtered or exhausted directly to the outside.
Transmission-based precautions
• Health care workers should wear protective masks at all at all times
while in the patients room.
• Droplet precautions – are used for organisms such as influenza,
meningococcus which can be transmitted by close contact with
respiratory or pharyngeal secretions. When caring for a patient
requiring droplet precautions, the nurse should wear a facemask
within 3 to 6 feet of the patient.
Transmission-based precautions
• But , because the risk of transmission is limited to close contact, the
door may remain open.
• Contact precautions – are used for organisms that are spread by
skin to skin contact, such as antibiotic- resistant to organisms
• Contact precautions are designed to emphasise cautious technique
and the use of barriers for organisms that have serious
epidemiological consequences or those easily transmitted by
contact between health care workers and patients
