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CPH LEC NOTES OF CANDICE

Week 4 CPH LEC - Introduction to Basic epidemiologic methods tend to rely on careful
Epidemiology observation and use of valid comparison groups to
assess whether what was observed, such as the
Fundamentals of Epidemiology in Public Health number of cases of disease in a particular area
Practice during a particular time period or the frequency of
an exposure among persons with disease, differs
DEFINITIONS from what might be expected.

EPIDEMIOLOGY is the study of the distribution Epidemiology is a quantitative discipline that relies
and determinants of health-related states or events on a working knowledge of probability, statistics,
in specified populations, and the application of this and sound research methods.
study to the control of health problems
Epidemiology is a method of causal reasoning
Epidemiology is the heart of public health. based on developing and testing hypotheses
grounded in such scientific fields as biology,
Field of science dealing with the relationship of the behavioral sciences, physics, and ergonomics to
various factors which determine the frequencies explain health-related behaviors, states, and
and distribution of an infectious process, a disease, events.
or a physiological state in human community
DISTRIBUTION
Study of the behavior of disease in the community
rather than in individual patients and includes the o Descriptive epidemiology – pattern chuchu
study of reservoirs and sources of human diseases o Leptospirosis, dengue – rainy days
o Human kuto – summer
Epidemiology is the:
Epidemiology is concerned with the frequency and
o study (scientific, systematic, data-driven) pattern of health events in a population:
o of the distribution (frequency, pattern)
o paano nakakahawa? Gaano kadami? Frequency refers not only to the number of health
o and determinants (causes, risk factors) events but also to the relationship of that number
o of health-related states and events (not just to the size of the population.
diseases)
o in specified populations (patient is community, The resulting rate allows epidemiologists to
individuals viewed collectively), compare disease occurrence across different
o and the application of (since epidemiology is a populations.
discipline within public health)
o this study to the control of health problems. Pattern refers to the occurrence of health-related
events by time, place, and person.
STUDY
Time patterns may be annual, seasonal, weekly,
Epidemiology is a scientific discipline with sound daily, hourly, weekday versus weekend, or any
methods of scientific inquiry at its foundation. other breakdown of time that may influence disease
or injury occurrence.
Epidemiology is data-driven and relies on a
systematic and unbiased approach to the Place patterns include geographic variation,
collection, analysis, and interpretation of data. urban/rural differences, and location of work sites
or schools.
o Descriptive epidemiology
o Basic featuresof epidemiology Personal characteristics include demographic
o Time, places, personse, factors which may be related to risk of illness,
occurrence of diseases injury, or disability such as age, sex, marital
o Analytical epidemiology status, and socioeconomic status, as well as
o Experimental epidemiology- trials behaviors and environmental exposures.
(vaccines, meds)
o Observational epidemiology ???
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CPH LEC NOTES OF CANDICE

DETERMINANTS 1854

Epidemiology is also used to search for In the mid-1800s, an anesthesiologist named John
determinants, which are the causes and other Snow was conducting a series of investigations in
factors that influence the occurrence of disease and London that warrant his being considered the
other health-related events. “father of field epidemiology.”

To search for these determinants, epidemiologists Twenty years before the development of the
use analytic epidemiology or epidemiologic studies microscope, Snow conducted studies of cholera
to provide the “Why” and “How” of such events. outbreaks both to discover the cause of disease and
to prevent its recurrence.
They assess whether groups with different rates of
disease differ in their demographic characteristics, Because his work illustrates the classic sequence
genetic or immunologic make-up, behaviors, from descriptive epidemiology to hypothesis
environmental exposures, or other so-called generation to hypothesis testing (analytic
potential risk factors. epidemiology) to application.

HISTORICAL EVOLUTION OF EPIDEMIOLOGY 19th and 20th centuries

Circa 400 B.C. In the mid- and late-1800s, epidemiological

methods began to be applied in the investigation of
Hippocrates attempted to explain disease disease occurrence. At that time, most investigators
occurrence from a rational rather than a focused on acute infectious diseases.
supernatural viewpoint.
In the 1930s and 1940s, epidemiologists extended
In his essay entitled “On Airs, Waters, and Places” their methods to noninfectious diseases. The period
Hippocrates suggested that environmental and host since World War II has seen an explosion in the
factors such as behaviors might influence the development of research methods and the
development of disease. 1662 theoretical underpinnings of epidemiology. 19th
and 20th centuries
Another early contributor to epidemiology was John
Graunt, a London haberdasher and councilman During the 1960s and early 1970s health workers
who published a landmark analysis of mortality applied epidemiologic methods to eradicate
data in 1662. naturally occurring smallpox worldwide.

This publication was the first to quantify patterns In the 1980s, epidemiology was extended to the
of birth, death, and disease occurrence, noting studies of injuries and violence. In the 1990s, the
disparities between males and females, high infant related fields of molecular and genetic epidemiology
mortality, urban/rural differences, and seasonal (expansion of epidemiology to look at specific
variations. pathways, molecules and genes that influence risk
of developing disease) took root. 19th and 20th
1800 centuries

William Farr built upon Graunt’s work by Meanwhile, infectious diseases continued to
systematically collecting and analyzing Britain’s challenge epidemiologists as new infectious agents
mortality statistics. emerged (Ebola virus, Human Immunodeficiency
virus (HIV)/ Acquired Immunodeficiency Syndrome
o Mortality – actual number of deaths
(AIDS)), were identified (Legionella, Severe Acute
Respiratory Syndrome (SARS)), or changed (drug-
Farr, considered the father of modern vital
resistant Mycobacterium tuberculosis, Avian
statistics and surveillance, developed many of the
influenza).
basic practices used today in vital statistics and
disease classification.
Beginning in the 1990s and accelerating after the
terrorist attacks of September 11, 2001,
He concentrated his efforts on collecting vital
epidemiologists have had to consider not only
statistics, assembling and evaluating those data,
natural transmission of infectious organisms but
and reporting to responsible health authorities and
the general public also deliberate spread through biologic warfare
and bioterrorism.
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CPH LEC NOTES OF CANDICE

USES OF EPIDEMIOLOGY Characteristics of Agents of Disease

1.Study the history of the health population and 1. Inherent characteristics – physical feature,
the rise and fall of diseases and changes in their biological requirement, chemical composition,
character resistance
2.Diagnose the health of the community and the 2. Characteristic in relation to the environment
condition of the people – refers to the reservoir and source of infection and
3.Study the work of health services with a view of modes of transmission
improving them 3. Characteristic directly related to man
4.Estimate the risk of diseases, accidents, defects Infectivity – ability to gain access and adapt to the
and the chances of avoiding them human host to the extent of finding lodgment and
5.Complete the clinical feature of chronic disease multiplication
and describe their natural history Pathogenicity – measures the ability of agent
6.Search for cause of health and disease when lodged in the body set up a specific reaction

CORE EPIDEMIOLOGIC FUNCTIONS Virulence – refers to the severity of the reaction

Five major tasks of epidemiology in public health produced and is usually measured in terms of
practice were identified: fatality

1. Public Health Surveillance Antigenicity – ability to stimulate the host to

2. Field Investigation produce antibody. Immunogenenecity – ability of
3. Analytic Studies agent to produce specific immunity in the host.
4. Evaluation
5. Linkages Toxigenicity – capacity of the agent to produce
6. A sixth task, Policy Development, was recently toxin or poison. Disease results form the toxin
added produced by the agents rather than form the agent
itself.
DISEASE
Resistance – ability of the agent to survive adverse
It is a specific illness or disorder that is
environmental conditions.
characterized by a recognizable set of signs and
symptoms which are attributable to hereditary,
Modes of Transmission
infection, diet or environment.
1. Direct Transmission – immediate transfer of
It results when the infection produces notable
infectious agent to a receptive portal of entry 2.
changes in the human physiology specifically those
Indirect transmission
that cause damage to the body’s organ system.
a. Vehicle-borne – contaminated inanimate objects
or materials
THE AGENT FACTORS OF DISEASE
b. Vector-borne – from other living organisms (ex.
Agent is any element, substance or force whether insects)
living or non-living; the presence of absence can o Mechanical vector
initiate or perpetuate a disease process Types of o Biological vector Modes of Transmission
Agent
3. Airborne – dissemination of microbial aerosols
This could be living or non-living, physical or to a suitable portal of entry usually the respiratory
mechanical in nature such as extremes of tract
temperature, light, electricity
a. Droplet nuclei – usually small residues which
They could be chemicals – endogenous (within the result from evaporation of fluid from droplets
body) or exogenous (poison) emitted by an infected host
b. Dust

Portal of Entry Mode of

Transmission
Mouth Ingestion, Intimate
oral contact
Skin Skin penetration, bite
of arthropod
Nose Inhalation
Genitals Sexual intercourse
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CPH LEC NOTES OF CANDICE

Naturally acquired passive immunity – exhibited

THE HOST FACTORS OF DISEASE by the transfer of antibodies from mother’s
placenta to the fetus and transfer of antibodies
1. Age from breast milk to the baby
2. Sex
3. Race Artificially acquired passive immunity – Injection
4. Habits, customs and religion of artificially prepared substance like immune
5. Exposure to agent serum or gamma globulin. These two are antibodies
6. Defense mechanism of the host preparation. (ex. anti-tetanus antibodies,
diphtheria antitoxin)
Humoral defense – there are cells in our body like
plasma cells and lymphocytes that produce o Rabies vaccine
antibodies to neutralize harmful effects of the
infectious agents and body fluids in our body that THE ENVIRONMETAL FACTORS OF DISEASE
possess substance that have antimicrobial
properties Environment – sum total of an organism’s external
surrounding conditions and influences that affect
Cellular defense – there are cells in our body like its life and development. It has three components:
macrophages and neutrophils involve in the
process of phagocytosis. 1. Physical Environment

IMMUNITY o Climate – certain diseases have seasonal

distribution
This is the total property of an individual to protect o Geography and location
himself from an infectious agent
2. Biologic Environment – living environment of
Two types of immunity man consists of plants, animals and fellow human
beings
1.Non specific resistance – present at the time of
birth or has developed during maturation 3. Socio-economic Environment – which may be
in form of level of economic development of the
2.Specific resistance – acquired as a result of community, presence of social disruptions ad the
prior exposure with a foreign substance like.

Two folds of specific resistance CLASSIFICATION OF DISEASE According to

Occurrence
1. Active – when what has been introduced to the
individual is the antigen and the body makes the 1. Sporadic disease (singly; rare, rabies)
antibody
o occurs occasionally.
Naturally acquired active immunity – when we get o Intermittent presence of a disease
sick the infective agent will gain entry to the body, o Occurrence of a few cases every now and then
act as stimulant for antibody formation because the often without relationship to each other
organism acts as antigen. The immunity is lifelong
(ex. measles, chickenpox, hepatitis A) 2. Endemic disease (malaria; Samar and Palawan)

Artificially acquired active immunity – when the o constantly present in particular location or
antigen has been deliberately introduce like population.
injecting vaccines, they act as antigen to stimulate
antibody formation. It makes use of vaccine which 3. Epidemic disease (Outbreak)
is a suspension of killed or living organism (ex.
o It is a disease that affects a large number of
MMR, OPV, BCG)
people in a given population within a short
2. Passive – when what has been introduced to the span of time. Excess of normal expectancy.
body is already antibodies that provide immediate
4. Pandemic disease – is a disease that affects
protection against microorganisms
populations across large regions (several countries
or continents) around the world.
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CPH LEC NOTES OF CANDICE

DISEASE CAUSATION

The occurrence of disease follows biologic laws

which apply to both communicable and non
communicable diseases:

1. Disease results from imbalance between the

forces of the agent and host

2. The nature and extent of imbalance depends on

the nature and characteristics of host and agent

3. The characteristics of two are influenced

considerably by the condition of the environment

Approach to Disease and its Determinants

Epidemiology approach is based on the interaction

of the host the causative agent and the
environment.

The presence of infections materials varies with the

duration and the extent of its excretion from an
infected person the climactic conditions affecting
survival of the agent, route of entry into the host
and the existence of alternative reservoir or host of
the agent.

Availability of susceptible host depends upon the

extent mobility and interpersonal contact within
the population group, and the degree and duration
of immunity from previous infections with the same
or related agents,

DISEASE DISTRIBUTION

Methods and technique of epidemiology are desired

to detect the cause of a disease in relation to the
characteristic of the person who has it or to a factor
present in his environment.

Since neither population and environment of

different times or places are similar, these
Incubation Period Time
characteristics and factors are called Epidemiology
variables.
between exposure to infectious agent up to the time
of appearance of the earliest signs and symptoms.
Time – refers both to the period during which cases
of the disease being studied were exposed to the
o Clinical Incubation Period
source of infection and the period during which the
o Biological Incubation Period
illness occurred.

Persons – refers to the characteristics of the

individual who were exposed and who contacted
the infection of the disease in question.

Place – refers to the features, factor or conditions

which existed in or described the environment in
which the diseases occurred.
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CPH LEC NOTES OF CANDICE

Classification of Agents, Host and influence on vertebrates

Environmental Factors which determine the and arthropods as
occurrence of Disease in Human Population source of agents
Socio-economic Environment
1. Agents of Diseases Occupation Exposure to chemical
agents
Urbanization Urban crowding, tension
Agents of Disease Etiological Factors
and pressures
Physical agents Heat, Light, Ionizing
Disruption Wars, Disasters
radiation
Chemical agents
Poisons Carbon monoxide,
drugs PATHOGENESIS and INFECTION
Allergens Hives, Ragweeds, poison
ivy Pathogenesis
Nutritive Elements
Excess Cholesterol, It is the development of an infection and disease.
Carbohydrates
Deficiencies Vitamins, Proteins Certain virulence agents with mechanisms of
Biological / Infectious Agents resistance against the host protective factors are
Metazoa / Helminths Flatworm; Roundworm, involved in the proliferation of microorganisms and
Flukes the progress of diseases.
Protozoa Amoeba, Plasmodium
Bacteria Rheumatic fever, Infection
Pneumonia, typhoid,
PTB
It involves the growth and multiplication of
Fungi Histoplasmosis,
microorganisms that cause damage to their host
athelete’s foot,
Rickettsia Rocky Mountain spotted
fever It is the bodily invasion of pathogenic
Viruses Measles, mumps, microorganisms that reproduce/ multiply, and then
chicken pox, polio, cause diseases through local cellular injury , toxin
rabies secretion, or antigen-antibody reaction in the host.
2. Host (Intrinsic) Factors – Influences exposure,
susceptibility or response to agents TYPES OF INFECTIONS According to the Cause

Intrinsic Factors Conditions 1. Autogenous infection - It caused by a

Genetic Sickle cell disease, microorganism form the microbiota of the host.
Thalassemia
Age 2. Iatrogenic infection - It is an infection that
Sex occurs as the result of some medical treatment or
Ethnic group procedure.
Physiologic Fatigue, pregnancy,
puberty, stress
3. Opportunistic infection - It is an infection that
Immunologic
affects immunocompromised hosts but not with
Experience Hypersensitivity
Active Prior infection, individuals with a normal immune system.
Immunization
Passive Maternal Antibodies The overuse of antibiotics, immunosuppressive
Inter-current or pre- drugs, and chemotherapeutic agents may cause
existing disease this infection.
Human Behavior Personal Hygiene, Food
Handling 4. Nosocomial infection - it is also known as the
3. Environmental (Extrinsic) Factors – Influences hospital-acquire infection. It is a type of infection
existence of the agent, exposure, or susceptibility to that is acquired at a healthcare facility
agent.
Handwashing is still the cornerstone of modern
Extrinsic Factors infection control program.
Physical Environment Geology, Climate
Biological Environment
Human population Density
Flora Sources of food,
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CPH LEC NOTES OF CANDICE

Four (4) Common types of Nosocomial b. Septicemia

Infections: o It is the active multiplication of
the invading bacteria in the blood.
1. Urinary Tract Infection c. Pyemia
2. Lung Infection (Pneumonia) o It is a condition wherein pus-
3. Surgical site infection producing organisms repeatedly
4. Blood Stream Infection invade the bloodstream and
become localized at different parts
Predesposing factors to nosocomial infections: of the body.
d. Toxemia
a. Wide variety of microbes in the hospital
o It is the presence of toxins in the
environment,
blood.
b. Weakened or immunocompromised patients
o Bacteria are localized in one area
c. Chain of transmission (direct or indirect)
but produce a toxin that spreads
1. From health workers to patient
and gets absorbed by the body
2. From patient to patient
cells.
3. Use of fomites (catheters, needles,
dressings, beds etc.) EXTENT OF INFECTIONS
4. Airborne Transmission – for
tuberculosis, inhalation of droplets ≤5 µm; 1. Primary Infections
for pertussis, inhalation of droplets >5µm.
5. Vector-borne transmission o It is the initial infections that causes the
illness.
TYPES OF INFECTIONS According to the Host o An example is the common cold.
Distribution
2. Secondary Infections
1. Local Infection
o It is caused by opportunistic pathogens after
o it means signs and symptoms are confined the primary infections has weakened the host’s
in one area. immune system.
o Some examples are infected wounds, boils o Some examples are pneumonia and bronchitis
or abscesses. that may develop form a common cold.

2. Focal Infection 3. Latent Infection (Silent phase)

o it starts as a local infection before o It is clinically silent inside the body and causes
spreading to the other parts of the body. no noticeable illnesses in the host. Then, a
o Some examples are tooth infection, severe and acute infections manifests.
tonsilitis, appendicitis, and wound o An example is the asymptomatic-type of polio
infections caused by Clostridium tetani. infection.

3. Systemic Infection (Generalized Infection) 4. Mixed Infections

o It means microbes spread throughout the o it is caused by two or more organisms.

body through blood or lymph. o An example is a wound infection.

TYPES OF INFECTIONS 5. Acute Infections

There are four (4) types of systemic infections: o It is a type of infection that develops and
progresses slowly. An example is a whooping
a. Bacteremia cough.

o It is the presence of bacteria in the blood. 6. Chronic Infections

o The organisms invade the bloodstream
without active multiplication. o It is an infection which develops slowly with
o The highest concentration of bacteria in milder but longer-lasting symptoms.
the blood occurs before the fever spikes. o Example is tuberculosis.
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CPH LEC NOTES OF CANDICE

ROUTES OF INFECTIONS ISOLATION AND QUARANTINE ISOLATION

1. Direct transmission – as applied to patient, separation for the period of

communicability, of infected persons or animals
o Congenital – S. agalactiae, N. gonorrheae, and from others in such places and under such
T. pallidum subsp. pallidum. conditions as to prevent or limit the effect of the
o Sexual contact – N. gonorrheae, T. pallidum direct or indirect transmission of the infectious
subsp. pallidum, C. trachomatis. agent from those infected to those who are
o Infectious respiratory secretions or droplets – susceptible or who may spread the disease agent.
S. pyogenes and N. meningitidis Hand-to-hand
transmission – Rhinovirus Categories of Isolation

2. Indirect transmission Fomites 1. Strict Isolation – this category is designed to

prevent transmission of highly contagious or
o Water – Salmonella, Shigella and Vibrio virulent infections that may spread by both air and
o Arthropod vectors – Borrelia, Francisella and contact
Yersinia
2. Contact Isolation – for less highly transmissible
CLASSIFICATION OF INFECTIOUS DISEASES or serious infections, for disease or conditions
which are spread primarily by close or direct
1. Communicable or contagious disease contact

o It spreads from one host to another, either 3. Respiratory Isolation – to prevent transmission
directly or indirectly. of infectious diseases over short distances through
o Some examples are tuberculosis, herpes, flu the air
and chickenpox.
4. Tuberculosis Isolation (AFB Isolation) – for
2. Non-communicable disease patients with pulmonary tuberculosis who have a
positive sputum smear or chest x-rays which
o It does not spread from one host to another.
strongly suggests active tuberculosis Categories of
o It is caused by external microbes or by
Isolation
opportunistic pathogens living inside the body.
o Some examples are tetanus and botulism. 5. Enteric Precautions – for infections transmitted
by direct or indirect contact with feces
PHASES OF INFECTIOUS DISEASES
6. Drainage/secretion Precautions– to prevent
1. Incubation period - It is the time between the
infections transmitted by direct or indirect contact
exposure to a pathogenic organism and the onset of
with purulent material or drainage from an infected
symptoms
body site

2. Prodromal period - It is the appearance of the

7. Blood/body fluid Precautions – to prevent
signs and symptoms
infections that are transmitted by direct or indirect
contact with infected blood or body fluids
3. Clinical or illness period - It is the peak of
characteristics signs and symptoms of an infection
Recommended isolation practice for admitted
or a disease.
infectious diseases

4. Decline period - It is the period in which the

1. AIDS Blood/body fluid
signs and symptoms begin to subside as the host’s
Precaution
condition improves.
2. Chicken pox Drainage/secretion
Precaution
5. Convalescence or the period of recovery - It is
3. Cholera Enteric Precaution
the period in which the surviving host is
4. Dengue No isolation
recuperating towards full recovery.
5. Diarrhea Enteric Precaution
6. Diphtheria Strict Isolation
7. German Measles Contact Isolation
8. Hepatitis A Enteric Precaution
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CPH LEC NOTES OF CANDICE

9. Leptospirosis Blood/body Fluid Precaution Ecological – this is also called Correlational Study.
10. Malaria Blood Precaution o The unit of observation is population or groups
11. Pertussis Respiratory Precaution of people rather than individuals.
12. Poliomyelitis Enteric Precaution o Cross-sectional – this measures the prevalence
13. SARS Strict Isolation of disease at a certain point in time, and
14. Typhoid Enteric Precaution relates it with the basic population
characteristics being surveyed such as age,
QUARANTINE sex, ethnicity, socio-economic groupings, etc.
– restriction of the activities of a well persons or
animals who have been exposed to a case of
communicable diseases during its period of
communicability to prevent disease transmission
during incubation period if infection should occur

Categories of Quarantine

1.Absolute or Complete Quarantine – limitation

of movement of those exposed to a communicable
diseases for a period of time not longer than the
longest usual incubation period of that disease

2.Modified Quarantine – selective, partial

Case-control – this attempts to show the influence
limitation of freedom of movements of contacts
of a risk factor in the causation of disease.
THE DIFFERENT EPIDEMIOLOGIC STUDIES
o The procedure starts with the selection of
people with a particular disease, and the
Observational Study
selection of people without the disease
1. Descriptive Study a. Time b. Place c. Person
2. Analytical Study
a. Ecological
b. Cross-sectional
c. Case-control
d. Cohort

Experimental Study
1. Randomized Controlled Trials
2. Field Trials
3. Community Trials

Observational Study
Cohort – this approach is suitable in determining
the influence of a particular risk factor in the
1. Descriptive Study
causation of an event, such as a particular disease.
It begins with the identification of a group exposed
o It is the description of various epidemiological
to a risk factor and a comparable group not
features of a particular event.
exposed
o Describe the what, who, where, when, and
why/how of a situation
o Descriptive epidemiology covers:
o time – occurrence of disease
o Place – provides insight into the geographic
extent of the problem and its geographic
variation
o Person – personal characteristics may affect
illness, organization and analysis of data
2. Analytical Study
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Experimental Study It includes the initial forces/factors which initiated

the process in the environment or elsewhere
1. Randomized Controlled Trial through the resulting changes which took place in
man, until continuing equilibrium is reached, or
It is an epidemiological experimental study of a new defect, disability, or death ensues. Phases: Pre-
preventive or therapeutic regimen. pathogenesis

For this reason, it is also commonly referred to as This is the phase before man is involved. Through
therapeutic trial, and when testing the effectiveness the interaction of the agent, the host and
of a drug to prevent a disease, it is referred to as environment factors, the agent finally reaches man.
prophylactic trial.
It may be said that everyone is in the period of
Subject in a population are randomly allocated to prepathogenesis of many diseases because agents
groups, usually called treatment and control are present in the environment where man lives
groups, and the results are assessed by comparing Pathogenesis
the outcome in the two or more groups.
This phase includes the successful invasion and
Randomized control trials establishment of the agent in the host

After a period of incubation, whereby the agent

multiplies and develops, or gets absorbed and fixed
in the tissues, sufficient tissue or physiologic
changes may have taken place to produce
detectable evidence of the disease process in man

THE PROCESS OF INFECTION

There are six requirements for the successful

invasion of the host by an infectious agent

1. Condition in the environment must be

2. Field Trials - It involves people who are disease- favorable to the agent or the agent must be
free but presumed to be at risk. able to adopt to the environment
2. Suitable reservoirs must be present
Since the subjects are disease-free and the purpose 3. A susceptible host must be present
is to prevent the occurrence of diseases that may 4. Satisfactory portal of entry into the host
occur with relatively low frequency, field trials are 5. Accessible portal of exit from the host
often huge undertakings involving major logistics 6. Appropriate means of dissemination and
and financial considerations transmission to a new host

3. Community Trials - In this form of experiment Chain of infection

the treatment groups are the communities rather
than individuals.

This is particularly appropriate for diseases that

have their origins in social conditions, which in
turn can most easily be influenced by intervention
directed at group behavior as well as at individuals.

THE NATURAL HISTORY OF COMMUNICABLE

DISEASE AND THE LEVELS OF DISEASE
PREVENTION

The natural history of diseases comprises the body

of knowledge about the agent, host and
environmental factors relating to the disease
process.
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CPH LEC NOTES OF CANDICE

ACTIVITY: Information about dengue fever is

already known. After studying this information,
outline the chain of infection by identifying the
following: • reservoir(s) • portal(s) of exit • mode(s)
of transmission • portal(s) of entry, • factors in host
susceptibility