Principles of Infectious

Disease and
Epidemiology
Chapter 14
Outbreak, Warner Bros. Pictures (1995)

Objectives
Define an infectious disease
Describe the microbiome and its role in human

health
Understand the classification of infectious
diseases
List the modes of transmission of infectious
diseases

Objectives
Give examples of factors which contribute to

the development of emerging infectious

diseases
List the methods by which outbreaks are
recognized
Describe the steps of conducting an outbreak
investigation
Learn the terminology used to describe an
outbreak

Triad of Infectious Diseases

PATHOGEN

HOST

ENVIRONMENT

The Human Microbiome

The human body contains
1013 human cells but
harbors 1014 bacterial
cells
Normal flora or normal
microbiota are all the
microorganisms which
colonize the human body
HMP-Started in 2007

Human Microbiome Project

Symbiosis
Relationship between two organisms in which

at least one is dependent upon the other

Commensalism

One organism derives benefit while other is unaffected

Mutualism

Both organisms benefit from symbiotic relationship

Parasitism (tape worm)

One organism benefits at expense of the other

Opportunistic pathogens (candida)

Normal microbiota can become pathogenic in the right

conditions

Symbiosis

What is the cause of this disease?

Traditional Microbiology
Test

Take all the suspected and isolate

The actual cause

Kochs Postulates
Establishing a causal

relationship between pathogen

and infectious disease

1. Same pathogen present in

2.
3.
4.

every case of the disease

Pathogen must be isolated from
diseased host and grown in
pure culture
Pathogen from pure culture
must cause disease in a healthy
laboratory animal
Pathogen must be isolated from
inoculated animal and shown to
be the original pathogen
Figure 14.3

Exceptions to Kochs Postulates

Some diseases can be caused by multiple

pathogens (pneumonia)
Dysbiotic diseases - Perturbation of normal flora
(yeast infection)
Some agents can cause several disease
conditions Streptococcus pyogenes (scarlet fever)
Some agents are not culturable in the
laboratory (leprosy)
Some pathogens only cause disease in humans
(small pox)

Classifying Infectious Diseases

Incubation, Duration and Severity
Acute infection

Rhinovirus & influenza

Acute infection

Measles

late complication
(encephalitis)
Latent infection

Chronic infection

viral shedding
Chronic infection
late disease
Slow infection
(madcow)

Varicella

SSPE
Zoster

Herpes Simplex Virus

Hepatitis B Virus

Cancer

Creutzfeldt-Jacob Disease (prion)

time

Classifying Infectious Diseases

Extent of Host Involvement
Local infection

Pathogen limited to small area of body

Systemic infection
Generalized infection affecting multiple organs
spread via blood and/or lymph

Focal infection

Agent travels through the blood or lymph but

causes disease only in one site or organ

Subclinical disease

No noticeable signs or symptoms (potential carriers

of the disease)

Classifying Infectious Diseases

Extent of Host Involvement

Bacteremia - bacteria in the blood

Viremia viruses in the blood
Toxemia toxins in the blood
Septicemia

Multiplication of pathogens in the blood

leading to sepsis

Sepsis

Generalized inflammatory condition affecting

multiple organ systems

The Stages of a Disease

Incubation before the

appearance of any signs

(objective changes) or symptoms
(subjective)

Prodrome early mild symptoms

of disease
Illness disease is most severe
Decline signs and symptoms
subside
Convalescence patient regains
strength and the body return
to its prediseased state

Figure 14.5

Reservoirs of Infection
Reservoirs allow for survival, replication
and transmission of a pathogen

Human most human infectious diseases

depend upon human reservoirs
Carriers can be healthy (subclinical), in the

incubation period, have active disease, or be in

the convalescent phase

Animal diseases transmitted from animals

to human are called zoonoses

Non-living soil, water, food, etc.

Transmission of Disease
1.Contact transmission

Direct contact (person-to-person spread)

Horizontal physical contact

Vertical from mother to fetus/newborn (AIDS,
yeast infection, gonorrhea)

Indirect contact

Fomites inanimate objects that facilitate

spread of a pathogen

Droplet transmission

Short range droplet nuclei (<1 meter from host)

Transmission of Disease
2.Vehicle transmission

Foodborne inappropriately handled foods

Waterborne fecal contaminated water
Airborne small droplets that remain
airborne for extended periods of time
(aerosolized) and can travel more than 1
meter from the host

3.Vector transmission

Mechanical passive transport of pathogen

Biological biting/feeding on the host

Nosocomial (Hospital-Acquired)
Infections
Acquired as a result of a hospital stay
5-15% of all hospital patients acquire
nosocomial infections

Figure 14.6b

Figure 14.9

Emerging Infectious Diseases

New or old diseases increasing in

incidence, or showing a potential to

increase in the near future

New and Emerging Pathogens

Expanding human population

New and Emerging Pathogens

Globalization

New and Emerging Pathogens

Climate change

New and Emerging Pathogens

Growing immunocompromised population

New and Emerging Pathogens

Decreasing herd immunity

waning immune response in vaccinated individuals
unvaccinated or inadequately vaccinated populations

New and Emerging Pathogens

Increasing recognition of new clinical
syndromes

New pathogens
Novel host responses

New and Emerging Pathogens

Antibiotic Resistant
Organisms

Epidemiology
Greek: epidemios (prevalent) + logos (study)
Study of the causes, distribution and control of

disease in human populations

Infectious disease epidemiology tries to
determine:
Causative agent
Source and/or reservoir of agent
Mechanism of transmission
Host and environmental factors that facilitate

development of disease
Best control measures

Classifying Infectious Diseases

Communicable disease:

Disease that is spread from one host to another

(Measles, chickenpox, influenza, the common cold, SARS, and tuberculosis )

Contagious disease:

Disease that is easily spread from one host to

another (measles, chickenpox)

Noncommunicable disease:

A disease that is not transmitted from one host to

another

(Botulism, tetanus)

Epidemiology
Descriptive (retrospective study)

Collection and analysis of data concerning a disease,

such as affected individuals, place and period

Analytical (case-control study)

Comparison of a diseased group and a healthy group

to determine its probable cause

Experimental (cohort study, randomized

control study)
Begin with a hypothesis and use controlled

experiments to test the hypothesis with a group of

people

Outbreak
An occurrence of disease greater than would

be otherwise expected at a particular time

and place
Epidemic outbreak that affects an entire
region in a country or group of countries
Pandemic global outbreak
Endemic disease that normally occurs in a
particular geographic area (among a particular
population) (within a certain period of time)

West Nile Virus

Outbreak: New York City, 1999

59 cases of WNv encephalitis in NYC

Epidemic: spread across North America,
1999-2002
Endemic: declared endemic in USA by the
CDC, 2002

Influenza A/pH1N1/09 Pandemic

Outbreak: Mexico, January to April 2009

Tens of thousands of people infected

Epidemic: spread across North America, then
to other countries worldwide, April to May
2009
Pandemic: declared by WHO, June 11, 2009

Occurrence of Disease
Incidence:

Fraction of a population that contracts a disease

during a specific time

Prevalence:

Fraction of a population having a specific disease at a

given time
cases)

(regardless of when it first appeared; include old and new

Example:

400 new AIDS cases in 2004 (incidence) compared to 9000 total

cases living with AIDS in 2004 (prevalence)

Epidemiology

The study of where

and when
diseases occur
What does graph (b) indicate about transmission of Lyme Disease? What can you
conclude from graph (a) and (c)?
Figure 14.10

Reported AIDS Cases in US

1st 250,000 cases was in 12 yrs, whereas the 2nd, 3rd & 4th occurred in 3-6 yrs
What was the incidence and prevalence of AIDS in 2004?

Why investigate outbreaks?

Prevent additional cases

Prevent future outbreaks
Increase our understanding of the disease
Evaluate prevention strategies
Legal, financial and ethical responsibilities
Public reassurance
Reduce socioeconomic impact

In the early days of HIV?AIDs studies, epidemiologists

pointed to a common risk factor: the number and frequency
of sexual contacts. Some Christian leaders went to say that
AIDs is Gods punishment for promiscuity. What is your
response to this statement? Give reasons (scientific and
biblical to support).