EPIDEMIOLOGY

Common Vehicle Type Single exposure or sometimes called single source, or point epidemic. Generally is related to a certain factor that may have occurred at the same time. It indicates the simultaneous exposure of the population to a common source. Example is food borne disease as in breakdown of meat supply is meat-borne epidemic. This represents a circumstance in which a sharp increase occurs within relatively short time interval as the result of a single agent acting during a limited period (e.g. food or chemical poisoning, typhoid). There is varying degrees of incubation period even if they get it at the same time because of the difference of the dosages and relative resistance so that it is not at the same day that they show disease. If we eat the same kind of food, the cases are distributed equally. The manner of onset is explosive or sudden. The population here is more of primary cases than secondary. Multiple Exposure, sometimes the exposure may be continuous, eg. Water supply epidemic. We expect a wavy appearance coinciding with the breakdown of water supply as seen in dysentery. Propagated or Progressive Type Sometimes called contact epidemic, this refers to the peak, regular or irregular in the occurrence of a disease which is more or less constantly present in a community (e.g) measles or poliomyelitis This type is propagated by: a) Person to person spread b) Arthropod c) Vector reservoir We expect in person or insect borne epidemics to have a gradual manner of onset because before we can build up the epidemic we need contact for the disease to spread in a fan fashion. Suppose we have a disease in a community and we have something like water where we expose the individual, he gets down at once. If it is contact type of epidemic it takes time for the disease to spread in a fan like as time goes on if there are more reservoirs than there is more spread of the disease. So, it takes time for the epidemic to develop. It is the same in the insector or vector, epidemics for example, in malaria a feed infected mosquitoes spread the infection but as time goes on , greater number of mosquitoes are affected. The number grows as there is greater increase of incidence.

Characteristics of epidemics Type of Onset or Manner of Onset A) May be SUDDEN, ABRUPT or EXPULSIVE. This type of onset is based on time relationship. The time factor is the period of incubation (entrance of organization until the appearance of the first sign and symptoms of the disease). If the majority of the cases of the particular epidemic fails within the initial incubation period of the disease, it is sudden in onset B) INSIDUOS or GRADUAL, where more cases start after the incubation period. If gradual, transmission is difficult from person to person, or propagated epidemic. The term primary is relative. PRIMARY CASES are usually the cases not traceable to a pre-existing cases, mass infection is more of primary cases. SECONDARY CASES are those that we trace to pre-existing cases. Progressive infection is more of secondary cases. Example, if several people get infected because of the primary case, it is secondary cause. DIFFERENT TYPES OF EPIDEMIC CURVES The type of epidemic curves are: 1.CLASSICAL which is characterized by short ascending and climb This is a picture of common source, there is a rapid transmission where there Is a big dose of the organism or else the resistance is weaker. The huger decending limb is due to the development of secondary cases. Generally, we expect deaths in the ascending limb or in primary cases who got a heavier dose of the organism. Descending limb represents secondary cases have less deaths because, they got lesser virulent organisms.

2 INVERTED CURVE characterized by LONG ASCENDING, SHORT DESCENDING LIMB, it indicates the transmission is more complex and the disease has a longer incubation period. This is a picture of person to person spread, MALARIA and INSECT BORNE DISEASE.

3 BELL SHAPED CURVE with rapid ascending and rapid descending limb It indicates that the spread is rapid and the transmission is simple so there is rapid elimination of susceptible, as in measles and polio. It thus indicates a rapid reduction of susceptible. Those who develop the disease earlier have more deaths and this depends on the resistance and experience of the disease.

DISEASE OUTBREAK INVESTIGATION Data from an investigation of an epidemic of German Measles in a remote village in Brazil are given in the table below:

Question what is the incidence rate (%) of illness for all age groups? Incidence (NEW CASES) Rate = Incidence / Population FORMULA : Total number of persons with Symptomatic Illness/ Total Population at risk x 100% 312/614 x 100% = 50.8 What is the percentage of % of infection that is asymptomatic (subclinically) FORMULA: %Assymptomatic cases= Total No. of Assymptomatic Persons/ Total number of infected persons x100% [207/(207+312)x100% = 39.9% Based on the age specific infection rates, approximately when din German measles previously occur in this village in relation to the current epidemic. ANSWER: The low attack rate (10%) in persons over 60 suggests that this age group had developed immunity in German measles as a result of prior exposure at least 60 years before since there was uniform susceptibility to .

DISEASE OUTBREAK INVESTIGATION Approximately 100 people attended a buffet dinner at which they were served fried chicken, ham, meat balls, green beans, potato salad, and apple pie. Thirty guests developed vomiting and diarrhea within 6 hours of the dinner. An epidemiologic investigation , interviewing 60 guests (25 ill and 35 not ill). Revealed the ff data:

Question: The incriminated food item is most likely to be: a)Chicken b)ham c) meatballs d)potato salad e) apple pie

Answer: The specific attack rate must be significantly higher in the group that ate the food compared to the group that did not eat the food. If there is significant difference In the attack rates, the food rates, the food item is not responsible for the outbreak. The data given in the question show that the meatballs were responsible. Note that two ill persons did not eat meatballs. These cases could have occurred by cross contamination of serving spoons or as a result of an unrelated diarrhea-causing agent.

NOTES FROM Dr. Manalos Lecture Transcribed by: Leoluis Nathaniel R. Uy