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Epidemiology Notes Definition: ______________________________________________________________________ _______________________________________________________________________________ Epidemiology – What is it? The study of the ___________________________________________________________ ____________________________ disease, disability, and death in human populations. Also involves characterizing the distribution of heath status, diseases, or other health problems in terms of _________________________________________________________________ _______________ This characterization is done in order to explain the _________________________________ ___________________________ in terms of the causal factors Serves as the foundation and logic of interventions made in the interest of _______________ _____________________________________________________. ____________________________ of public health research ____________________________________ for identifying risk factors for disease Used to determine ___________________________________approaches to clinical practice. In the work of communicable and non-communicable diseases, the work of epidemiologists range from ___________________________________________________________ ___________________________________________________ and the documentation of results for submission to peer-reviewed journals. ______________________ may draw on a number of other scientific disciplines such as biology in understanding disease processes and social science disciplines including sociology and philosophy in order to better understand proximate and distal risk factors History The Greek physician _____________ is sometimes said to be the father of epidemiology. He is the first person known to have examined the relationships between the occurrence of disease and environmental influences. He coined the terms _____________ (for diseases usually found in some places but not in others) and __________________ (for disease that are seen at some times but not others). One of the earliest theories on the origin of disease was that it was primarily the ___________ _____________. This was expressed by philosophers such as Plato and Rousseau, and social critics like Jonathan Swift In the medieval Islamic world, physicians discovered the contagious nature of infectious disease. In particular, the Persian physician Avicenna, considered a "father of modern medicine," in _______________________ ______), discovered the contagious nature of tuberculosis and sexually transmitted disease, and the distribution of disease through water and soil. Avicenna stated that bodily secretion is contaminated by ___________________ before being infected. He introduced the method of _____________ as a means of limiting the spread of contagious disease. He also used the method of risk factor analysis, and proposed the idea of a syndrome in the diagnosis of specific diseases. When the Black Death (____________) reached Al Andalus in the 14th century, Ibn Khatima hypothesized that infectious diseases are caused by small "minute bodies" which enter the human body and cause disease. Another 14th century Andalusian-Arabian physician, Ibn alKhatib (1313–1374), wrote a treatise called On the Plague, in which he stated how infectious disease can be transmitted through bodily contact and "through garments, vessels and earrings." In the middle of the 16th century, a famous Italian doctor from Verona named Girolamo Fracastoro was the first to propose a theory that these _______________________________ that cause disease were alive. They were considered to be able to spread by air, multiply by themselves and to be destroyable by fire. In this way he refuted Galen's theory of __________ (poison gas in sick people). In 1543 he wrote a book De contagione et contagiosis morbis, in which he was the first to promote ________________________________________________. The miasmatic theory of disease held that diseases such as cholera or the Black Death were caused by a miasma (Greek language: "pollution"), a _________________. In general, this concept has been supplanted by the more scientifically founded _______________________. The development of a sufficiently powerful microscope by Anton van Leeuwenhoek in 1675 provided visual evidence of living particles consistent with a __________________________. John Graunt, a professional ___________________ and serious amateur scientist, published Natural and Political Observations ... upon the Bills of Mortality in 1662. He used analysis of the mortality rolls in London before the ____________ to present one of the first _________ and report time trends for many diseases, new and old. He provided ____________________ for many theories on disease, and also refuted many widespread ideas on them. Dr. John Snow is famous for his ________________________ of the science of investigations into the causes of the epidemiology. 19th Century _________ __________. He began with a comparison between the ___________ from areas supplied by two ____________________________ in Southwark. His identification of the Broad Street pump as the cause of the Soho epidemic is considered the classic example of epidemiology. He used chlorine in an attempt to clean the water and had the handle removed, thus ending the outbreak. (It has been questioned as to whether the epidemic was already in decline when Snow took action.) This has been perceived as a major event in the history of public health and can be regarded as the Other pioneers include Danish physician P. A. Schleisner, who in 1849 related his work on the prevention of the epidemic of __________________ on the Vestmanna Islands in Iceland. Another important pioneer was Hungarian physician Ignaz Semmelweis, who in 1847 brought down infant mortality at a Vienna hospital by instituting a _____________________ procedure. His findings were published in 1850, but his work was ill received by his colleagues, who discontinued the procedure. Disinfection did not become widely practiced until British surgeon Joseph Lister 'discovered' antiseptics in 1865 in light of the work of Louis Pasteur. In the early 20th century, _______________________________ were introduced into epidemiology by Ronald Ross, Anderson Gray McKendrick and others. Purposes of Epidemiology To explain the _______________ ______ of a single disease or group of diseases using information management To determine if data are consistent with _________________ To provide a basis for developing control measures and prevention procedures for groups and at risk populations Terms to know Disease __________________________________________________________________ _________________________________________________________________________ also – an abnormal state in which the body is not capable of responding to or carrying on its normally required functions Pathogens _________________________________________________________________ _________________________________________________________________________ Pathogenesis _____________________________________________________________ Pathogenic _____________________________________________________________ Pathogenicity______________________________________________________________ _________________________________________________________________________ Infective __________________________________________________________________ _________________________________________________________________________ Virulence _____________________________________________________________ _____________________________________________________________ the capacity and strength of the disease to produce severe and fatal cases of illness Invasiveness _______________________________________________________________ _________________________________________________________________________ Etiology _____________________________________________________________ Toxins __________________________________________________________________ _________________________________________________________________________ notably toxic when introduced into the tissues, and typically capable of inducing antibody formation Antibiotics _______________________________________________________________ _________________________________________________________________________ endemic: _____________________________________________________________ hyperendemic: _____________________________________________________________ holoendemic: _______________________________________________________________ _________________________________________________________________________ epidemic: _________________________________________________________ _________________________________________________________________________ pandemic: _________________________________________________________ _________________________________________________________________________ incidence: _________________________________________________________ _________________________________________________________________________ prevalence: _________________________________________________________ _________________________________________________________________________ point prevalence: _________________________________________________________ _________________________________________________________________________ How many people have had the disease in the past Duration of the disease in the population 7 Uses of Epidemiology 1. To study the _________________________ Studies trends of a disease for the _______________________ Results of studies are useful in __________________________________________ 2. Community diagnosis What ___________________________________________________________________ _____________________________________________ 3. Look at risks of __________________ as they affect _________________________ What are the risk factors, problems, behaviors that ________________ Groups are studied by doing ____________________________ 4. Assessment, evaluation and research How well do public health and health services ______________________________________ Effectiveness; efficiency; quality; access; availability of services to treat, control or prevent disease 5. Completing the clinical picture Identification and diagnostic process to establish that a _______________________________ ________________________ Cause effect relationships are determined, e.g. _____________________________________ 6. Identification of syndromes Help to establish and _______________________________, some examples are: Down, fetal alcohol, sudden death in infants, etc. 7. Determine the _____________________________________________ Findings allow for control prevention, and elimination of the causes of disease, conditions, injury, disability, or death The Epidemiology Triangle Outbreaks in a population often involves several factor and entities Many people, objects, avenues of transmission, and organisms can be _________________ ________________________________ Epidemiologist have created a model to help explain the multifaceted phenomena of disease transmission: _____________________________________ Many diseases rely on an _______________ or single factor for an infectious disease to occur. Epidemiologist use an _____________________________ to assess the interaction of various elements and factors in the _____________________________________________________ When more than a ____________________ must be present for a disease to occur, this is called _________________________ The interrelatedness of 4 factors contribute to the outbreak of a disease 1. _____________________________ 2. _____________________________ 3. _____________________________ 4. _____________________________ The epidemiology triangle is used to analyze the role and interrelatedness of each of the four factors in epidemiology of infectious diseases, that is the influence, reactivity and effect each factor has on the other three The___________________ is the cause of the disease Can be ___________________________________________________________ __________________________________________________________________ The _________ is an organism, usually human or animal, _________________________ _____________________ disease-causing _______________________ or related substance Offers subsistence and lodging for a _____________________ __________________________________________________________________ within the host can determine the effect of a disease organism can have upon it. The _____________________________ is the favorable surroundings and conditions external to the human or animal that ___________________________________________________ Environmental factors can include the _____________________ as well as the __________________________________________________________________ Time accounts for _____________________________, ______________ of the host or pathogen, ______________________________ of illness or condition. The mission of the epidemiologist is to ________________________________, which disrupts the connection between ______________________________________ stopping the continuation of an outbreak. The goals of public health are the ______________________________________________. By ____________________________________________, public health intervention can partially realize these goals and stop epidemics An epidemic can be stopped when one of the elements of the triangle is ___________________________________________________________________. Disease Transmission ____________________ inanimate objects that serve as a role in disease transmission ____________________________________ __________________ any living non-human carrier of disease that transports and serves the process of disease transmission _________________________________________ ___________________ humans, animals, plants, soils or inanimate organic matter (feces or food) in which infectious organisms live and multiply _____________________ often serve as reservoir and host ______________________ when a animal transmits a disease to a human __________________________ one that spreads or harbors an infectious organism Some carriers may be infected and not be sick. e.g. Typhoid Mary Mary Mallon (1869 – 1938) was the first person in the United States to be identified as a healthy carrier of typhoid fever. Over the course of her career as a cook, she infected 47 people, three of whom died from the disease. Her notoriety is in part due to her ___________________ denial of her own role in spreading the disease, together with her refusal to _____________________________. She was forcibly quarantined twice by public health authorities and died in quarantine. It is possible that she was born with the disease, as her mother had typhoid fever during her pregnancy. ___________________ individual exposed to and harbors a disease-causing organism. May have recovered from the disease ___________________ exposed to and harbors disease-causing organism (pathogen) and is in the recovery phase but is still infectious ___________________ exposed to an harbors pathogen, has not shown any symptoms ____________________ exposed to and harbors a disease and is in the beginning stages of the disease, showing symptoms, and has the ability to transmit the disease ___________________ exposed to and harbors disease and can intermittently spread the disease _____________________ exposed to and harbors disease causing organism, but has no signs or symptoms Modes of Disease Transmission methods by which an ___________________________________________ to the next or can ____________________________________________ (either person or animal) Two general modes ________________ ________________ _________________________ or person to person Immediate transfer of the pathogen or agent _________________________ or person to person Immediate transfer of the pathogen or agent from a ____________________________ Can occur through direct physical contact or direct personal contact such as _______________________________________________________ ___________________________ pathogens or agents are transferred or carried by some ________________________, means or process to a susceptible host done in one or more following ways: _______________________________________ _______________ _________________________ carry the pathogen to the host and infect it ________________________________ all spray microscopic droplets in the air ________________ Carried in _______________________ streams or lakes used for swimming. Examples: ______________ Vehicleborne Related to _________________ Vectorborne A pathogen uses a _____________________________________ as a mechanism for a ride or nourishment this is mechanical transmission _______________________________ when the pathogen undergoes changes as part of its life cycle, while within the host/vector and before being transmitted to the new host Chain of Transmission Close association between the triangle of epidemiology and the chain of transmission Disease transmission occurs when the ____________________ leaves the _________________ through a ________________ and is spread by one of several _______________________________ _______________ in the chain of transmission will _______________________________ Classes of Outbreaks Common Source Epidemic – when a _______________________ is exposed to a common ___________________________ Point source from a single source (food) Persons exposed in ______________________________ and become ill within the _______________________ Ex: ________________________________________ Intermittent ____________________________________ _______________________ spread by person to person contact and people move around and interact with other people Continuous epidemic When an epidemic spreads through a ___________________________ at a high level, affecting a large number of people within the population ___________ Propagated Epidemic when a single source ______________________, yet the epidemic or diseases continues to spread from __________________________ Usually experiences exponential growth Cases occur over and over longer than one incubation period Mixed Epidemic a __________________________ is followed by ___________________ contact and the disease is spread as a ________________________________ Levels of Disease Diseases have a range of ___________________________________________________________ Classified into 3 levels Acute _____________,_______________________________________________________ usually the patient ___________________________ Subacute intermediate in _______________________, having some acute aspects to the disease but of longer duration and with a degree of severity that detracts from a _______ _____________________ Patient expected to _________________________ Chronic less severe but of ____________________________________, lasting over ________________________________________________________ Patient may not fully recover and the disease can get worse overtime Life not immediately threatened, but may be over long term Immunity and Immunization History Before polio vaccine became available in 1955, _____________ cases of polio occurred in peak years. ½ of these cases resulted in permanent paralysis Prior to measles vaccine in 1963, ___________________________ cases per year Immunization of 60 million children from 1963-1972 cost ________________, but saved _________________ Mumps used to be the leading cause of__________________________ 10% of children with _____________________________ According to CDC, unless ____ or greater of the population is vaccinated, ______________ can occur Three types of immunity possible in humans Acquired Immunity obtained by having __________________________________ ____________________________________ or artificially stimulating immune system Active Immunity body produces _________________________ can occur through a _______________________________________________ _______________ Similar to acquired Passive Immunity (natural passive) acquired through ___________________ transfer of a mother’s immunity to diseases to the unborn child (also _______________) can also come from the introduction of already __________________________ into a susceptible case When there is little to no immunity within a population, ____________________________________ Herd Immunity the resistance ____________________________________ has to the invasion and spread of an infectious disease Disease for which vaccines are used Antrhax Chicken pox Cholera Diphtheria German measles (rubella) Hepatitis A & B HPV Influenza Malaria (in process) Measles Menigitis Mumps Plague Pneumonia Polio Rabies Small pox Spotted fever Tetanus Tuberculosis Typhoid Fever Typhus Whooping Cough Yellow Fever