Chapter 7

Communicable diseases:
epidemiology surveillance and
response
Group 3
 contents

 Introduction & Definitions
 Role of epidemiology
 The burden of communicable disease
 Threats to human security and health systems
 Epidemic and endemic disease
 Epidemics & Endemic diseases
 Emerging and re-emerging infections
 Chain of infection & The infectious agent
 Transmission ,Host &Environment
 Investigation and control of epidemics
 Investigation , Identifying cases
 Management and control
 Surveillance and response
1. Axmed maxamed Axmed faqay (leader) 524
2. hafsa osmaan ali 513
3. C/qani xuseen cali 491
4. c/Malik Mohamed abdi 478
5. farah mahad Abdullahi 500
6. ayuub hasan Mohamed 531
7. haliimo Mohamed cibaar 518
8. Mohamed mohamuud Mohamed 486
9. mohamed dahir cali. 577
10. .caaliyo c/Rahman Abdullahi 508
11. farrtuun c/rahman jimcaale 538
12. c/qani cali muxumud 564
13. Anas cabdisalaan Nor 522
14. Mohamed muse maxamuud 507
15. Maryan cabdi muse 573
definitions
 A communicable (or infectious) disease is one caused by transmission
of a specific pathogenic agent to a susceptible host.

 Infectious agents may be transmitted to humans either:

 directly, from other infected humans or animals,

 indirectly, through vectors, airborne particles or vehicles.
 ROLE OF EPIDEMIOLOGY

 Epidemiology developed from the study of outbreaks of

communicable disease and of the interaction between agents,
hosts, vectors and reservoirs.

 The ability to describe the circumstances that tend to spark

epidemics in human populations – war, migration, famine and
natural disasters – has increased human ability to control the
spread of communicable disease through surveillance, prevention,
quarantine and treatment.
 The burden of communicable disease
Communicable diseases account for 14.2 million deaths each year
Another 3.3 million deaths are attributable to maternal and perinatal
conditions and nutritional deficiencies.

Together these account for 30% of the world’s deaths and 39% of the
global burden of disability.

Six causes account for almost half of all premature deaths, mostly in
children and young adults, and account for almost 80% of all deaths from
infectious diseases
o Acute respiratory infections (3.76 million)
o HIV/AIDS (2.8 million)
o Diarrheal diseases (1.7 million)
o Tuberculosis (1.6 million)
o Malaria (1 million)
o Measles (0.8 million)
 Threats to human security and
health systems
 Communicable diseases pose an acute threat to individual health and have
the potential to threaten collective human security. While low-income
countries continue to deal with the problems of communicable diseases,
deaths due to chronic diseases are rapidly increasing, especially in urban
settings

 Although high-income countries have proportionally less communicable

disease mortality, these countries still bear the costs of high morbidity from
certain communicable diseases. For example, in high-income countries, upper
respiratory tract infections cause significant mortality only at the extremes of
age (in children and elderly people).
 Epidemics
 Epidemics are defined as the occurrence of cases in excess of what is
normally
expected in a community or region.
 The number of cases needed to define an epidemic
varies according to the agent, the size, type and susceptibility of population
exposed, and the time and place of
occurrence.

 The identification of an epidemic also depends on the usual frequency of

the disease in the area and the dynamic of an epidemic is determined by the
characteristics of its agent and its pattern of transmission, and by the
susceptibility of its human hosts.
 A limited number of bacteria, viruses and parasites cause most
epidemics, and a thorough understanding of their biology has
improved specific prevention measures.
 Vaccines, the most effective means of preventing infectious
diseases, have been developed so far only for some viral and
bacterial diseases. If the attempt to make a malaria vaccine is
successful, this will be the first vaccine for a parasitic disease .

a point-source epidemic, susceptible individuals are exposed

more or less simultaneously to one source of infection.
 Endemic diseases
Communicable diseases are termed endemic when they have a relatively stable
pattern of occurrence in a given geographical area or population group at
relatively high prevalence and incidence.

Endemic diseases such as malaria are among the majorhealth problems in low-
income tropical countries.
 EMERGENCE AND RE EMERGENCE OF
INFECTIOUS DISEASE
• Emergence is Defined as diseases which were not experienced
previously •
• Re emerging infectious diseases are those which was previously
controlled and eflicaciously treated but have recurred in a new
epidemiological setting with increased frequency and mortality
or in a more virulent form to be a significant public health
problem.
Examples of emergence: Examples of re-
• • AIDS after 1981 emergence :
. Sars 2003 Malaria and dengue
.Anthrax 200 in WB
 Chain of infection
 Communicable diseases occur as a result of the
interaction between:
 the infectious agent
 the transmission process
 the host x the environment.
 The control of such diseases may involve changing one or
more of these components,
 the first three of which are influenced by the environment.
These diseases can have a wide range of effects, varying
from silent infection - with no signs or symptoms- to severe
illness and death.
 The infectious agent
 The specific characteristics of each agent are important in determining the
nature of the infection, which is determined by such factors as:
 The pathogenicity of the agent: its ability to produce disease, measured by
the ratio of the number of persons developing clinical illness to the number
exposed.
 Virulence: a measure of the severity of disease, which can vary from very
low to very high. Once a virus has been attenuated in a laboratory and is of
low virulence, it can be used for immunization, as with the poliomyelitis
virus.
 Infective dose: the amount required to cause infection in susceptible
subjects.
 the reservoir of an agent: its natural habitat, which may include
humans, animals and environmental sources
 The source of infection: the person or object from which the host
acquires the agent. Knowledge of both the reservoir and the source
is necessary if effective control measures are to be developed. An
important source of infection may be a carrier – an infected person
who shows no evidence of clinical disease. The duration of the
carrier state varies between agents. Carriers can be asymptomatic
throughout the course of infection or the carrier state may be
limited to a particular phase of the disease. Carriers played a large
role in the worldwide spread of the human immunodeficiency virus
due
 Transmission
The second link in the chain of infection is the
transmission or spread of an infectious
agent through the environment or to another.

Transmission may be:

A) Direct
B) Indirect
Direct transmission
Direct transmission is the immediate transfer of the infectious
agent from an infected
host or reservoir to an appropriate entry point through which
human infection can take place.
This may be by direct contact such as touching, kissing sexual
intercourse, or by the direct spread of droplets by sneezing ,
coughing or Blood transfusions
 and transplacental infection from mother to fetus .
Indirect transmission

Indirect transmission may be vehicle-borne, vector-borne or

airborne.
Vehicle-borne transmission occurs through contaminated materials
such as food, clothes, bedding and cooking
utensils. Vector-borne transmission occurs when the agent is
carried by an insect or animal (the vector)
to a susceptible host.
Airborne transmission occurs when there is
dissemination of very small droplets to a suitable point of
entry, usually the respiratory tract.
 Dust particles also facilitate airborne transmission
 Example fungal spores.
 Host
The host is the third link in the chain of
infection and is defined as the person or
animal that provides a suitable place for an
infectious agent to grow and multiply under
natural conditions.
The points of entry to the host vary with the agent and
include the skin, mucous membranes, respiratory and
gastrointestinal tracts.
The incubation period the time between entry
of infectious agent and appearance of the first
sign or symptom of the disease varies from a
few hours (staphylococcal food poisoning) to
years (AIDS).
 The consequences of infection are largely
determined by the host's resistance.

Immunization (or vaccination) is the protection of

susceptible individuals from communicable
disease by the administration of a vaccine.
That can be
1. A living modified infectious agent (as for
measles)
2. An inactive toxin (as for tetanus)
3. Bacterial polysaccharides.
4. In activated organisms ( pertussis).
 Environment
The environment plays a critical role in the
development of communicable diseases.

Factors that influence all stages in the chain

of infection:
• General sanitation
• temperature
• Airr pollution
• water quality
In addition, socioeconomic factors – such as population
density, overcrowding and poverty are of great
importance.
 Investigation and control of epidemics
 The purpose of investigating a communicable disease epidemic is
to identify its cause and the best means to control it.
 This requires detailed and systematic epidemiological work, in
the following sequential or simultaneous steps:

 undertaking preliminary investigation

 identifying and notifying cases
 collecting and analysing data
 managing and controlling
 disseminating findings and follow-up
Investigation
 The initial stage of investigation should verify the
diagnoses of suspected cases and confirm that an
epidemic exists. the number of cases in a single
area may be too small to draw attention to an
epidemic.
Identifying cases
 The investigation of a suspected epidemic requires that new cases be
systematically identified, detailed information on at least a sample
of the cases needs to be collected.
 The cases reported early in an epidemic are often only a small
proportion of the total; a thorough count of all cases is necessary to
permit a full description of the extent of the epidemic.
 As soon as an epidemic is confirmed, the first priority is to control it
Management of epidemic and follow up

 One might aim control measures at the specific agent,

source, or reservoir. For example, an outbreak might be
controlled by destroying contaminated foods, disinfecting
contaminated water, or destroying mosquito breeding sites
or an infectious food handler could be suspended from the
job and treated.
General principles in the
management of epidemics
 A. Measures Directed Against the Reservoir
 Domestic animals as reservoir:
 ƒImmunization. Example – giving anti-rabies vaccine for dogs.
 ƒdestruction of infected animals e.g anthrax
 Wild animals as reservoir:
 post-exposure prophylaxis for human beings- Example: rabies
 Humans as reservoir
 a. Isolation of infected persons.
 b. Treatment to make them noninfectious- e.g., tuberculosis.
 c. Quarantine- is the limitation of freedom of movement
 B. Measures that interrupt the transmission of organisms
 Action to prevent transmission of disease by ingestion:
 i. Purification of water
 ii. Pasteurization of milk
 iii. Inspection procedures to ensure safe food supply.
 iv. Improve housing conditions.
 Actions to reduce transmission of respiratory infections

 include ventilation of rooms. In the case of diseases that

involve an intermediate host for transmission, for
exampleschistosomiasis, clearing irrigation farms from snails is
an appropriate measure.
 C. Measures that reduce host susceptibility

immunization (vaccination). Example vaccination for

meningitis.ƒ Chemoprophylaxis: for example, use of
chloroquine to persons traveling to malaria endemic areas.
After the epidemic is controlled, strict follow up
mechanisms should
be designed so as to prevent similar epidemics in the
future.
Report of the investigation
 At the end prepare a comprehensive report and submit to
the appropriate/concerned bodies like the MOH.
 The report should discuss in detail:
 ƒ Factors leading to the epidemic.
 ƒ Measures used for the control of the epidemic.
 ƒ Recommendations for the prevention of similar
episodes in the future.
Definition of Health surveillance

 Health surveillance is the ongoing systematic collection,

analysis and interpretation
 of health data essential for planning, implementing and
evaluating public health
 activities.
 surveillance mechanisms include
 compulsory notification regarding specific diseases, specific
disease registries (population-based or hospital-based),
continuous or repeated population surveys and
aggregate data
 The scope of surveillance
 The scope of surveillance is broad, from early warning
systems for rapid response in
 the case of communicable diseases, to planned response in
the case of chronic diseases which generally have a longer
lag time between exposure and disease. Most
 countries have regulations for mandatory reporting of a
list of diseases.
 Principles of surveillance
 incidence and prevalence
 indices of severity (case-fatality ratio)
 mortality rate and premature mortality
 an index of lost productivity (bed-disability days)
 medical costs
 preventability
 epidemic potential
 information gaps on new diseases.
 Sources of data
Sources of data may be general or disease-
specific, and include the following

 mortality and morbidity reports

 hospital records
 laboratory diagnoses
 outbreak reports
 vaccine utilization
 sickness absence records
 biological changes in agent, vectors, or reservoirs
 blood banks
Surveillance in practice
 Surveillance requires continuing scrutiny of all aspects of
the occurrence and spread of disease
 The analysis of data from a surveillance system indicates
whether there has been a significant increase in the
reported number of cases.
 Analysis and interpretation of surveillance data Surveillance
is not only a matter of collecting data, as the analysis,
dissemination and use of the data for prevention and
control are equally important