STEP 1

Preventive : Step to prevent illness

Consult : to talk about something to someone professional in order to make a

decision

Natural History : Track record of disease

Step 2

1. How to avoid infection disease?

2. What are example of infection disease?
3. What kind of preventive?
4. What are the cause of infection?
5. How does the infection work?
6. What are the symptoms of the flu?
7. What are the media of infection disease?
8. How to solve infection disease when it happen our society
9. What is the function of the immune system in our body?
10. How to spread the disease?
11.How could flu symptoms persistent with medicine?
12. What of definition of infection disease?

STEP 3

Infection disease

1. What of definition of infection disease?

A Disease that can be occurred by germs which enter the body become
pathogen (rizky)
Inflation and culturing microorganism in body tissue (Yunitia)
2. How to avoid infection disease?
Do the healthy life style (jeffri)

Wash Hand
Use masker
 Vaccination
Immunitation
Sterilization (Defry)

Use a clean cookware (Neily)

Cover mouth and nose when sneezing and coughing (Rizky)

Keep your immune system with rest enough (Ovita)

3. What are example of infection disease?
Influenza ,DHF, TBC (fARAH)
Meningitis, HIV/AIDS (Muthia)
Gonorea(Jeffri)
Diare (Ala’ul)
Typhus ( Neily)
Malaria, polio (Rizky)
Colera ( Ovita)
Hepatitis B & C ( SGD 10)
H5N1, H1N1 (Defry)
ETC
4. What kind of preventive?
Preventive Primare : to avoid infect some disease ( Immunitation,
supplement, kill the vector of disease, exercise )
Preventive sekunder : to detect our risk of disease ( medical check up)
Preventive tertiary :Cure a disease ( Therapy, Rehabilitation)
5. What are the cause of infection?
- Bacteri
- Viruse
- Fungi
- Parasit (SGD 10)

6. What are the media of infection disease?

 Air ( Nauval)
Water
Food and beverages ( Ovita )
Insect , mosquito , physical contact Direct (skin to skin), Indirect (blood) (
Farah)
Soil (Muthia)
Medical tools ( Defry )
Animals that can bring the infection disease (Caesar)
Free Sex (jeffri)
7. How to solve infection disease when it happen our society?
Stop the disease the life cycle ( Nauval)
Isolate the suspect ( Jeffri )
8. How to disease spread ?
- Endogent ( the disease by him/her self)
- Cross (the disease by the other people)
- Environment (medical tools)

Immune and flu

9. What are the symptoms of the flu?

- Fever
- Cough
- Shorerthrout
- Stuffy nose
- Headache
- Chill (Neily)
-
10. What is the function of the immune system in our body?
To protect our body from infection(muthia)
To keep the stability of our body
11.How could flu symptoms persistent with medicine?
Because the microorganism become resisten with the drug (mutation)
Factor virulancy the strength of infaction
Natural History of disease

12.What is the definition of natural history of disease?

- Riwyat penyakit yang meliputi RPD , RPK, RPS (Nauval)
- Perkembangan suatu penyakit yang di tangani tanpa suatu campur
tangan oleh medis atau intevensi medis
13.How step of natural history of disease?
Agent infection enter our body -> our body giving immunity respon -> local
and systemic clinical symptom appear ( Yunitia)

Prepatogenesis -> pathogenesis -> infeksi -> akhir penyakit

14. What are benefit of knowing natural history of disease?
- To helping diagnostic (Muthia)
- To help make a therapy ( Yunitia)
- To prevent the other from infected ( Jeffri)

STEP 4

The factor of infectious disease

Natural History

Infectious Disease

Preventif Promotive

Transmission of Disease
Infection disease

1. What is the definition of infection disease?

Infection disease is caused by a biological agent such as by a virus,
bacterium or parasite.
Infection disease are the invasion of a host organism by a foreign replicator,
generally microorganisms, often called microbes, that are invisible to the
naked eye.
http://www.metrohealth.org/2013(muthia)

Invasion and breeding of microorganisms in body tissues, may not

seem clinically or local cellular injury arising as a result of
competition metabolism, toxins, intracellular replication, or
antigen-antibody response.
Dorland's Medical Dictionary, 29th edition (farah)

2. How to avoid infection disease?

Wash your hands. This is especially important before and after preparing food, before eating
and after using the toilet.

Get vaccinated. Immunization can drastically reduce your chances of contracting many diseases.
Make sure to keep your recommended vaccinations, as well as your children's, up to date.

Stay home. Don't go to work if you're vomiting, have diarrhea or are running a fever. Don't send
your child to school if he or she has these signs and symptoms, either.

Prepare food safely. Keep counters and other kitchen surfaces clean when preparing meals. In
addition, promptly refrigerate leftovers — don't let cooked foods remain at room temperature
for extended periods of time.

Practice safe sex. Use condoms if you or your partner has a history of sexually transmitted
infections or high-risk behavior.

Don't share personal items. Use your own toothbrush, comb and razor. Avoid sharing drinking
glasses or dining utensils.
 Travel wisely. Don't fly when you're ill. With so many people confined to a small area, you may
infect other passengers on the plane. And your trip won't be comfortable, either. If you're
traveling out of the country, talk to your doctor about any special vaccinations you may need.

http://www.mayoclinic.com/health/infectious-
diseases/DS01145/DSECTION=prevention(yunitia)

 Health improvement
- Health education
- Vacation
- Healthy home
- Healthy life style
 General protection and spesific protection
- Immunization
- Using a spesific nutriens
- Avoid allergyc substancess
 Early diagnosis, quick and early treatment
- General check up reguraly
- Selective survey of specific diseases
- Right treatment for the begining of disease
 Inability of limitation
- Prevention against complications and disability
 Rehabilitation
Source : “Buku Ajar Epidemiologi” 2008 page 20 (defry)
3. What are example of infection disease?
1. Influenza
The disease is caused by a virus that attacks the respiratory tract. These diseases include
diseases that quickly spread. Symptoms of the disease are chills, fever, headache, sore
back muscles, the body feels weak, tired, sweaty, sore throat, cough - cough, runny nose,
and body temperature rises.

How to treat influenza disease is to consume as much water - quantity and adequate rest.
- And Flu Relief Drink Beverages.

2. Dengue Hemorrhagic Fever (DHF)

Dengue fever is an infectious disease that can be fatal in a very short time. Dengue fever
is not contagious through direct human contact but can be transmitted through mosquito
Aedesaegypti females that keep the virus in eggs and will transmit the virus to humans
through bites. This type of mosquito bite usually during the day (09:00 to 10:00) and
afternoon (16:00 to 5:00 p.m.)

Symptoms of dengue fever is among adala arrived - arrived, severe headache, pain in
joints and muscles, as well as the raised dots - red spots on the skin. Prevention of dengue
fever can be done by:

mosquito spraying in the home and community,

clean waterways, cover water storage,
mengurasbak cleaning and bathing,
and bury stuff - junk that are not used

3. Diarrhea
Diarrhea is a disease caused by a virus. People with diarrhea will have frequent bowel
movement faces a watery texture. Severe diarrhea if not handled properly can cause
dehydration and can also cause death.

Disease symptoms of diarrhea can be caused by injury, allergies to certain substances,

illness from food, consuming excess vitamin C. Diarrheal diseases can be treated by
consuming plenty of fluids, especially oralit that could replace the amount of fluid that
comes out through bowel movements.

4. Tuberculosis (TB / TB)

Tuberculosis is caused by Mycobacterium tuberculosis bacteria that can attack all parts of
the body but is most lung. People affected by TB can infect others through the respiratory
system. TB disease is now more difficult to cure after the discovery of the virus that
mutates XDR-TB that are resistant to existing drugs currently

5. Smallpox
Chickenpox Varicella Zoster virus that caused it is contagious. In the skin the patient will
find a bunch of little spots, sided liquid, or scab. The spots are making people feel itchy.
The long term effects on the skin defects, infertility, and sometimes blindness. Other
symptoms such as fever, headache, body aches and rash.

6. Malaria
Malaria has killed 2 million people per year and cause about 400 to 900 million cases of
fever each year. The malaria parasite is transmitted by mosquitoes, and they multiply in
red blood cells. Symptoms such as anemia, fever, nausea, and in some extreme cases can
lead to coma and death. Malaria is the biggest problem in the tropics and subtropics of
the world.

7.Muntaber
Well, this last disease can be said the most severe of all on and off. Patients with diarrhea
and vomiting can dehydrate the body quickly, especially if it affects children and infants.

8. Measles
Measles is a disease caused by a virus paramiksovirus. The disease is transmitted from
the saliva of the patient. The incubation period of this disease is 10-14 days. This disease
symptoms are hot, runny nose, cough, sore throat, pain in muscles and the eyes become
red. At its peak the patient will feel pain, rashes all over the body and high body
temperature. This disease can be prevented with the measles vaccine as a baby.

9. Polio
Polio is caused by a virus that includes family picornavirus genus enterovirus that causes
the sufferer paralyzed wilt. The virus is resistant to physical and chemical effects. The
virus can also live in feces for 90-100 days. The virus can survive longer in wastewater
and surface water, even up to several kilometers from the source of infection.

10. Cholera
Cholera (cholera) is a disease of the intestinal tract infection. The nature of acute cholera,
the bacterium Vibrio cholerae causes. These bacteria enter the body through
contaminated food or drink. In the gut bacteria secrete enterotoxin (poison). As a result,
patients with diarrhea (diarrhea) accompanied by acute and severe vomiting. As a result
of information, people lose a lot of fluids and get in on the state of dehydration that can
be fatal.

11. Plague
Bubonic plague is better known as "Black Death", is a contagious disease caused by the
bacterium Yersinia Pesti, most often carried by rodents and fleas. In medieval times,
millions of people across Europe died from plague caused by rat infestation that is widely
available in homes and offices.

Now there has been an efficient antibiotics to treat the disease if detected early. But if
someone has been infected and is not treated immediately, likely to cause death. Bubonic
plague is sometimes still occur in rural communities.

12. Typhus
Typhus is still prevalent in developing countries, so that foreign tourists should be
vaccinated against it. The disease is caused by Salmonella typhi bacteria carried into the
bloodstream and intestinal tract.

Symptoms of typhoid fever as a sustainable, weakness, abdominal pain, headache and

loss of appetite. In some cases, there is a rash and red spots on pasein. Typhoid fever is
usually treated with antibiotics that can disappear for 2-3 days of infection.

13. Yellow fever

Yellow fever is a deadly viral disease that is transmitted by mosquitoes. This naming
because infected patients can look yellow. Yet no cure for yellow fever. Treatment is
only aimed at reducing the patient's symptoms, such as fever, abdominal pain, vomiting,
and bleeding from the mouth, nose and eyes.

There are 30,000 deaths from yellow fever each year, most commonly in the tropics.
Currently, vaccination is the most important preventive measure against yellow fever.

14. Spanish Flu

Between 1918 and 1919, the Spanish flu killed 20 to 40 million people. This is truly a
global disaster. This deadly flu strikes people aged 20 to 40 years, and infected 28
percent of the American population.
http://www.tricajus.asia/jenis-jenis-penyakit-menular/ (rizly)

a. Hepatitis A
b. smallpox
c. Cholera
d. Dysentrie
e. Thypus
f. wormy
g. DBD
h. H5N1
i. Measles
j. Trachoma
k. Ascariasis
l. etc
http://ejournal.litbang.depkes.go.id/index.php/blb/article/viewFile/1199/3
248 (neily)

Common influenza or commonly called the flu is a disease caused by a virus

, called influenza virus .

Cervical cancer that only affects women is a disease caused by a virus , the
human virus pappiloma virus ( HPV ) oncogene . These viruses include
virulent virus due to a division by very fast , uncontrolled and unnoticed

Ebola is a disease caused by the Ebola virus . The disease is so terrible

because the body of the patient will experience bleeding throughout the
body of the patient
 Avian influenza or bird flu is a disease caused by influenza virus type A
H5N1 strain that is transmitted by birds and attack humans . Countries in
Asia most easily confirmed infected with the H5N1 virus .

SARS is acute respiratory disease syndrome caused by a virus , the SARS

virus . This disease first appeared in Guangdong province , China and then
spread into an epidemic in several countries through an airport where
there are a lot of people from various countries .

Chicken pox is a disease caused by a virus , called varicella - zoster virus .

Smallpox only once during the life of human suffering . It is recommended
to maintain immunity to avoid this virus .

Herpes is a viral disease caused by herpes simplex . Herpes can attack the
skin , mouth and genitals ( herpes Genetalis ) . Herpes is known as
inflammatory disease of the skin characterized by redness rash with
bubbles clustered water .

Hepatitis is a viral disease caused by the hepatitis A , B , non- A and non-B

Known hepatitis with jaundice or liver due to virus attacks the liver . The
cause of hepatitis is viral infection , the presence of metabolic disorders ,
alcoholism, autoimmune ,

Polio is a disease caused by a virus , called polivirus . Polio causes

paralysis of parts of the body , especially the legs . These viruses enter
through the mouth and then infect the intestinal tract , enter through the
bloodstream and invade the central nervous and cause permanent paralysis
within hours .

AIDS is a viral disease caused by HIV ( Human Immunodeficiency Virus ) .

AIDS is known as a variety of symptoms and infections arising from damage
to the immune system . Or in other words , when a person infected with
HIV , then that person has no immune system , so if the patient is exposed
to the flu or other illnesses it will be very difficult to recover .

 Meningitis : a symptom triad of headache,neck stiffness and photophobia.

The causes can be :
 Bacterial : meningococcus

 Viruses : entero viruses,herpes simplex virus

 Fungal : cryptococcus,candida
 Diarrhoea : an increased frequency and volume of stool pased.
The causes can be :
 Staphylococcus aureus
 Escherichia coli

 Bacillus cereus
 Salmonella enteritidis
 Cellulitis : an infection of the subcutaneous tissues and dermis.
 Streptococcus

 Gastroenteritis : an infection of the gastrointestinal tract, which usually causes

diarrhoea and/ or vomiting.
 Example : vibrio cholerae
  HIV/AIDS : endemic around the world, but the highest rates of morbidity and mortality.
 Human Immunodeficiency Virus (HIV)

 Tubercolusis : caused by mycobacterium tuberculosis.

Nickerson emma.2007.Infectious Disease.USA:Mosby Elsevier

http://palingseru.com/14538/foto-gambar-bakteri-dan-virus-berbahaya-yang-diperbesar
(muthia)

4. What kind of preventive?

a. Preventive Primare : an attempt to maintain a healthy people to stay

healthy. (immunization, environmental sanitation and sports)
b. Preventive sekunder : an attempt to prevent people who have been sick
to heal, and prevent complications. Secondary prevention can be done
by detecting the disease early and do a quick and proper treatment
c. Preventive tertiary : prevention is intended to reduce the disability and
rehabilitation held. This prevention can be done by:
1. maximizing organ function disabilities
2. make the prosthesis limb amputation due
3. establish medical rehabilitation centers
From : book pengantar epidemologi edisi 2 (Neily)
5. What are the cause of infection?
BACTERIAL INFECTIONS
VIRAL INFECTIONS
FUNGI INFECTION
http://emedicine.medscape.com/infectious_diseases (farah)

- Virus
- Prion
- Chlamydal
- Mycoplasma
- Rickettsioses and Ehrlichioses
- Bacteri
- Mycoses
- Protozoa
- Toxic algae
- Helminthes
- Ectoparasitic

Sumber: buku mendel (jeffri)

6. What are the media of infection disease?

A. Vehicle - Borne , namely the spread or transmission of pathogenic

microbes through inanimate object ( fomite ), such as medical pelatan ,
materials or medical materials pelatan eating / drinking patients
B. Vector - borne , ie the spread or transmission of microbial pathogens
with intermediate vectors such as flies . Open wounds , burns are the
most vulnerable cases exposed to flies
C. Food borne , namely penyebaraan or transmission of pathogenic
microbes through diet drinks that are served to patients . Microbial
pathogens also accompany causing gastrointestinal symptoms and
complaints , whether mild or severe
D. Water borne , the possibility of infection or the spread of infectious
diseases through the water , very small , given the availability of clean
water in the hospital is through a standard quality test
 E. Water borne , terjdinya chances of cross-infection through
intermediaries is quite high because of the room / ward closed
technically relatively poor ventilation and lighting . This condition is even
worse if the number of people who pretty much
Problematia and control of nosocomial infections , a senior official , P24
(OVITA)

water, air, soil, weather, food, skin contact, and animals

From : book pengantar epidemologi edisi 2 (neily)

 through the air (Some infections are spread when an infected person sneezes or coughs
out tiny airborne droplets).

 Sexually transmitted infections (These infections are most commonly transmitted by

sexual contact. Sexual contact means genital to genital, oral to genital, or oral or genital
to anal contact).
 Saliva ( Some infections are spread by direct contact with saliva (such as kissing) or
indirect contact with contaminated objects (such as children sucking
and sharing toys).

 skin or mucous membrane (Some infections are spread directly when skin or mucous
membrane comes into contact with other skin or mucous membrane. Infections are spread
indirectly when skin or mucous membrane comes in contact with contaminated objects or
surfaces.)

 Food or waterborne diseases (These diseases result from ingestion of water or a wide
variety of foods contaminated with disease-causing micro-organisms or their toxins.
Often these infections are also spread by the faecal-oral route).
 urine (Some infections are spread when urine is transferred from soiled hands or objects
to the mouth).

 blood and body secretions (Some infections are spread when blood or other body fluids
from an infected person comes into contact with the mucous membranes or bloodstream
of an uninfected person, such as through a needle stick or a break in the skin)

http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/h
ealth+conditions+prevention+and+treatment/infectious+diseases/ways+infectious+diseases+spread.Aus
tralia. (muthia)
7. How to solve infection disease when it happen our society?
Break the chain of transmission (sequence the process of moving from a
source of transmission of pathogenic microbes (resevoir) to host with /
without media intermediaries).

Eliminate microbial pathogens sourch the resevoir and observing the

transmission mechanism, especially using media intermediaries.

Source: Darmadi. (2008). Infeksi Nosokomial : Problematika dan Pengendaliannya. Jakarta:

Salemba Medika. (Caesar)

Disease prevention and control activities occurs at 4 level

1.First level is individuals and is predominantly the domain of the clinician
2.Second level is that of the institution,which is predominantly the domain
of the infection control practitioner or the school health official
3.Third level is targeted to the community in general and is predominantly
the domain of public agencies
4.Fourth is related to global strategis
Source : mendel part 4 page 3248 (jeffri)

8. How to disease spread ?

There is 2 classification of transmission mechanism

- Direct Agent Transmission
o Direct transfer of an infections agent to receptive portal of entry
through which the human infection is established
 Ex : kissing,sex,etc
o Direct transfer of infection occurs when host susceptible tissue is
exposed to the agent,
 Ex : animal bite,contact with soil,etc
o Transplacental transmission
- Indirect Agent Transmission
 o Vehicle-borne : occurs when any material serves as an
intermediate means by which an infectious agents is transported
or introduced into the susceptible host through a suitable portal
of entry
 Ex : water,food,blood,surgical equipment,serum,plasma
o Vector-borne : there is 2 different between vector-borne
mechanical transmission and biological transmission
Mechanical transmission : insect bite
Biologic transmission : propagation,cyclic and cyclopropagative
o Airborne : through the air
Source : mendel part 1 page 157 (jeffri)

1) The permanent or transient flora of the patient

Bacteria present in the normal flora cause infection because of transmission to sites outside the
natural habitat (urinary tract), damage to tissue (wound) or inappropriate antibiotic therapy that
allows overgrowth (C. difficile, yeast spp.). For example, Gram-negative bacteria in the digestive
tract frequently cause surgical site infections after abdominal surgery or urinary tract infection
in catheterized patients.

2) Flora from another patient or member of staff

Bacteria are transmitted between patients: (a) through direct contact between patients (hands,
saliva droplets or other body fluids), (b) in the air (droplets or dust contaminated by a patient’s
bacteria), (c) via staff contaminated through patient care (hands, clothes, nose and throat) who
become transient or permanent carriers, subsequently transmitting bacteria to other patients by
direct contact during care, (d) via objects contaminated by the patient (including equipment),
the staff’s hands, visitors or other environmental sources (e.g. water, other fluids, food).

3) Flora from the health care environment

— in water, damp areas, and occasionally in sterile products or disinfectants (Pseudomonas,

Acinetobacter, Mycobacterium)

— in items such as linen, equipment and supplies used in care; appropriate housekeeping
normally limits the risk of bacteria surviving as most microorganisms require humid or hot
conditions and nutrients to survive

— in food
 — in fine dust and droplet nuclei generated by coughing or speaking (bacteria smaller than 10
μm in diameter remain in the air for several hours and can be inhaled in the same way as fine
dust).

Source: World Organization Health (2002). Prevention of Hospital-acquired infections. Malta.

(caesar)
9. What are the symptoms of the flu?

Feel miserable,increasing body temp ,dizzy, and discomfortable on

respiration system, (nose, lung, faring)
Source : www.dpd.cdc.gov (Nauval)

10.What is the function of the immune system in our body?

- keeping people healthy
- preventing infections
http://kidshealth.org/parent/general/body_basics/immune.html(
muthia)

11.How could flu virus persistent with medicine?

Virus mutated to againts the antibody, this is basic self defense of every
organism. m.medicastore.com/index.php?mod (Nauval)

Natural History of disease

12.What is the definition of natural history of disease?

Natural disease development without any treatment, start from healthy
until sick is called natural history of disease
Source: “Buku ajar epidemiologi kebidanan” 2008 ,page16

13.How step of natural history of disease?

Prepatogenesis ->interaction between host and agent of infection
outside of body,agent of infection outside of body
host and not enter to host body.
Pathogenesis -> 1. Incubation step = time between inokulasi time

and first symphtoms ex : malaria : 15 day

2. Early disease stages = is calculated starting from

the appearance of disease symptoms, at this stage

of the host are ill but still mild in nature.

3. Advanced disease stage

If more and more severe disease, the disease

entered the advanced stages of the disease. At this

stage the patient was no longer able to do the job

and if it comes to treatment, have generally require

treatment

4. End Stage Disease

Course of the disease at some point will end

 complete recovery
 cured but flawed
 career
 chronic
 die
Beaglehole R, Bonita R, Kjellström T. Basic epidemiology. Geneva, Switzerland:
WHO; 1993 (yunitia)
 (rizky)

5. End Stage Disease

• Course will stop.
• The end of the course of many
circumstances, namely:
a. Complete recovery
both form and function as the body returns to its original
situation before the sickness
b. Cured with disabilities
Patients cured imperfect healing
found defects in the host. Disabling conditions
physical, functional and social.
c. Career
Course of the disease symptoms as if suspended
disease does not appear (within the host still
germs found) a moment illness
may recur (decreased endurance)
d. Chronic
Course of the disease seemed to stop the symptoms of the disease are not
change does not gain weight or lighter
e. Die
Trip interruption host disease dies
world. (a state which is not expected)

Mindel A, Tenant-Flowers M. Natural history and management of early HIV infection.

BMJ 2001;332:1290–93.
 Cobb S, Miller M, Wald N. On the estimation of the incubation period in malignant
disease. J Chron Dis 1959;9:385–93 (muthia)

14. What are benefit of knowing natural history of disease?

a. for diagnostic: the incubation period can be used guideline

determination of the type of disease
b. for prevention: the chain knowing course of the disease can be easily
searched cut points that are important in disease prevention
c. for therapy: therapy is usually directed to the earliest phase. in the early
stages of the disease journey proper treatment has been given. early
therapy will be better expected results
From : book pengantar epidemiologi. Dr. M.N BUSTAN (Neily)

 to anticipate prognosis
 to identify opportunities for prevention
 tell us roughly the time frame within which we have to intervene to alter the
clinical course of the illness and prevent the development of more serious
consequences.
Bhopal R. Concepts of epidemiology. Oxford: Oxford University Press;
2002(yunitia)
 The factor of causing infectious disease

Natural History of disease

Infectious Disease

Preventif Promotive

Transmission of Disease

Decreased transmitted infection Increased transmitted infection