29/03/2016

Infectious &
Non-Infectious
Diseases

The notes contained in this

PowerPoint presentation is for
Unit 11 LO1- The Role of Public
Health in Health and Social Care
and the these lectures notes are
available on the VLE.
Please print your own copies of
the lecture notes prior to coming
to class.
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Videos 1
http://www.youtube.com/watch?v=PIJ8UYDAF
3M river blindness*
http://www.youtube.com/watch?v=90i3XI1x_dI

Infectious disease/non infectious disease

https://www.youtube.com/watch?v=O9c6UC0ieTI
Waterborne disease
https://www.youtube.com/watch?v=wPGqyBx_GY
k
Vector borne diseaseICON COLLEGE LO1

Videos 2
http://www.youtube.com/watch?v=gv0VWLMqP
NU (combating infectious disease)

http://www.dailymail.co.uk/health/article-
2976572/Even-OUTSIDE-packaging-chicken-
food-bug.html
foodborne

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Learning Outcome

LO1: Understand different approaches

and strategies used to measure,
monitor and control the incidence of
diseases in communities

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Infectious Diseases
Infectious diseases are caused by
pathogenic microorganisms, such as
bacteria, viruses, parasites or fungi; the
diseases can be spread, directly or
indirectly, from one person to another.

How Infections Occur

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The Triangle of Epidemiology

ENVIRONMENT

Time

HOST AGENT

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Pathogenic organisms
Pathogens are organisms that are capable of producing
disease such as bacteria, viruses, or parasites
Pathogenesis the development, production or process of
generating disease
Pathogenicity Describes the potential ability and strength
of a pathogenic substance to cause disease
Virulence The extent of pathogenicity or strength of
different organisms. It also refers to the capacity and strength
of the disease to produce severe and fatal cases of illness
Invasiveness Ability of a pathogen to get into a susceptible
host and cause a disease within the host

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Natural history of disease

The uninterrupted progression of the disease in an individual

from the moment of exposure to the causal agents.

The progress of a disease process in an individual over time

without intervention

Four major possible outcomes in an individual of exposure to

a causal agent.

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Modes of Disease transmission

Direct transmission (person-to-person-): Immediate transfer
of a pathogen or agent from a host/reservoir to a susceptible
host; e.g. touching contaminated hands, skin-to-skin contact,
kissing
Indirect transmission: Occurs when pathogens or agents are
carried by other intermediate items or organisms to
susceptible host
- Airborne
- Waterborne
- Foodborne
- Vehicleborne
- Vectorborne
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Methods of Transmission

Droplet Contact
Also known as the respiratory route, it is a typical
mode of transmission among many infectious agents. If
an infected person coughs or sneezes on another person
the microorganisms, suspended in warm, moist droplets,
may enter the body through the nose, mouth or eye
surfaces.
Diseases that are commonly spread by coughing or
sneezing include (at least):

Droplet Transmission (cont.)

Bacterial Meningitis
Chickenpox
Common cold
Influenza
Mumps
Strep throat
Tuberculosis
Measles
Rubella
Whooping cough

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Fecal Oral Transmission

Direct contact is rare in this route, for humans at least. More
common are the indirect routes; foodstuffs or water become
contaminated (by people not washing their hands before
preparing food, or untreated sewage being released into a
drinking water supply) and the people who eat and drink them
become infected.
In developing countries most sewage is discharged into the
environment or on cropland as of 2006; even in developed
countries there are periodic system failures resulting in a sanitary
sewer overflow. This is the typical mode of transmission for the
infectious agents of (at least):
1. Cholera
2. Hepatitis A
3. Polio
4. Rotavirus
5. Salmonella

Sexual Transmission
This refers to any disease that can be caught during sexual activity
with another person, including vaginal or anal sex or (less
commonly) through oral sex. Transmission is either directly between
surfaces in contact during intercourse (the usual route for bacterial
infections and those infections causing sores) or from secretions
(semen or the fluid secreted by the excited female) which carry
infectious agents that get into the partner's blood stream through tiny
tears in the penis, vagina or rectum (this is a more usual route for
viruses).
Some diseases transmissible by the sexual route include (at least):
1. HIV/AIDS
2. Chlamydia
3. Genital warts
4. Gonorrhea
5. Hepatitis B
6. Syphilis
7. Herpes

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Transmission by Direct Contact

Diseases that can be transmitted by direct contact are called
contagious . These diseases can also be transmitted by sharing a
towel (where the towel is rubbed vigorously on both bodies) or
items of clothing in close contact with the body (socks, for example)
if they are not washed thoroughly between uses. For this reason,
contagious diseases often break out in schools, where towels are
shared and personal items of clothing accidentally swapped in the
changing rooms.
Some diseases that are transmissible by direct contact include:
1. Athlete's foot
2. Impetigo
3. Syphilis (on rare occasions, if an uninfected person touches a
chancre)
4. Warts

Vector Borne Transmission

A vector is an organism that does not cause

disease itself but that transmits infection by
conveying pathogens from one host to
another.

Examples include mosquitoes, deer ticks,

animal bites, etc.

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Responses
(Natural history following exposure)
First, no apparent effect.
Second, damaging effect of the exposure which may be
repaired/without illness.
Third, illness that is rapidly contained by the body's defence
mechanism.
Finally, the illness may progress until it leads to continuing
long term problems, irreversible damage or death.
The outcome will depend on the interactions of host, agent
and environmental factors.

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Incubation period
(Natural history)
Time between exposure and the development of
disease is the incubation period.
Diseases that have long incubation periods generally
have a long clinical course and, if so, they are called
chronic diseases.
Some chronic diseases, paradoxically, lead to sudden
and unexpected death e.g. a stroke or heart attack.
The label chronic disease is based on the natural
history.

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Incubation period
(Natural history)

Diseases with a short incubation period usually have

a short course, and are known as acute diseases.

These include most infections and many toxic

disorders.

The effects of acute disease may also be severe and

prolonged, e.g. post-viral syndromes.
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Natural history: Applications

Natural history is vital for disease prevention

It underlies screening.

It provides a rationale for all health care

Purpose of health care, including medicine, is to

influence the natural history of disease
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Natural history:
Role of medicine and public health
Public health and medical action

Death

past

future
Present
Full health Time

Infancy childhood adolescence adulthood old age

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Disease transmission
Fomites Inanimate objects that serve a role in disease transmission e.g.
clothing, pencils, cups
Vector Any living non human carrier of disease that transports or serves the
process of disease transmission, e.g. insects, rodents, cats and other pets
Reservoir Humans, animals, plants, soil, or inanimate organic matter such
as faeces and food in which infectious organisms live and multiply. Such
activities within the reservoir are done in a way that allows disease
transmission to a host
Zoonosis The transmission of disease from animals to humans (the
transmitted diseases are called zoonoses)
Carrier A person or animal which harbours and spreads an infectious
organism, usually without noticeable manifestation of the disease

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Spectrum of disease

Disease may present with varying signs, symptoms and

severity.
Diseases may be mild or even silent - one of the many
explanations for undiagnosed disease in the community.
This phenomenon is described by the metaphors of the
iceberg and pyramid of disease.
For most health problems there are large numbers of
undiscovered or misdiagnosed cases.
Serious and killing disorders such as diabetes, atrial
fibrillation and hypertension are good examples of this.
Cases that have been correctly diagnosed can be likened to
the tip of the iceberg.
Epidemiology that forgets the iceberg phenomenon of disease
Is weak and potentially misleading.
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Iceberg phenomenon
Cases of illness correctly diagnosed by clinicians in the
community often represent only the tip of the iceberg.

Many additional cases may be too early to diagnose or may remain

asymptomatic.

Examples: Tuberculosis, meningitis, polio, hepatitis A, AIDS.

The risk is that persons with in-apparent or undiagnosed

infections may be able to transmit infection to others.

10/10/2009 Dr. Salwa Tayel 24

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The pyramid and iceberg of disease

1 Diseased, diagnosed & controlled

2 Diagnosed, uncontrolled Diagnosed

disease

3 Undiagnosed or wrongly
diagnosed disease

Undiagnosed or
4 Risk factors for disease wrongly diagnosed disease

5 Free of risk factors

Blocks 1 and 2 correspond to the iceberg above the sea-level

and 3 to 5 below sea level

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The Spiders web model

For many disorders our understanding of causes is highly

complex.

These disorders are referred to as multifactoral or

polyfactorial disorders.

Mechanisms of causation are not apparent.

Portrayed by the metaphor of the spiders web.

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The web of causation

1. There is no single cause

2. Causes of disease are
interacting
3. Disentangling causes is
nigh possible
Disease
4. Causality may be two
way

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Communicable diseases for which vaccines are

used
Anthrax Pneumonia
Cholera Polio
Measles Rabies
Hepatitis A Smallpox
Hepatitis B Tetanus
Meningitis Tuberculosis
Mumps Yellow fever
Whooping cough Chicken pox
ebola
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RE-EMERGING INFECTIOUS
DISEASES
Refers to diseases which were a problem
previously but are now re-emerging as major
public health concerns e.g. tuberculosis

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HISTORY OF TB
In 19th century TB killed more than any other disease
Improvements in nutrition, housing, sanitation &
medical care in 1st half of 20th century cut cases
significantly
Further decline in case rates due to effective antibiotic
therapies in the 1940s and 50s

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TUBERCULOSIS

About nine million new cases of TB globally, yearly

Nearly two million deaths from TB yearly
TB is the leading cause of death among curable infectious diseases.
The World Health Organization declared TB a global emergency in 1993.
10- 15 million have latent TB; 10% will develop active disease during
lifetime.
In 2011, there were 9042 new cases of TB reported in the UK (14.0 per
100,000) and the London region accounted for 40 per cent of cases (44.8
per 100,000) (Health Protection Agency 2012)
TB transmission occurs in the impoverished, malnourished, drug &
alcohol addicted, overcrowded or in poor health
Minorities disproportionately affected

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Causes of resurgence

HIV/ AIDS pandemic

Immigrants arriving from countries with TB
Limited access to health care
Poor compliance with treatment regimens; leading to
drug resistant TB (MDR-TB)
Contributory conditions such as poor housing,
overcrowding, poverty, poor nutrition

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TUBERCULOSIS
DESCRIPTION
- Chronic bacterial infection causing high
disease morbidity and mortality world-wide
- Airborne disease that is transmitted only
after prolonged exposure to someone with
active disease
-TB usually infects the lungs but other organs
can be involved

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Mycobacterium tuberculosis
(Gram negative bacilli)

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Effects of TB
(and other infectious diseases)

Human misery through suffering, pain and death

Economic loss due to loss of productivity
Societal loss because of the demise of
future leaders in all aspects of society

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CONTROL MEASURES
Identification of infected individuals early
Isolation of active disease
Treating infected individuals with drugs in
combination (DOT-directly observed
therapy)
Patient education
Improved living and sanitary conditions

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Food/water borne infections

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Water-related diseases
Water, sanitation and hygiene have important impacts on
both health and disease.
Water-related diseases include:
those due to micro-organisms and chemicals in water
people drink;
diseases like schistosomiasis which have part of their
lifecycle in water;
diseases like malaria with water-related vectors;
drowning and some injuries;
and others such as legionellosis carried by aerosols
containing certain micro-organisms.
Water also contributes to health, for example through
hygiene.
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Definition
Food-borne illness two or more cases of a similar
illness resulting from the ingestion of a common food
Water-borne illness an illness that occurs after
consumption or use of water intended for drinking or
as illness associated with recreational water such as
swimming pools, whirlpools, hot tubs, spas, water
parks, and naturally occurring fresh and marine surface
waters

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Epidemiology - Food-borne
Cholera only bacterial food-borne illness
that must be reported internationally
Hepatitis A only viral food-borne illness
that is reported
Globally only 1-10% of food-borne
illness incidences are reported.

Epidemiology - Food-borne
List of most common bacterial food-borne
illness, listed in order of occurrence
1) Campylobacter
2) Salmonella
3) Shigella
4) E. Coli

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Non Infectious Disease

Non-communicable diseases
Chronicconditions
Occupational disorders

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Non Infectious Disease

Non-infectious diseases (also called Non-
communicable diseases ) are those diseases that are not
caused by a pathogen and cannot be shared from one
person to another.

Non-infectious diseases may be caused by either the

environment, nutritional deficiencies, lifestyle choices, or
genetic inheritances. Unlike infectious diseases, non-
infectious diseases are not communicable or contagious,
although some kinds can be passed down genetically to the
children of a carrier.

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Infectious vs. Non-Infectious

Historically, infectious diseases were the main
cause of death in the world and, indeed, in some
developing regions this may still be the case.
With the development of antibiotics and
vaccination programs, infectious disease is no
longer the leading cause of death in the western
world.

Non-infectious disease is now responsible for

the leading causes of death in both developed
and some developing countries.

Causes of Non-Infectious Disease

Causes of non-infectious disease are
categorized into genetically inherited
diseases and environmental diseases.

Non-infectious diseases that are not

genetic disorders are environmental
diseases, although many diseases are
affected by both genetic and environmental
factors.

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Environmental Diseases
Environmental disease is a very broad category. It includes
avoidable and unavoidable conditions caused by external factors,
such as sunlight, food, pollution, and lifestyle choices. The diseases
of affluence are non-infectious diseases with environmental causes.
Examples include:

Many types of cardiovascular disease

Chronic obstructive pulmonary disease caused by smoking tobacco
Type 2 Diabetes
Malnutrition caused by too little food, or eating the wrong kinds of
food (e.g. scurvy from lack of Vitamin C)
Skin cancer caused by radiation from the sun

Cancer
Cancer is a non-infectious disease that affects
millions of people. The most common cancer type
are non-melanoma skin cancer, with about one
million cases a year.
Lung cancer is the second-most common, with
about 219,440 new cases and 159,390 deaths. Other
common cancers include bladder, breast, leukemia,
pancreatic, prostate, thyroid, colorectal, endometrial
and kidney cancer.

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Heart Disease
Coronary heart disease (CHD) is the leading
cause of death both in the UK and
worldwide.
It's responsible for around 74,000 deaths in the
UK each year. About 1 in 5 men and 1 in 8
women die from CHD.
In the UK, there are an estimated 2.7m people
living with the condition and 2m people
affected by angina (the most common
symptom of coronary heart disease).

Heart Disease
Heart or cardiovascular disease refers to a variety
of conditions that involve the circulatory system.
Heart attacks, strokes, chest pain, tachycardia,
high cholesterol, heart valve disease, high blood
pressure, palpitations and congenital heart
disease are some of the non-infectious heart
diseases.

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Mental Disease

Mental disease covers a broad range of non-

infectious diseases that affects people of all ages.
Autism, panic attacks, narcolepsy, manic-
depressive disorder, depression, bulimia nervosa,
bipolar disorder and Asperger's syndrome are
examples of non-infectious mental diseases.

Bone Disease

Non-infectious bone diseases include osteoporosis,

Paget's disease and osteogenesis imperfecta.
Osteoporosis indicates a low bone mass, fragile
bones, and high risk of bone fractures.
Paget's disease presents as bones that grow larger and
weaker than normal bones. Osteogenesis imperfecta
(OI) is a non-infectious genetic disorder. OI
symptoms include bones that break easily.

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Muscle & Joint Disease

Non-infectious muscle and joint diseases
include fibromyalgia, rheumatoid arthritis and gout.

Fibromyalgia is a chronic non-infectious disease

identified as pain and tender points in soft tissue,
muscles and joints throughout the body.
RA symptoms range from mild occasional joint
pain to severe and debilitating pain.
Gout is a non-infectious disease caused by high
levels of uric acid in the joints and manifests as
sudden severe joint pain, possibly accompanied by
fever and feeling ill.

Diabetes
When carbohydrates are eaten, they get converted to
glucose which is blood sugar. To stabilize blood
sugar levels, the pancreas releases insulin.
In people that have diabetes, a noninfectious disease,
the pancreas does not release insulin properly or at
all in the most severe cases. This can cause kidney
failure, blindness, nerve damage and heart problems.

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Non-communicable disorders
Mental and psychiatric disorders (schizophrenia, sleep disorders)
Nutritional deficiency disorders
1. - malnutrition (e.g. scurvy, iron deficiency anaemia)
2. - over nutrition (obesity)
3. - under nutrition (e.g. eating disorder, anorexia)
Obesity
Diabetes
Suicide
Accidents
Drug abuse
Cancer
Stroke
Alcoholism
Etc
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Chronic disorders
(Acute disorder Short duration and generally caused by a pathogen
(communicable))

Chronic disease Usually of long duration (more than 3

months)
Not often caused by a pathogen or infection (non-infectious)
Result from lifestyle, risk-taking behaviours, occupational
exposure, and ageing process
Incidence of chronic disease increases with age
Also referred to as, or result in, impairment chronic or
permanent defect and loss of ability to perform various physical
and sensory functions

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Industrial diseases

Lead poisoning (potters)

Mercury poisoning (mirror makers)
Infectious diseases
Physical Injuries
Chemical burns and injuries
Mental illness

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Disability
Disability Any long or short term reduction of a persons activity as a
result of acute or chronic condition
Limitation of activity Any long-term reduction in a persons capacity to
perform the average kind or amount of activities associated with his or her
age group
Restriction of activity Any particular kind of behaviour usually
associated with a reduction in activity due to either long- or short-term
conditions.
Disability imposes huge social, emotional, economic and other costs/ burden
to individuals, families, workplaces, communities, health systems and
society in general

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Risk factors in chronic diseases and

behaviourally caused diseases
Those experiences, behaviours, acts or aspects of
lifestyle, that increase the chances of acquiring or
developing a disease, condition, disorder or death
Sources of risk factors for no communicable diseases are
behavioural, physiologic/ genetic, social, and
environmental
Increased risk factor exposure increases the probability
of disease occurring
Risk factors also known as at-risk behaviour,
predisposing conditions, or predisposing factors
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Reducing the risk factors for

heart disease

1. Attain and maintain desirable weight

2. Regular check for high blood pressure
3. Stop smoking and tobacco use
4. Avoid heavy drinking
5. Regular exercise
6. Healthy diet, low in saturated fats
7. Low stress lifestyle
8. Good coping skills

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Prevention & Control of chronic diseases

1. Increased fitness and exercise
2. Proper weight maintenance
3. Reduction in stress
4. Increased safety measures
5. - Road traffic
6. - Workplace accidents
7. - Safe housing & recreation
8. Early Detection Programmes (EDP)
9. - Screening (breast cancer etc.)
10. Vaccination
11. Behavioural and lifestyle changes
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Class involvement
Using the figures below

Describe the incidence of Describe the incidence of

tuberculosis in the UK Cancer in the UK and
mortality in Europe

Please use statistics or figures in your sentences

to illustrate your point

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Source:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/360
335/TB_Annual_report__4_0_300914.pdf
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Source:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/360
335/TB_Annual_report__4_0_300914.pdf
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Number of new cases and rates by age

and sex UK 2006
60,000 3,500

50,000 3,000
Male cases 2,500

Rate per 100,000 population

40,000 Female cases
Number of new cases

Male rates 2,000

30,000 Female rates
1,500
20,000
1,000
10,000 500

0 0

75+
under 15

15-24

25-34

35-44

45-54

55-64

65-74
Age at diagnosis

Age-standardised (European) incidence and mortality rates,

all cancers (exc NMSC), GB 1975-2007

450.0
400.0
350.0
Rate per 100,000 population

300.0
250.0
200.0
150.0
100.0
Persons Incidence Persons Mortality
50.0
0.0
1999
1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

2001

2003

2005

2007

Year of diagnosis/death

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Question and Answer

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