Natural History of Disease

Background

Infectious disease epidemiology

the occurrence of infectious disease in a given host is dependent on the presence of disease in other members of the population and the length of time that infected hosts are able to transmit disease to others understanding these characteristics of a disease allow us to develop rational measures to control disease

Definition & Stages

Definition ; The course of a disease from onset (inception) to resolution. Stages
Progress to a fatal termination

Stage of pathologic onset

Pre-symptomatic stage

Clinically manifest disease

Remission and relapses Regress spontaneously, leading to recovery

Risk Factors

Precursors

Effect of Treatment

Prognostic factor

Risk factor
Risk factor; An aspect of personal behavior or life

style, an environmental exposure, or an inborn or inherited characteristic, that, in the basis of epidemiologic evidence, is known to be associated with health-related condition (s) considered important to prevent. Risk marker; increased probability of a specified outcome; not necessarily a causal factor Determinant; can be modified by intervention, thereby reducing the probability of occurrence of disease or other specified outcomes

The Natural history of disease in a patient

Preclinical Phase Clinical Phase

(A)

(P)

(S)

(M)

(D)

(T)

A ; Biologic onset of disease P ; Pathologic evidence of disease if Sought S ; Signs and symptoms of disease M ; Medical care sought D ; Diagnosis T ; Treatment
Gordis L. Epidemiology. WB Saunders Company. 1996

THE NATURAL HISTORY OF A DISEASE STIMULUS to the HOST interrelation of Agent, Host and Environmental factors PREPATHOGE NESIS Health Promotion Specific Protection HOST REACTION RECOVERY

Latent Period (Presymptomatic)

Symptoms, Signs(Clinical)

with or without Defects, Disability

PERIOD OF PATHOGENESIS

Early Diagnosis and Prompt Treatment,

Disability Limitation Rehabilitation

PRIMARY SECONDARY TREATMENT TERTIARY PREVENTION PREVENTION PREVENTION (Leavell's Level of Application of Preventive Medicine)

TIME
Death Infection Susceptible host No infection Clinical disease Recovery

Incubation period Latent Exposure Infectious Onset Non-infectious

Latent period the time interval from infection to development of infectiousness Infectious period the time during which time the host can infect another susceptible host Non-infectious period the period when the hosts ability to transmit disease to other hosts ceases Incubation period the time interval between infection to development of clinical disease

e.g : Chicken pox

an infectious disease caused by the varicella-zoster virus the latent period for chicken pox is shorter than the incubation period, so a child with chicken pox becomes infectious to others before developing symptoms

TIME
Death Infection Susceptible host No infection Clinical disease Recovery

Incubation period Latent Exposure Infectious Non-infectious Onset

Other examples?

HIV (AIDS)
latent period relatively short infectious period occurs (many years) before the onset of symptoms

TIME
Death Infection Susceptible host No infection Clinical disease Recovery

Incubation period Latent Exposure

Infectious
Onset

e.g : Malaria
caused by protozoan parasites of the genus Plasmodium the stages of the parasite that are infective to mosquitoes occur about 10 days after the development of symptoms latent period is around 10 days longer than the incubation period, so early treatment of symptoms could have an important effect on transmission

Natural history of disease

TIME
Death Infection Susceptible host No infection Clinical disease Recovery

Incubation period Latent Exposure Onset Infectious

Latent Period of Chronic Disease

Definition; "Interval between exposure to a diseasecausing agent and the appearance of manifestations of the disease" cf. incubation period in infectious disease
1) brief exposure Two conditions 2) prolonged or continuous exposure

Primary Prevention

'Preventing the occurrence of disease or injury by modifying risk factors.' 'Various aspects are considered to produce effective primary prevention program. Especially, advancing knowledge of disease causation must be required.

Primary Prevention
** Guidelines for effective prevention programs(RB Wallace, GD Everett,1986)
Programs must be based on scientific evidence. Prevention programs should be supported by effective data system. Programs should be flexible. Programs must be sensitive to ethical issues. Programs should be targeted to the recipients most in need. Programs should muster a variety of community resources. Effective prevention requires legislative action and social policy decisions. Programs should be continuous.

Primary Prevention

General health promotion

'Proper nutrition, mental hygiene, adequate housing, and appropriate balance between work and play, est and exercise, and useful and productive place in society, are among the best recognized factors ontributing to maintenance of optimum health.(Commission on Chronic illness, USA, 1957)

Specific protection Health Promotion

'Health promotion is any combination of educational, organizational, economic, and environmental supports for behavior and conditions of living conducive to health (LW Green, 1992).'

Criteria for the Development of Health Promotion and Education Programs

A health promotion program should address one or more risk

factors which are carefully defined, measurable, modifiable, and prevalent among the members of a chosen group, factors

which constitute a threat to the health status and the quality of

life of target group members.
A health promotion program should reflect a consideration of

the special characteristics, needs, and preferences of its target

groups(s)

From APHA Technical Report

Criteria for the Development of Health Promotion and Education Programs

health promotion programs should include interventions which will

clearly and effectively reduce a targeted risk factor and are appropriate for a particular setting
A health promotion program should identify and implement

interventions which make optimum use of available resources.

From the outset, a health promotion program should be organized,

planned, and implemented in such a way that its operation and effects can be evaluated.

Tertiary Prevention

'Minimizing the effects of disease and disability by surveillance and maintenance aimed at preventing complications and premature deterioration' Medical rehabilitation

Social rehabilitation