Humbio 151
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| Epidemiology (1) | investigation of chronic diseases (eg heart disease, cancer) and outbreaks (eg swine flu, salmonella)
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| Epidemiology (2) | basic methodology to instigate public health research
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| Epidemiologic process | 1. describe disease risks and trends
2. explain the factors responsible
3. make predictions - health policy & planning
4. instigate control and prevention initiatives
5. evaluate control/prevention
6. advocate and influence policy
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| shoe-leather epidemiology | gumboot, field-epi - case studies
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| miasma | bad air (agent of spread)
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| index case | aka patient zero/primary case
the initial patient in the population sample of an epidemiological investigation
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| epidemic curve (1) | graphic depiction of the number of outbreak cases by date of illness onset
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| epidemic curve (2) | provides info on:
1. pattern of disease spread
2. outbreak magnitude
3. time trend
4. outliers
5. disease incubation period
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| common source | cases acquire the infection from the same source
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| intermittent common source epi curve | irregular peaks reflecting the timing and extent of exposure
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| continuous common source epi curve | often causes epi curve to rise gradually and perhaps plateau
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| point common source epi curve | -brief period of exposure, all cases occur within one incubation period
-typically shows abrupt upward slope and subsequent decline
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| norovirus incubation period | 12-48 hours
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| Campylobactor incubation period | 48-96 hours
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| tick borne relapsing fever | ground squirrels
agent: borrelia hermsii
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| case fatality ratio | number of deaths/number of cases
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| SARS agent | coronavirus
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| nosocomial | hospital related disease transmission
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| prevalence | number positive / number tested
number positive samples / sample size
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| anatomy of disease | DREEMS
1. Susceptible hosts
2. Disease agent
3. Reservoir/source
4. Entry into susceptible host
5. Exit from infected host
6. Mode of transmission
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| disease agents | 1. viruses
2. bacteria
3. fungi
4. parasites
5. prions
6. cancer cells
7. pollutants
8. malnutrition/poverty
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| reservoir/source | 1. humans
2. animals
3. environment
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| true multi-host pathogens | brucellosis
bison <--> cattle
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| spillover (dead-end) hosts | WNV from birds to humans
birds --> humans
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| apparent multi-host pathogens | frequent spillover
domestic dogs --> jackals
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| emerging infectious disease | infrequent spillover, high subsequent transmission
chimp --> human <--> human
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| typhoid fever agent | Salmonella typhi
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| infectivity | ability of a disease agent to cause infection in a susceptible host
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| pathogenicity | ability of a pathogen to cause disease (onset of harmful symptoms)
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| virulence | the severity of the disease / fatality ratio / proportion of cases that develop disease
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| modes of disease transmission | 1. contact (direct/indirect)
2. droplets
3. airborne
4. vector-borne
5. vehicle-borne (food and/or water)
6. vertical
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| entry into susceptible host | 1. contact
2. airborne
3. vectors
4. food/water
5. vertical transmission
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| cluster | observation of above normal number of cases
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| outbreak | sudden increase in disease cases
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| epidemic | outbreak on scale, depends on who is working on the disease
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| pandemic | outbreak at international/global scale
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| endemic | normal/baseline natural distribution or rates of disease
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| epizootic | epidemic in wildlife
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| enzootic | endemic in wildlife
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| number of people suffering from disease | 1. tells present scale of problem
2. meaningful for advocacy
3. logistically informative
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| point prevalence | infected cases at census point
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| period prevalence | infected cases during census period (existing and new infections)
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| incidence (1) | number of new cases that occur during a specific period of time in a population at risk for developing disease
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| person-time units | length of time individuals are in states of health, exposure (at risk), infection, infectiousness, etc.
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| incidence (2) | # cases / person-time @ risk
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| cohort | well defined group of subjects or patients who have had a common experience or exposure and are then followed up for the incidence of new diseases or events
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| fixed cohort | all people present at beginning of study; no new entries
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| open cohort | people can enter study at any time
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| epidemiologic surveillance | ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation, and evaluation of public health practice closely integrated with the timely dissemination of these data to those who need to know
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| who recognizes outbreaks? | 1. medical practitioners
2. patients and families
3. public health surveillance data
4. local media
5. internet
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| case ID | confirming a disease agent
1. isolate disease agent from host
2. identify the disease agent
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| tools to identify the disease agent | 1. culture
2. infection
3. microscopy
4. PCR
5. pulsed-field gel electrophoresis (PFGE)
6. antibody
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| PFGE(1) | 1. DNA chromosome restricted by enzymes into 10-20 fragments
2. pulsed voltage
3. gel separates DNA fragments
4. run positive control
5. record image, compare in BioNumerics
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| PFGE(2) | 1. simple to perform
2. universal sub-typing method
3. high discrimination
4. high reproducibility within and between labs
5. 'gold standard' of molecular sub-typing methods
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| problem with lab tests | positive results
1. target is present
2. contamination
3. random events
negative results
1. target is absent
2. failure to work
3. random events
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| test validity | the ability to distinguish between presence and absence of a disease
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| sensitivity | ability of test to correctly identify cases that have the disease
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| specificity | ability of the test to correctly identify cases that do not have the disease
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| test validity influenced by | 1. test type
2. sampling time of test
3. prevalence of the disease (rare or common)
4. number of times test is performed
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| PPV | positive predictive value - how likely is a given positive test result likely to be a true positive
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| case investigation | 1. verify that an outbreak is occurring
2. establish preliminary hypothesis
3. make case definition
4. case finding
5. case questionnaires
6. organize data (line listing)
7. describe current outbreak information
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| cause investigation | systematically review
1. disease agent
2. reservoir/source
conduct:
LEVEL
laboratory investigations
epidemiologic/clinical investigations
veterinary/wildlife/vector investigations
environmental investigations
law enforcement investigations
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| risk factor | aka determinant, a variable associated with an increased risk of disease or infection
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| factors influencing epi | spatial: physical distribution of a disease in an area
seasonality
human risk factors
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| human disease risk factors | 1. sex
2. age
3. race
4. socioeconomic status
5. culture
6. class
7. behavior
8. beliefs
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| disease risk factors for chronic diseases | 1. tobacco
2. diet
3. obesity
4. reproductive and hormonal factors
5. viruses, bacteria, etc.
6. occupational hazards
7. environment
8. genes
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| ecological fallacy | inferences about the nature of specific individuals are based solely upon aggregate statistics collected for the group to which those individuals belong
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| guidelines for causality (1) | 1. temporal relationship: exposure to the factor must precede sickness/health
2. strength of association: stronger (risk/odds ratio) implies causal relationship
3. dose-response relationship: if risk of disease increases with dose of exposure
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| guidelines for causality (2) | 4. reproducible findings: if relationship is causal, it should be evident in different studies and different populations
5. biologic plausibility: epi findings must be consistent with existing biological knowledge
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| guidelines for causality (3) | 6. consideration of alternate explanations: take into account and rule out other possibilities
7. cessation of exposure: risk of disease should decline when exposure to the factor is reduced or eliminated
8. consistency with other knowledge
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| guidelines for causality (4) | 9. specificity of the association: relationship is between causal factor and a certain specific disease
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| retrospective cohort | disease outbreak is occurring
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| prospective cohort | -looking forward, does not self select who got the disease
- academic, usually chronic diseases
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| case-control study | -ask cases and controls the same questions about exposures
-calculate odds ratio
-quick alternative to large cohort studies
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| suspected case | clinically compatible case without presumptive or confirmatory lab results
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| probable | clinically compatible case with presumptive lab results
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| confirmed | clinically compatible case with confirmatory lab results
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| contact tracing | process of locating and notifying partners (contacts) that have exposed to disease
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| line listing | -common file for information
-each case = 1 row
-cases and noncases
-updated through investigation
-every row a unique ID
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| methods of disease control (1) | 1. isolation
2. vaccination
3. barriers
4. eradication
5. treatment
6. education
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| methods of disease control (2) | reduce Ro by altering
1. duration of infectiousness
2. contact rate
3. transmission probability
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| anatomy of disease control | 1. reduce number of susceptible hosts
2. reduce sources of infection
3. reduce infectiousnes
4. reduce contact rates
5. interrupt transmission
6. increase herd immunity
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| plague agent | Yersinia pestis
most lethal bacterium known to man
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| modes of transmission | 1. contact
2. respiratory droplets/secretions
3. airborne
4. vehicle-borne
5. vector-borne
6. vertical transmission
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| entry/exit into susceptible host | 1. contact
2. airborne
3. vectors
4. food/water
5. vertical transmission
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| Ro | basic reproductive number - average number of secondary infectious cases produced by an index case in a susceptible population
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| population disease categories | 1. susceptibles
2. infected
3. removed
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| R | effective reproductive number - average number of secondary infectious cases produced by infectious cases
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| Rc | control reproductive number - effective reproductive number in presence of control measures
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| herd immunity threshold | vaccinating a proportion of the population protects unvaccinated individuals
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| passive surveillance | health officials report cases of illness, but no special effort is made to find unsuspected disease incidents
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| active surveillance | field investigation of disease incidence
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| lyme disease | -agent: borrelia burgdorferi (spirochete)
-mode of transmission: vector-borne
-reservoir/source: zoonotic disease (rodents)
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| vaccination | 1. reduces number of susceptible hosts
2. reduces sources of infection
3. reduces contact rates
4. interrupts transmission
5. increases herd immunity
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| childbirth epi |
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| structural violence | systemic ways in which a given structure or social institution kills people slowly by preventing them from meeting their basic needs
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| health and media | - real vs. perceived risk
- evaluating scientific claims
- importance of working with the public and governments to achieve PH goals
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| environmental disease | -environmental hazards may induce acute/chronic responses to exposure
-patterns are highly predictable based on the mechanism of the hazard
-some hazards may produce both
-share pathologic features of disease caused by other factors
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| definition of disaster | - 10 or more dead
- 100 or more affected
- declaration of a state of emergency
- request for international assistance
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| types of disasters | 1. geophysical
2. meteorological
3. hydrological
4. climatologically
5. biological
6. extra-terrestrial
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| principles of disaster risk reduction | risk = hazard + exposure + vulnerability
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| infant mortality | number of infant deaths (<1 year) per 1,000 live births
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| average length of pregnancy | 280 days/40 weeks
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| perinatal period | end of 22 weeks of gestation until end of 7 days after birth
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| neonatal period | birth to 28 days later
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| stillbirth or fetal death | death prior to the complete expulsion or extraction from its mother
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| perinatal deaths | deaths in first week of life and stillbirths
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