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Chapter 32 Epidemiology the Core Understanding of Public Health Epidemiology: Study of Disease Occurrence, Distribution and Determinants of Health Infectious Disease Death Rates, USA Clicker Questions: Clicker Questions: Epidemic vs Endemic … Dots on A Map John Snow – First Epidemiologist Cholera Outbreak, London 1854 The Pump, The Pub Epidemiology Who, When Where…Tracking Disease Pattern Prevalence = (Total # cases in a pop)/Total people x 100% Incidence = (# New Cases)/(# Susceptible People) Usually based on 100,000 people Centers for Disease Control, Atlanta Morbidity and Mortality Weekly Report Morbidity and Mortality Weekly Report Clinical Stages of Disease Classical Symptoms Here Incubation Periods Some diseases are transmitted by active carriers: a pathogen infected individual who has had the disease and recovered, but continues to carry and spread the pathogen Incidence of California Encephalitis Clicker Question: Types of Epidemics by Incidence Co-Evolution of Host/Pathogen: The Australian Rabbit and Myxoma Virus Experiment Clicker Question: Herd Immunity The USA AIDS Eipdemic HIV Infects Both Sexes Nosocomial Infections Causes of Death: Africa and Americas Clicker Question Emerging and Re-emerging Infectious Diseases Small Pox: The Eradicated Disease? Clicker Question: Small Pox: The Eradicated Disease? Clicker Question Follow Up: Planned Bioterrorist Attacks 1984: A group sprayed salad bars in The Dalles, Oregon with Salmonella enterica Tiphimuriuim causing 751 salmonellosis cases. 1995: Sarin (neurotoxic gas) sprayed in Tokyo subway, killed several people. Since 1995: Most common are Bacillus anthracis spores: sprays, in letters, etc. Bacillus anthracis causes Anthrax Clicker Question: Bacillus anthracis causes Anthrax Clicker Question: The Three Forms of Anthrax 1. Cutaneous Anthrax (skin hemorrhage) 2. Pulmonary Anthrax (lung and cerebral hemorrhage; fatality rates at ~90% plus) Cutaneous Anthrax 3. Gastrointestinal Anthrax (rare) Pulmonary Anthrax Anthrax: 2 Toxins, 3 Proteins PA Protective Antigen LF Lethal Factor EF Edema Factor _____________________________________________________ PA-LF Lethal Toxin (cytotoxin) PA-EF Edema Toxin Clicker Question: Weaponized Anthrax Spores Endospores mixed with talc powder: in mailed envelopes or packages to news media (Florida), government (Washington DC), non-focused in Pennsylvania, New Jersey, New York. 22 cases of Anthrax: 11 cutaneous + 11 pulmonary 5 Deaths Bioterroist was a bioweapons lab worker. Bioweapon facility in Sverdlovsk, Russia: inadvertant release of 1 gram of endospores 77 anthrax cases, 66 died. Anthrax Vaccination - Treatment Incubation Period: at least 8 days 1. treatment with Ciprofloxacin prophylactically to exposed persons. 2. Vaccine: AVA Anthrax Vaccine Absorbed : prepared from cell-free culture filtrate. 3. Clicker Question: