Infectious Disease

Epidemiology

Dr.Kedar Kaeki

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 Features unique to infectious diseases:
1. A case may also be a source.
2. People may be immune.
3. A case may be a source without being
recognized.
4. There is often a need for urgency.
5. Preventive measures often have good
scientific basis.

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 Outcomes of exposure
1. No infection
2. Clinical infection resulting in death,
immunity, carrier or non-immunity
3. Sub-clinical infection resulting in
immunity, carrier or non-immunity
4. Carrier

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 Definitions:
1. Incidence
2. Prevalence
3. Attack rate
4. Primary/secondary cases
5. Case fatality rate or ratio
6. Virulence

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 Definitions continued:
7. Mortality
8. Reproductive rate
9. Vector
10. Transmission routes
11. Reservoir vs source
12. Zoonosis

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 Definitions continued:
13. Incubation period
14. Serial interval
15. Infectious period
16. Latent period
17. Epidemic

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 Mathematical Models for Epidemics
Person to person spread relies on the
reproduction rate, which is the average
number of people infected by one case.
This is influenced by the attack rate of
disease, the frequency of contact, the
duration of infectivity and the immune
status of the population.

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 Outbreak Analysis
Early analysis:
Person: who is the case?
Place: where was the case infected?
Time: when was the case infected?

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 Outbreak Analysis continued
Epidemic Curve
1. Plot the date on the horizontal
axis.
2. Plot the number of cases on the
vertical axis.
3. Determine if the outbreak is point
source, continuous or person to
person.
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 Outbreak Analysis continued
Check the geography.
Check the age and sex.

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 Factors Affecting Surveillance
Outbreak discovery
Outbreak analysis
Validity of notification data
Notification delays
Information feedback
Sources of data

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 Factors Affecting Infectivity
Dose and route
Immunity
Co-factors
Subclinical infection

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 Seroepidemiology
Used for:
1. Description of seroprevalence in
populations
2. Follow incidence by estimation from
changes using multiple samples
from a population

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 Seroepidemiologycontinued
Importance of case and control
classification:
Use of a gold standard reference.
Use of clinical diagnosis.

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 Seroepidemiologycontinued
Sensitivity
Specificity
Positive predictive value
Negative predictive value
Pre-test probability of disease

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Sensitivity Specificity
 Sensitivity (Se): probability of a positive
test given the individuals is diseased.
 Se = # diseased individuals with a positive
test/ # diseased individuals
 Specificity (Sp): probability of a negative
test given the individual is not diseased.
 Sp =# non-diseased individuals with a
negative test/ # non-diseased individuals

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Positive predictive value
 Positive predictive value (PPV):
probability of disease given a positive
test, influenced by population disease
prevalence (pD).
 PPV = true positives/true positives +
false positives
 PPV = (pD x Se/{pD x Se} + {[1-pD] x
[1-Sp}}

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Negative predictive value
 Negative predictive value (NPV):
probability of the absence of disease
given a negative test, influenced by
population disease prevalence.
 NPV = true negatives/true negatives +
false negatives
 NPV = pD x {1-Se}/{pD x [1-Se]} +
{[1-pD] x Sp}

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 Transmission Probability Ratio
TPR is a measure of risk of transmission
from infected to susceptible individuals
during a contact.
For any given type of contact or agent, an
estimate of the effect of a covariate on
susceptibility, infectiousness or both can
be made.

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 TPR continued
TPR of differing types of contacts,
infectious agents, infection routes or
strains can be calculated.
There are 4 types of transmission
probabilities (tp).

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 Study Designs
Cross-sectional: risk or prevalence ratio
Case control: odds ratio
Cohort: relative risk
Survival analysis

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 Study Issues
Confounding
Bias
Misclassification
Interaction

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 Epidem iology of vaccination
Direct: immunity by infection or
vaccination
Indirect: herd immunity
Vaccine efficacy (%)Iu=-Iv/Iu x 100

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Herd immunity
 Herd immunity: the number of people immune
in the population decreases the risk of infection
to the susceptible by diminishing the
probability of exposure. The higher the basic
reproductive rate of infection, the larger the
number of immune people are required to
confer herd immunity.

 Iu = incidence in the unvaccinated

 Iv = incidence in the vaccinated

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 Conclusion
Infectious and “non”-infectious disease
epidemiology have important
differences due to the inherently
different nature of the risk factors
(biological agent i.e. virus, bacteriavs
chemical, environmental or genetic).
It is important to understand and
consider these differences when
conducting infectious disease research.

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