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BMS2052 > Epidemiology > Flashcards

Epidemiology Flashcards

1
Q

What is public health?

A

When we look at the health of the population as a whole

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2
Q

What is epidemiology?

A

The study of the distribution of health related events, and the determinants of these health related events in specified populations, and the application of this study to the prevention and control of health problems

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3
Q

Breaking down epidemiology definition

A

Study: Is scientific, looks at data
Distribution: Look at the patterns and frequencies present in data
Determinants: Looks at risk factors that contribute to an increased risk of developing the disease (genetic, social, environmental, behavioural)
Health events - unfavourable health states such as physical injury or mental harm; includes communicable diseases which involves the transmission of a specific infectious agent to a susceptible host, and non-communicable diseases, which are not passed person -person and do not have an acute infectious process - they are often chronic (cancer, CVD)
Specified population - we study the health and disease of groups that are representative of populations - we do not look at individual health status

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4
Q

Origins of Epidemiology

A

19th century is when we started measuring the distribution of disease in human populations and kept records regarding this
We started off with communicable diseases such as cholera which caused a lot of deaths at the time. In the 20th century, we looking at linking environmental factors to non communicable diseases (cancer, CVD), and more recently, we have looked at linking social determinants such as low income and inadequate access to healthcare to to disease

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5
Q

What do epidemiologists do

A
  • They study positive health events, course of disease, and how to improve the health status of populations
    -They discover the causative agent of communicable diseases, contributing host, and environmental factors that affect health
  • They look at patterns in causes of ill health, disability and death and determine the relative importance of these causes
    They identify segments of the population that have the greatest risk of developing a disease when considering specific causes of ill health
    They evaluate the effectiveness of health programs and services in improving the health of populations
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6
Q

Who is John Snow, and what did he contribute to epidemiology

A

John Snow is considered to be the father of epidemiology
He used public health measures and epidemiological techniques to discover the causes of diarrhoeal disease outbreaks
A water pump in Broad Street, London was discovered to be the source of the outbreaks - outbreak was resolved by ensuring the water pump was not in use

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7
Q

Cholera disease perspective, then

A

Then:
The cause of cholera was considered to be bad air (miasma), or punishment from God, or the rich poisoning the poor
There was little concept of the existence of microorganisms
There was high mortality rates from cholera
Water supply was directly derived from the Thames river
No efficient sewage system separating water for consumption and waste water - waste water directly flowed into the Thames River

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8
Q

Cholera disease perspective, now:

A

Now

  • Cholera is caused by the consumption of drinking water contaminated by bacteria
  • The specific microbial agent is Vibrio Cholerae
  • Still high mortality from cholera, although it has reduced in comparison to Then
  • Separate water supply - efficient water sanitation systems that separate water for consumption from waste water and therefore prevent contamination of drinking water
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9
Q

How did John Snow discover the source of cholera?

A
  • John Snow didn’t believe that the cause of disease was bad air- if the disease is airborne then it would have affected the lungs, but it didn’t
    John Snow believed the disease was waterborne and set out to prove it
    He located the houses of people who had the disease and calculated the distance from their homes to water pumps in the region to conclude which water pumps served as their water supply
    He then compared various water supplies in the region in terms of how much of a link they had to cases
    He linked the outbreak to the Broad Street pump - everyone who got their water from the Broad Streep Pump got sick - furthermore, there was a certain of group people who lived in close proximity to the Broad Street Pump but didn’t develop cholera because they got their water from the wine brewery the worked at instead of Broad Street Pump
    So, we see that the consumption of drinking water from the Broad Street Pump led to disease, and those who didn’t drink water from the pump didn’t develop the disease - the presence of the pump in Cholera cases but its absence in healthy people’s habits confirmed that the Broad Street pump was the source
    John Snow then convinced the authorities that the problem was the Broad Street pump which was distributing contaminated drinking water to residents in the area, thus causing disease
    This lead to the realization that water could contain disease-causing agents - moving forward authorities focused on building better sanitation systems
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10
Q

What are the 3 determinants of infectious disease epidemiological triad?

A
  1. Infectious agents - we look at type of infectious agent (bacteria, virus, fungi), how virulent it is, how quickly it grows, and the amount present in the environment (dose)
  2. Host factors which affect their susceptibility or resistance to the pathogen such as ethnicity, gender, behaviours such as alcohol consumption and diet, cultural practices, genetics such as strength of immune system
  3. Physical environment factors such as climate and weather patterns which can enhance transmission, and the availability of vector in the environment for the transmission of infectious disease, and the social factors such as income, education, overcrowding, access to health care
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11
Q

How is pathogen dose important?

A

Pathogen dose can affect the development of disease
Individuals who were exposed to a greater dose of salmonella had a shorter incubation period - the onset of disease symptoms was much quicker after exposure than normal

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12
Q

What are risk factors?

A
  • Anything that increases your chance of developing disease
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13
Q

What are two types of risk?

A

Modifiable risk - Refers to risks that can be changed - if so, they can improve health. Often refers to factors external to host - environmental risks such as asbestos which can be altered by removing the hazard and changing the built environment. Also refers to behavioural risks such as unhygienic behaviours- we can educate people about the importance of handwashing and remove this risk.

Unmodifiable risk factors - risk factors that cannot be changed, such as a host’s genetics

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14
Q

Mortality

A

Amount of deaths due to the disease in the population - number of deaths/number of cases

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15
Q

Morbidity

A

Doesn’t look at deaths - looks at amount of illness/symptoms due to disease - can be useful for looking at the disease traits of pathogens and ranking the severity of pathogens

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16
Q

Elimination

A

Involves reducing cases to 0 in a defined geographical location (one part of the world) - requires continuous intervention and doesn’t mean every single microbe that exists has been disposed of , eg measles

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17
Q

Eradication

A

Complete and permanent reduction of cases to 0 worldwide - besides where the microorganism is stored in labs for studies and tests, it should be completely disposed of - it should not exist in nature eg smallpox

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18
Q

Burden of disease

A

Measures the impact of living with disease and dying prematurely from illness
Represents the gap from the current health status of the population from the ideal health status
Considers factors such as morbidity and mor income lost due to living with days
Unit of measure - Disability Adjusted Life Years - 1 DALY represents one year of healthy life lost due to this disease

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19
Q

Prevalence

A
  • Looks at the total number of cases in a population at a specified point in time - is considered a snapshot
  • total number of cases/ total population
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20
Q

Example of Prevalence

A

Random sample of adults in Victoria were rung up based on randomisation of their phone numbers and 3794 interviews were conducted (standardised questionnaire)

  • People were asked to report on mental health problems and 497 reported they were experiencing some kind of mental distress
  • The prevalence of mental illness here is 497/3794 x 100 = 13.1% (so roughly 13.1% of people in the population reported mental health issues)
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21
Q

Incidence

A

Looking at only the number of new cases of disease in a population compared to the total number of cases that was in the population in a previous time period
Is an indication of infection risk
Number of new cases/ total population

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22
Q

Example of Incidence

A
  • Start with a population that is free of disease
    • On the first day (Monday), in the essentially naïve population of 1000, there were 50 new cases
    • On Tuesday, there were 100 new cases in addition to the previous 50 cases which have now become the existing cases
  • Prevalence on Tues would be 150 per 1000 (15%) whereas incidence for Tues would be 100 per 1000 (10%)
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23
Q

Prevalence vs Incidence : Similarities

A

Both measures allow comparison between different populations in the same time frame, and require you to know the size of the population, and the number of people who have the disease within a specific timeframe

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24
Q

What does prevalence measure?

A

The level of current disease in a population

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25
Q

What does incidence measure?

A

How quickly are new cases happening

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26
Q

How can we decrease prevalence?

A

Through treatment, which will reduce the total number of cases

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27
Q

How can we decrease incidence?

A

Through prevention methods such as vaccines which slow the spread and decrease the rate at which new cases happen

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28
Q

What does high incidence but low prevalence indicate?

A

That the disease is contagious (high incidence) but has a high mortality so the total number of cases at any point is lower because people die too quickly

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29
Q

What does high prevalence but low incidence indicate?

A

That the disease is incurable or long-lasting, but a highly effective vaccine for it has been developed. The prevalence would still be high due to pre-existing cases, but incidence would be low as the vaccine is preventing new case from occurring.

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30
Q

Sporadic levels of disease

A

Cases coming in but then going to 0 occasionally at infrequent intervals in geographically separate areas

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31
Q

Endemic level of disease

A

Baseline level of disease- disease is always present in the population but at low to moderate levels- doesn’t go away

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32
Q

Epidemic

A

Increase in cases within a population above endemic/expected levels. Can be sudden and rapid.

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33
Q

Outbreak

A

large number of cases accumulating in a small geographic area such as a town

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34
Q

Cluster

A

Increased number of cases all grouped together around a similar time and similar location, with the number of actual cases often greater than what is reported - eg a certain number of cases are linked to a particular exposure site

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35
Q

What conditions do we need to go from endemic to epidemic?

A

The causative agent is present in high numbers perhaps due to an increase in the availability of vectors due to climate change, an increase in the amount of individuals that are susceptible in a population, mutations in pathogen that have resulted in increased virulence or more efficient human-human transmissions or allowed it to infect members through new portals of entry, changes to living standards of population that has increased chances that an individual’s environment is contaminated by the pathogen such as natural disaster

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36
Q

Naive population

A

A new pathogen emerges in a population that has no immunity to it

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37
Q

Re-emerging population

A

Population has been exposed to the pathogen previously but the pathogen hasn’t been around in the population for a long time due to elimination strategies so individuals now don’t have long-term immunity to fight infection

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38
Q

Pandemic

A

When you have the same epidemic in several countries - epidemic has spread from one country to other regions globally - often many continents, countries and people affected

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39
Q

Example of a pandemic

A

SARS in 2003
Outbreak in Southern China as virus crossed from animals to humans - as cases rose above baseline levels in China it spread to other continents and populations where the disease had never been observed

Many pandemics in recent years have been caused by coronaviruses - COVID-19, SARS

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40
Q

What is the first stage of disease

A

Exposure - the host and infectious agent must encounter each other - eg a healthy child sitting next to a child with influenza

41
Q

What are the 3 outcomes of exposure?

A

No infection - the host has a robust innate immune response
Clinical infection - the host develops symptoms - they either die from it or recover and gain immunity
Sub-clinical infection - Are infected but show no symptoms - are asymptomatic carriers

42
Q

After infection, what is the next stage?

A

Incubation period - refers to initial changes to the person after infection that goes unnoticed because the person has no symptoms (sub clinical infection)
The incubation period lasts until the onset of symptoms
The length of the incubation period varies for different pathogen - it depends on factors such as amount of pathogen, host factors, site of infection, and the transmissibility of the pathogen - eg COVID-19 has a 14 day incubation period but HEP A has a 7 week incubation period

43
Q

What is the next stage after incubation period

A

Some infections have a prodromal stage
This is the period after the incubation period but before symptoms develop
The pathogen continues replicating at site of infection, triggering an immune response and mild, non-specific symptoms that are not useful for diagnosis

44
Q

What information can the incubation period provide you with?

A

It can allow you to predict disease severity
- Eg for tetanus, individuals who had shorter incubation periods had a more severe form of the disease, whereas individuals with longer incubation period had a more mild/moderate form of disease

-It also helps you to identify how long a positive individual and close contacts should quarantine/isolate for, and what individuals would be considered close contacts

45
Q

What stage is after the prodromal period

A

Illness stage
Marked by onset of symptoms
Here is where the most severe symptoms and microbial growth occurs
Immune response is still being formed - innate immune response and IgM dominates
Peak of illness is called ACME , after ACME there is potential to recover or die
We see a wide spectrum of symptoms here, from mild to moderate to severe to fatal

46
Q

What period is after Illness

A

Decline (if there is capacity for recovery after ACME)
Microbial numbers decrease as adaptive immune response and number of antibodies peak - immune system is starting to defeat the pathogen

47
Q

What period is after Decline?

A

Convalescence- Complete recovery, symptoms disappear, although may continue to shed small numbers of the pathogen and can infect others

48
Q

Summarize stages of Disease

A

Exposure, Incubation, Prodromal, Illness, Decline, Convalescence (if no death)

49
Q

What are the types of infection

A

Asymptomatic infection - no symptoms,
Acute infection - Rapid onset of illness, but also usually a quick return to health eg influenza food poisioning
Chronic infection - Slow onset of illness, illness persists and is for long-term, eg tuberculosis (pathogen is in balance with host and not eliminated by immune system) - chronic infection can turn harmful if the immune system becomes compromised by external stressors
Latent infection - Acute infection then followed by a period where the virus remains dormant and there is no symptoms - however the virus can be reactivated ( herpes virus)

50
Q

What is the chain of infection:

A

Entry into reservoir/source via portal of entry
Exit from reservoir/source via portal of exit
Contact of infectious agent with host
Entry of agent into human via portal of entry
Agent exits human via portal of exit to infect another human or to re enter reservoir/source - enables transmission

51
Q

What is the source

A

The location where the pathogen is transmitted to the host
You can have an animate source - transmission of pathogen from an infected human to healthy human (human-human transmission) or transmission of pathogen from reservoir which can be animal to a human host (zoonosis)
You can also have an inanimate source - consumption of food or water contaminated with microbes

52
Q

What is the reservoir

A

Location where the infectious agent actually grows and multiplies
This can be the same source - infected individuals act as reservoirs for infection by maintaining endemic infection in population - they continue to be carriers
The reservoir can be different from the source - eg in food poisoning caused by Clostridium, the reservoir for the agent is soil (that is where Clostridum grows) but the source can be contaminated food
Eg in Hendra virus, the reservoir is bats but the infection is transmitted to humans from horses - horses are the source

53
Q

What is zoonosis

A

Disease is transmitted from animals to humans
Epidemics can happen due to zoonosis as a result of spillover effect - where the reservoir, the microbial agent, vector determinants outside the reservoir host, and the behavioural and biological determinants of the recipient human host
- Eg. Increased opportunity for exposure when wildlife habitats are destroyed, causing humans and their domestic animals to come into closer contact with these reservoirs or sources
- Climatic factors may also contribute to increased reproduction of the agent or increased availability of vectors and reservoirs to the population - wildlife may also migrate closer to human populations as their habitats start to change

54
Q

What are the four types of transmission?

A

Airborne, Contact, Vector, Vehicle

55
Q

Transmission can be ———- or —–

A

Direct or indirect
Direct transmission - involves person to person contract - exchange of cells/secretions
Indirect transmission -transmission from one host to another via an intermediate - the intermediate can be animate such as mosquitoes or inanimate (fomites)

56
Q

What are the two types of airborne transmission?

A

Can be spread by water droplets or dust - usually leads to respiratory infections
Water droplets can be from fluids such as saliva or mucus
Dust can become airborne due to disturbances

57
Q

Airborne - Droplets

A

You can get large respiratory droplets - which can be spread directly from person to person if these two people are standing 1m apart: when one person is coughing, laughing, sneezing

58
Q

Airborne - Aerosols

A

Have smaller diameter than respiratory droplets
Droplets evaporate to form aerosols. Aerosols can also be formed by talking, breathing, medical procedures, tap water running, toilet flushing.
aerosols can also be propelled from the respiratory tract by coughing, sneezing, laughing, and such aerosols can travel up to 4m - facilitating indirect transmission (if aerosol travels more than 1 m it is indirect transmission)
Aerosols can remain airborne for a long time and can travel long distances

59
Q

Airborne - Reservoirs

A

Air conditioning cooling towers generate aerosols containing Legionella
Showerheads generates aerosols containing M. aevium
If t

60
Q

Airborne- Dust

A

Common source of systemic fungal and hospital-acquired nosocomial infections

61
Q

Contact transmission

A

Can be person-person or via animal to person

62
Q

Contact transmission - person to person

A

Spread by touching, kissing, sex eg STIS, which involves an exchange of fluids such as saliva, genital secretions, blood
Spread by mothers through breastmilk - neonatal staphylcoccal infection
Can also be transmitted from mothers to fetuses via placenta - Toxoplasma gondii

63
Q

Contact transmission - animal to animal

A

Hendra viruses - horses to humans

Lissa viruses - from bats to humans

64
Q

Vehicle transmission

A

Refers to indirect transmission via inanimate objects
Infectious agent comes into contact with inanimate object, and this inanimate object comes into contact with the host later
Inanimate objects that are commonly contaminated with microbes are referred to as fomites (include medical equipment, needles, food utensils, door handles/phones)

65
Q

Vector-transmission

A

Indirect transmission via an animate object such as the bite of an insect or arthropod, which are carriers of the pathogen - vectors include mosquitoes and ticks

66
Q

External vector transmission

A

Vectors carry the pathogen on its surface - Shigella present in human faeces is picked up by flies and these flies when landing on our skin transfer the faeces containing Shigella to us

67
Q

Internal vector transmission

A

The pathogen is inside the vector - eg Plasmodium is inside mosquitoes

68
Q

Portals of entry for pathogen to humans

A

Oral route - foodborne, contaminated water
Dermal transmission - via skin- agent burrows into skin
Urogenital route - sexual transmission
Parenteral route - injection of pathogen directly into bloodstream by needles and vectors
Conjunctival Route - via surface of eye

69
Q

Portals of exit

A

Can be reverse of entry - entry via inhalation, exit via coughing
Or via new route - oral-faecal

70
Q

Primary case

A

First person in the population who had the disease - may not necessarily be the first person who reported to health authorities

71
Q

Index case

A

The first case of the disease reported to health authorities

72
Q

Secondary case -

A

People who get infected via transmission from the primary/index case

73
Q

What is R0?

A

The average number of people one infected person gives the disease to over the course of their infectious period - how many subsequent cases does one case generate

74
Q

What does R0 indicate?

A

How contagious the disease and the transmissibility of the pathogen

75
Q

What do we need to calculate R0?

A

The contact rate (the number of contacts each case has over time), the mode of transmission and the length of infectious period

76
Q

In what situation does R0 apply?

A

R0 only applies when no one in the population has immunity to the pathogen - they have not been exposed to the pathogen, there is no vaccine against the pathogen which has been given to the population - essentially its a naive population, and there is no known way of controlling the spread of disease

77
Q

What does R0=1 mean?

A

Each existing case gives rise to one new infection - pathogen will stay alive and stable in the population but there will be no outbreak of disease

78
Q

What does RO < 1 mean?

A

Pathogen numbers are declining as it not able to be transmitted to others and thus disease eventually dies out

79
Q

What does R0>1 mean?

A

Each existing case may give rise to multiple cases. Disease is spreading within population and the end result may be an outbreak or epidemic

80
Q

What does R0 =2 mean?

A

Each existing case on average generates 2 new infections

81
Q

What can R0 not be used to provide information about?

A

The severity of the disease

Really severe diseases such as Ebola can have low R0, whereas not as severe diseases such as influenza can have high R0

82
Q

How does contagiousness of the disease affect R0?

A

The more contagious the disease, the higher the R0

83
Q

What factors affect R0?

A
  • How contagious the disease is, the length of the incubation period, the properties of the pathogen, how likely an infected individual will come into contact with a susceptible person ( depends on population density and social organization), host factors such as immune system, climate (some diseases transmit better in cold conditions)
84
Q

If you are aiming for elimination of the disease, what should the R0 be?

A

R0 should be <1. IT SHOULD BE 0

85
Q

What reproduction rate is used when there is some level of immunity in the population and intervention measures to control the spread such as handwashing are introduced?

A

Re (effective reproduction rate)

86
Q

What is immunity?

A

The capacity to remain free of infection/ clinical illness after being exposed to an infectious agent

87
Q

How can we gain immunity?

A

Through recovering from illness, through vaccination

88
Q

How does immunity vary between diseases?

A

Exposure to some pathogens give you lifelong immunity - eg if you get measles once then you will never get it again - one vaccination is enough
Exposure to some pathogens gives you immunity but this immunity will wane in the long-term and you may be vulnerable again after (whooping cough) - thus the vaccines for these will need to be supplemented with boosters

89
Q

What is herd immunity?

A

The point of herd immunity is that if a large proportion of individuals have immunity through prior infection or vaccination, then that reduces the number of individuals who actually develop an infection in the population, and that reduces the probability that an infected person will come into contact with a susceptible person, and thus the spread of disease is stopped - herd immunity is where a large group provides protection to vulnerable members of community who can’t get vaccinated such as elderly, immunocompromised, infants)

90
Q

How do we calculate the level of herd immunity required to stop the spread?

A

1-(1/R0)

If R0 = 5, herd immunity required to stop the spread is 1-0.2= 0.8 (80%)

91
Q

How can we stop chain of infection through source/reservoir?

A

Remove the reservoir, vaccinate individuals to prevent infected individuals becoming a source for susceptible infections

92
Q

How can we break the chain of infection through agent?

A

Diagnose early and treat infection before person comes into contact with other

93
Q

How can we break the chain of infection through modes of transmission

A

Chemical sanitation can help to reduce the numbers of pathogen present in environment, reducing dose that you receive during exposure, try to reduce numbers of vector as well

94
Q

How can we break the chain through portals of entry/exit

A

Block these portals
Slow spread by wearing masks - prevent transmission via droplets/aerosols, emphasize handwashing/wearing gloves - prevent contact transmission

95
Q

How can we break the chain through portals of host -

A

Quarantining host and immunisation

96
Q

Who is Typhoid Mary?

A

Was a chronic carrier of Salmonella Typhi - she was asymptomatic and infected many people who developed the disease through her work as a cook
As an asymptomatic carrier - she was a reservoir for Typhoid infection, and the chain of infection was broken by removing Mary from the population and detaining her

97
Q

What can epidemiology be used for?

A

Monitoring public health through morbidity and mortality rates
To respond to outbreaks, epidemics and pandemics (determine causes and implement control measures)
To investigate emerging and re-emerging diseases - determine risk factors and implement control measures accordingly

98
Q

What are the 10 steps of outbreak investigations

A
  • Establish existence of an outbreak using data such as case numbers
    -Prepare fieldwork - research disease, gather supplies and equipment, and travel to the location where disease has appeared
    -Confirm that the disease that you research is the one that is present in the population - verify diagnosis
  • Define a case and identify who the cases are - interview patients, review clinical tests and lab results
  • Use descriptive epidemiology to orient the data and develop hypotheses about (what is the health issue of concern, when did it emerge, where did it emerge, who caused the outbreak, and why/how the outbreak occurred- look at causes of disease/risk factors/mode of transmission
    -Evaluate hypotheses by testing then
    -Refine hypotheses
    -Once cause of outbreak is identified implement control and prevention measures to reduce number of cases
    Develop policies and communicate findings so future generations are protected form outbreaks
99
Q

What is an ongoing role of surveillance?

A

Health surveillance - systematic collection of population health data to guide policymaking

BMS2052 (8 decks)

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