Nursing 50 - Ch. 2 The Dynamics of Disease Transmission - Reading Notes PDF

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Chapter 2 The Dynamics of Disease Transmission — Reading Notes: Week 1 Page 19 Human disease results from an interaction of the host (a person), the agent (bacterium), and the environment (contaminated) water supply Virtually all disease results from an interaction of genetic and environmental factors Disease epidemiological triad Host

Vector Agent Environment Disease is the product of an interaction of the human host, infectious agent and the environment vector, such as a tick, is often involved For an interaction to take place, host must be susceptible Human susceptibility is determined by a variety of factors genetic background nutrition immunologic characteristics Immune states of individual is determined by many factors of prior experience natural infection immunization Factors that can cause human disease include biologic physical chemical other types like stress Modes of Transmission Disease can be transmitted directly or indirectly Direct person to person by means of direct contact Indirect - through a vehicle such as contaminated air water vector like a mosquito Page 20

potential of a given organism for spreading and producing outbreaks depends on the characteristics of the organism rate of growth route by which it is transmitted Opportunities for infection respiratory system urogenital system alimentary track Skin skin is not the exclusive portal of entry for many agents infections can be required through more than one route Page 21 Clinical and Subclinical Disease When thinking of disease severity, think of iceberg only clinical illness is readily apparent Disease can still be transmitted even if the host does not show clinical symptoms Page 22 Disease severity appears to be related to the virulence of the organism (how good the organism is at producing disease) and to the site in the body at which the organism multiples Clinical Disease Characterized by signs and symptoms Nonclinical (Inapparent) Disease 1. Preclinical Disease - Disease that is not yet clinically apparent but is destined to progress to clinical disease 2. Subclinical Disease - Disease that is not clinically apparent and is not destined to become clinically apparent. 1. This type of disease is often diagnosed by antibody response or culture of organism 3. Persistent (Chronic) Disease - A person fails to shake off the infection, and it persists for years, at time for life 4. Latent Disease - An infection with no active multiplication of the agent, as when viral nucleic acid is incorporated into the nucleus of a cell as a provirus 1. only the genetic message is present in the host, not the viable organism Carrier Status

A carrier is an individual who harbors the organism but is not infected as measured by serologic studies or by evidence of clinical illness This person can still infect others, although the infectivity is often lower than with other infections Endemic, Epidemic, and Pandemic Endemic: Habitual presence of a disease within a given geographic area may also refer to the usual occurrence of a given disease within such an area Epidemic: Occurrence in a community or a region of a group of illnesses of similar nature, clearly in excess of normal expectancy, and derived from a common or from a propagated source Pandemic: Worldwide epidemic Page 25 Disease Outbreaks Assume a food becomes contaminated with a microorganism common-vehicle exposure: group of people who have eaten the food become sick single exposure- group exposed to microorganism once multiple exposure - groups exposed to microorganism more than once periodic - intermittent contamination continuous - persistent contamination Single-exposure common-vehicle outbreak Characteristics sudden and rapid increase in the number of cases if a disease in a population cases limited to those exposed in food-borne outbreak, cases rarely occur in persons who acquire the disease from a primary case In the US, the leading cause of food-borne related illness is contamination with norovirus Page 26 Immunity and Susceptibility Amount of disease in a population depends on a balance between number of people susceptible number of people immune immune due to previous having disease immunization genetic when balance moves toward susceptibility, likelihood of outbreak increases

Herd Immunity Herd immunity - the resistance of a group of people to an attack by a disease to which a large proportion of the members of the group are immune if a large % of population is immune, entire population is likely to be protected, not just immune Once a certain proportion of people in the community are immune, likelihood is small that an infected person will encounter a susceptible person to whom he can transmit the infection more encounters will be with immune people herd immunity is important when considering immunizations no need to immunize 100% immunize a large proportion and herd immunity does the rest 98% needed Conditions of herd immunity disease agent must be restricted to a single host species within which transmission occurs transmission must be relatively direct from one member of the host species to another infections must induce solid immunity If we have a reservoir in which the organism can exist outside the human host, herd immunity cannot operate because other means of transmission are available Herd immunity operates if the probability of an infected person encountering every other individual in the population is the same NEEDS RANDOM MIXING NO RANDOM MIXING, DISEASE WILL SPREAD Page 27 Incubation Period Incubation period: interval from receipt of infection to the time of onset of clinical illness during this time, you feel completely well and show no signs of disease Page 28 When a person is clinically ill, generally have a clear sign of potential infectiousness During at least part of the incubation period, the individual can still transmit the disease to others Quarantine is effective and worthwhile depending on the disease A precise incubation period does not exist for a given disease, rather, a range of incubation periods is characteristic for that disease Page 29

Length of the incubation period is characteristic of the infective organism Epidemic curve - the distribution of the times of onset of the disease IN A SINGLE-EXPOSURE, COMMON-VEHICLE EPIDEMIC the epidemic curve represent the distribution of incubation periods Page 30 Critical variables in investigating an outbreak or epidemic 1. When did the exposure take place 2. When did the disease begin 3. What was the incubation period for the disease KNOW ANY OF THE ABOVE 2, CAN CALCULATE THE THIRD Attack Rate Attack rate = number of people at risk in whole certain illness develops / Total number of people at risk Attack rate is useful for comparing the risk of disease in groups with different exposures attack rate can be specific for a given exposure Time is not explicitly specified in an attack rate time period is implicit in the attack rate Primary Case - person who develops disease from first-hand exposure Secondary Case - person who acquires the disease from exposure to a primary case Secondary attack rate - the attack rate in susceptible people who have been expose to a primary case good measure of person-to-person spread of disease after the disease has been introduced into a population THINK OF AS RIPPLE MOVING OUT FROM PRIMARY CASE Exploring occurrence of disease when a disease appears to have occurred at more than an endemic level, and we wish to investigate occurrence, ask who was attacked when did the disease occur where did the case arise Page 31 Who Characteristic of human host are clearly related to disease risk sex age

race Page 32 When Certain diseases occur within a certain periodicity often a seasonal pattern Where Disease is not randomly distributed in time or place Page 34 Outbreak Investigation Outbreak investigation follows this general pattern Page 35 Cross-tabulation When confronted with several possible causal agents, often the case in a food-borne disease outbreak, helpful method for determining which of possible agents is a likely cause is cross-tabulation Page 36 Conclusion...