33 Epidemiology and control of infectious diseases Flashcards

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1
Q

Epidemiology is study of population. Important to look at who, when, where when investigating an outbreak

Define prevalence

Define incidence

A

Prevalence is number of existing cases in population at specific given time. Influenced by incidence, and duration of diseases

Incidence is number of new cases occurring during a specific time period

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2
Q

What types of studies are used in scientific investigation

A

Cross-sectional study

Case-control

Cohort

Intervention

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3
Q

What are cross-sectional studies, and what are they useful for?

A

Observational study. Measure prevalence of a disease at specific point in time.

e.g what proportion of population has past infection lyme disease

Cheaper, and easy to do.

Sometimes difficult to tell what relationship is between outcome and exposure.

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4
Q

What are case-control studies, and what are they useful for?

A

Identify people with outcome (cases) and group without outcome (controls).

both of these groups then comapred with regards to previous history of exposure e.g smoking

good for investigating rare diseases

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5
Q

What are cohort studies, and what are they useful for?

A

Follow group of people who do not initially have the outcome of interest, and determine whether they develop disease after receiving different exposures

Measures incidence

Good at investigating rare exposures e.g radiation exposure causing disease

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6
Q

What are intervention studies, and what are they useful for?

A

Two groups allocated to either exposure or no exposure. Followed over period of time to see who develops disease.

Gold standard and provides strong evidence

Randomisation
Placebo-controlled
Double-blind

Expensive and time consuming

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7
Q

Infectiousness of an agent depends on many factors.

What are they?

A

Time between acquiring infection, and becoming infectious
Duration of infectiousness
Probability of transmission

Contact between susceptible people

Susceptibility of population

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8
Q

What is meant by “latent period of infection”

What is meant by “average generation time of infection”

A

Period between infection occurring, and becoming infectious

e.g measles is latent for 6-9 days, followed by infectious period of 6-7 days

Measles symptoms occur after becoming infectious, so isolating after this is futile.

Sum of latent period of infection, plus infectious period

These both reference the infective agent, and not the patient

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9
Q

What is meant by incubation period?

A

Time from infection, to symptoms developing

Incubation period and latent period can both be different.

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10
Q

What is meant by R0?

What if R0 is >1 or <1

A

Basic reproductive rate is average number of infected secondary cases produced by each infectious cases in susceptible population. Termed basic, as assumes fully susceptible population.

R0>1 - each infection causes more than 1 further infection

R0<1 - each case leads to less cases, so disease will run its course

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11
Q

what is R0 dependent on?

A
  • Duration of infectiousness
  • Number of contacts per unit time
  • Transmission probability

This gives basic reproductive rate, which assumes fully susceptible population.

Net reproductive rate is depending on R0 multiplied by proportion of susceptible individuals.

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12
Q

How does R0 relate to herd immunity?

A

Proportion of population immune to infection is called herd immunity. This is threshold in population that is needed to be immune in order for disease to die out R0<1

Allows us to estimate how much vaccine coverage required to control an infecitous disease.

Measles has high R0 (15-17), so need >92% for coverage

Rubella has lower R0 (7-8), so need only 85% coverage

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13
Q

How do we measure vaccine efficacy?

A

compare incidence of disease in unvaccinated and vaccinated individuals

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14
Q

Notifiable diseases should be reported to Health Protection Team. What role do they have?

A
Identify source
Offer chemoprophylaxis
Vaccination
Education
Closing down premises
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15
Q

What is schedule 1 and schedule 2 of Health Protection list of notifiable diseases?

A

Schedule 1 - notifiable diseases

Schedule 2 - notifiable organisms

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16
Q

What are examples of notifiable diseases? Schedule 1

diseases which may present significant harm or have high transmissibility.

Doctors can also report cluters of cases which are not notifiable e.g parovirus B19 on haematology ward

A
Acute encephalitis
Acute infectious hepatitis
Acute poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
COVID-19
Diphtheria
Enteric fever
Food poisoning
Hemolytic uremic syndrome
Infectious bloody diarrhoea
Invasive group A streptococcal disease
Legionnaire's disease
Leprosy
Malaria
Measles
Meningococcal sepsis
Mumps
Plague
Rabies
Rubella
Severe Acute Respiratory Syndrome (SARS)
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Typhus
Viral haemorrhagic fever (VHF)
Whooping cough
Yellow fever

Separate reporting system for HIV, STIs, HAI, CJD

17
Q

What are examples of notifiable organisms? Schedule 2

A
Bacillus anthracis
Bacillus cereus (only if associated with food poisoning)
Bordetella pertussis
Borrelia spp
Brucella spp
Burkholderia mallei
Burkholderia pseudomallei
Campylobacter spp
Chikungunya virus
Chlamydophila psittaci
Clostridium botulinum
Clostridium perfringens (only if associated with food poisoning)
Clostridium tetani
Corynebacterium diphtheriae
Corynebacterium ulcerans
Coxiella burnetii
Crimean-Congo haemorrhagic fever virus
Cryptosporidium spp
Dengue virus
Ebola virus
Entamoeba histolytica
Francisella tularensis
Giardia lamblia
Guanarito virus
Haemophilus influenzae (invasive)
Hanta virus
Hepatitis A, B, C, delta, and E viruses
Influenza virus
Junin virus
Kyasanur Forest disease virus
Lassa virus
Legionella spp
Leptospira interrogans
Listeria monocytogenes
Machupo virus
Marburg virus
Measles virus
Mumps virus
Mycobacterium tuberculosis complex
Neisseria meningitidis
Omsk haemorrhagic fever virus
Plasmodium falciparum, vivax, ovale, malariae, knowlesi
Polio virus (wild or vaccine types)
Rabies virus (classical rabies and rabies-related lyssaviruses)
Rickettsia spp
Rift Valley fever virus
Rubella virus
Sabia virus
Salmonella spp
SARS coronavirus
Shigella spp
Streptococcus pneumoniae (invasive)
Streptococcus pyogenes (invasive)
Varicella zoster virus
Variola virus
Verocytotoxigenic Escherichia coli (including E. coli O157)
Vibrio cholerae
West Nile virus
Yellow fever virus
Yersinia pestis
18
Q

When should ward doctor phone Health Protection, and when should on-call microbiologist contact Health Protection?

A

If clinical picture e.g necrotising fasciitis - ward doctor should inform HPE

If clinical picture e.g necoritisng fasciitis, and blood cultures show GAS - microbiologist should contact HPE