Epidemiology and infection control Introduction

1. Epidemiology and infection control Introduction

2. DEFINITIONS • What is epidemiology? • What is an epidemiologist?

3. EPIDEMIOLOGY is the study of the nature, cause, control and determinants of the frequency and distribution of disease, disability, and death in human populations.Epidemiology:the study of factors influencing the occurence, transmission, distribution, prevention and control of disease in a defined population

4. Classically speaking Epi = upon Demos = people Ology = science Epidemiology = the science which deals with what falls upon people….. Bridge between biomedical, social and behavioral sciences

5. Simple Old Definitions: Oxford English Dictionary THE BRANCH OF MEDICAL SCIENCE WHICH TREATS EPIDEMICS Kuller LH: American J of Epidemiology 1991;134:1051 EPIDEMIOLOGY IS THE STUDY OF "EPIDEMICS" AND THEIR PREVENTION Anderson G. In: Rothman KJ: Modern Epidemiology THE STUDY OF THE OCCURRENCE OF ILLNESS

6. A Modern Definition: Study of the occurrence and distribution of health-related diseases or events in specified populations, including the study of the determinants influencing such states, and the application of this knowledge to control the health problem

7. Demarcation (التخطيط)of Epidemiology Demarcation of scientific disciplines evolves historically as their intellectual(التثقيف), institutional and professional environments evolved (متطور) Epidemiology benefits from a rich plurality(التعدد) of scientific cultures and practices; consequently it enjoys diverse demarcation discourses, with diverse applications in public health policy, clinical practice, basic research….

8. An EPIDEMIOLOGIST is a public health scientist, who is responsible for carrying out all useful and effective activities needed for successful epidemiology practice

9. Epidemiologists are required to have some knowledge of: • Public health: because of the emphasis (التااكيد)on disease prevention •Clinical medicine: because of the emphasis on disease classification and diagnosis (numerators)  • Pathophysiology: because of the need to understand basic biological mechanisms in disease (natural history) • Biostatistics: because of the need to quantify disease frequency and its relationships to antecedents (denominators, testing hypotheses) • Social sciences: because of the need to understand the social context in which disease occurs and presents (social determinants of health phenomena)

12. Methods of Epidemiology • Public Health Surveillance(اشراف) • Disease Investigation • Analytic Studies • Program Evaluation

13. Terminology • Endemic • Hyperendemic • Holoendemic • Epidemic • Pandemic • Epizootic • Incidence • Prevalence Terms used for reference to various forms of outbreaks

14. Endemic:a disease or pathogen present or usually prevalent in a given population or geographic region at all times Hyperendemic: equally endemic in all age groups of a population Holoendemic: endemic in most of the children in a population, with the adults in the same population being less often affected Epidemic: a disease occuring suddenly in numbers far exceeding those attributable to endemic disease; occuring suddenly in numbers clearly in access of normal expectancy Pandemic: a widespread epidemic distributed or occuring widely throughout a region, country, continent, or globally Epizootic: of, or related to a rapidly spreading and widely diffused disease affecting large numbers of animals in a given region

15. Incidence:rate of occurrence of an event; number of new cases of disease occuring over a specified period of time; may be expressed per a known population size Prevalence: number of cases of disease occurring within a population at any one given point in time

16. Terms Associated with Disease Causation, etc. • Host • Agent • Environment • Fomites • Vector • Carrier – active • Incubatory • Convalescent • Healthy • Intermittent Your Assignment: Define these terms

17. Broad Types of Epidemiology • 1-DESCRIPTIVE EPI Examining the distribution of a disease in a population, and observing the basic features of its distribution in terms of time, place, and person. We try to formulate hypothesis, look into associations ? -Typical study design: community health survey (synonyms(المرادفات): cross-sectional study, descriptive study)

18. 2- ANALYTIC EPI • Testing a specific hypothesis about the relationship of a disease to a specific cause, by conducting an epidemiologic study that relates the exposureof interest to the outcomeof interest (? Cause-effect relationship) Typical study designs: cohort, case-control, experimental design

19. Descriptive Epidemiology Is A Necessary Antecedent(الاول) of Analytic Epidemiology To undertake an analytic epidemiologic study you must first: • Know where to look • Know what to control for • Be able to formulate / test hypotheses compatible with a-priori lab / field evidence

20. Basic Triad of Descriptive Epidemiology THE THREE ESSENTIAL CHARACTERISTICS OF DISEASE WE LOOK FOR IN DESCRIPTIVE EPIDEMIOLOGY ARE: • PERSON • PLACE • TIME

21. Personal Characteristics (whom) • Age • Gender • Socio-economic status (education, occupation, income) • Marital status • Ethnicity/race/genetic profile • Behavior / habits

22. Place (where ?) • Geographically restricted or widespread (outbreak, epidemic, pandemic)? • Climate effects (temperature, humidity, combined effects..) • Urban / sub-urban / rural   • Relation to environmental exposure (water, food supply, etc)   • Multiple clusters or one?

23. Time (when ?) • Changing or stable? • Clustered (epidemic) or evenly distributed (endemic)? • Time-trends(الاتجاهات): Point source, propagated, seasonal, combinations