1.

Skin
The skin is the largest organ of your body. Image of inflammatory response
It acts as a barrier between invaders (pathogens) and
MODULE 5.1
your body. Skin forms a waterproof mechanical
REVIEW OF IMMUNOLOGY barrier. Microorganisms that live all over your skin
can’t get through your skin unless it’s broken.

IMMUNITY 2. Tears, mucus and saliva

Immunity is the balanced state of Nose, mouth and eyes are obvious entry
multicellular organisms having adequate biological points for pathogens. However, tears, mucus and saliva
defenses to fight infection, disease, or other contain an enzyme that breaks down the cell wall of
unwanted biological invasion, while having adequate many bacteria. Those that are not killed immediately
tolerance to avoid allergy, and autoimmune diseases. are trapped in mucus and swallowed. Special cells line
and protect the nose, throat and other passages
The immune response is how your body within your body. The inner lining of your gut and lungs
recognizes and defends itself against bacteria, also produces mucus to trap invading pathogens.
viruses, and substances that appear foreign and An inflammatory response begins when a pathogen
harmful. 3. Cilia stimulates an increase in blood flow to the infected
area. Blood vessels in that area expand, and white
INNATE, OR NONSPECIFIC, IMMUNITY Very fine hairs (cilia) lining your windpipe blood cells leak from the vessels to invade the
is the defense system with which you were move mucus and trapped particles away from your infected tissue. These white blood cells, called
lungs. Particles can be bacteria or material such as
born. It protects you against all antigens. Innate phagocytes engulf and destroy bacteria. The area
dust or smoke.
immunity involves barriers that keep harmful often becomes red, swollen, and painful during an
materials from entering your body. These barriers 4. Stomach acid inflammatory response.
form the first line of defense in the immune response.
Stomach acid kills bacteria and parasites that have When a pathogen has invaded, the immune system may
Examples of innate immunity include: been swallowed. also release chemicals that increase body
temperature, producing a fever. Increased body
• Cough reflex 5. Urine flow temperature may slow or stop pathogens from growing
• Enzymes in tears and skin oils and helps speed up the immune response.
• Mucus, which traps bacteria and small particles Urine flow flushes out pathogens from the bladder
area. ANATOMY OF THE IMMUNE SYSTEM
• Skin
• Stomach acid 6. Normal Flora ‘Friendly’ (beneficial) bacteria IMMUNE ORGANS
1. Thymus
First line of defense • Only clearly individualized 1⁰ lymphoid organ
Normal flora are growing on the skin, in the
bowel and other places in the body (such as the mouth • Primary function:- production of thymic lymphocytes
The body's most important nonspecific and the gut) that stop other harmful bacteria from • A major organ for proliferation of lymphocytes in
defense is the skin, which acts as a physical barrier to taking over. body.
keep pathogens out. Even openings in the skin (such as
• Plays key role in determining the differentiation of T
the mouth and eyes) are protected by saliva, mucus, Second line of defense
cell
and tears, which contain an enzyme that breaks down 2. Bone marrow
bacterial cell walls. If a pathogen does make it into the body,
• Hematopoiesis
there are secondary nonspecific defenses that take
place. • B cell maturation
• B cell selection
• Puts out mature, naive B cells
3. Lymph nodes
• 1st line of response to antigens
• Secondary follicle (Germinal center) is site of B cell
proliferation, mutation, differentiation
• Specificity is high
• >90% of B cells die through apoptosis
• After Ag stimulation lymphocyte numbers up by 50X
in efferent lymphatic vessel
4. Tonsils
• Filters out older RBCs
• Responds to Ag in circulatory system
• Produces activated B cells
5. Appendix
• Responds to Ag
• Role in GI immune response
6. Mucosa-Associated Lymphoid Tissue (MALT)
• Lymphoid tissues below epithelium
• Presence of B cells Specific immune responses are triggered by antigens.
• Ag presented through unique cell (M cell) Antigens are usually found on the surface of
The humoral response (or antibody‐mediated
• Preferentially responds with IgA antibody pathogens and are unique to that particular pathogen. response) involves B cells that recognize antigens or
B. SPECIFIC DEFENSE: THE ADAPTIVE IMMUNE The immune system responds to antigens by producing pathogens that are circulating in the lymph or blood
SYSTEM cells that directly attack the pathogen, or by (“humor” is a medieval term for body fluid).
producing special proteins called antibodies.
When pathogens are able to bypass innate immune Antibodies attach to an antigen and attract cells that
defenses, the adaptive immune system is activated. will engulf and destroy the pathogen. The response follows this chain of events:
Cells that belong in the body carry specific markers
that identify them as "self" and tell the immune The main cells of the immune system are lymphocytes 1. Antigens bind to B cells.
system not to attack them. known as B cells and T cells. B cells are produced and 2. Interleukins or helper T cells co-stimulate B cells. In
mature in bone marrow. T cells are also produced in most cases, both an antigen and a co-stimulator are
Once the immune system recognizes a pathogen as bone marrow, but they mature in the thymus. required to activate a B cell and initiate B cell
"non-self," it uses cellular and chemical defenses to proliferation.
attack it. After an encounter with a new pathogen, B.1. Humoral immunity
3. B cells proliferate and produce plasma cells. The
the adaptive immune system often "remembers" the
Humoral immunity relies on the actions of antibodies plasma cells bear antibodies with the identical antigen
pathogen, allowing for a faster response if the
circulating through the body. specificity as the antigen receptors of the activated
pathogen ever attacks again.
B cells. The antibodies are released and circulate
through the body, binding to antigens.
4. B cells produce memory cells. Memory cells provide
future immunity.

B.2. Cell-mediated immunity

 Antibodies alone are often not enough to protect the  Ig can be transferred by breastfeeding as it is the chance of anaphylactic shock because of immunity
body against pathogens. In these instances, the most abundant Ig found in human milk against animal serum itself. Thus, humanized
immune system uses cell-mediated immunity to  placental transfer of IgG or milk transfer of IgA
destroy infected body cells. Artificial Active Immunity
molecules specific for microbial antigens and have  lasts much longer and is sometimes life-long lasting.
demonstrated their role in infectious disease  Artificial active immunization is where the microbe, or
The cell‐mediated response involves mostly T-cells prevention parts of it, are injected into the person before they
and responds to any cell that displays aberrant MHC are able to take it in naturally. If whole microbes are
markers, including cells invaded by pathogens, tumor B. Natural Active Immunity used, they are pre-treated, attenuated vaccines. This
cells, or transplanted cells. The following chain of vaccine stimulates a primary response against the
events describes this immune response:  occurs when the person is exposed to a live pathogen, antigen in the recipient without causing symptoms of
develops the disease, and becomes immune as a result the disease.
1. Self cells displaying foreign antigens bind to T cells. of the primary immune response. Once a microbe  Example:
penetrates the body’s skin, mucous membranes, or  Tetanus Toxoid, DPT, BCG
2. Interleukins (secreted by helper T cells) co-stimulate
activation of T cells. other primary defenses, it interacts with the immune
INFLAMMATORY RESPONSES
system. B-cells in the body produce antibodies that
3. If MHC‐I and endogenous antigens are displayed on help to fight against the invading microbes. The
the plasma membrane, T cells proliferate, producing  The inflammatory response (inflammation) occurs
adaptive immune response generated against the when tissues are injured by bacteria, trauma, toxins,
cytotoxic T cells. Cytotoxic T cells destroy cells
displaying the antigens. pathogen takes days or weeks to develop but may be heat, or any other cause.
long-lasting, or even lifelong. Wild infection, for
4. If MHC‐II and exogenous antigens are displayed on example with hepatitis A virus (HAV) and subsequent  The damaged cells release chemicals including
the plasma membrane, T cells proliferate, producing recovery, gives rise to a natural active immune histamine, bradykinin, and prostaglandins. These
helper T cells. Helper T cells release interleukins response usually leading to lifelong protection. chemicals cause blood vessels to leak fluid into the
(and other cytokines), which stimulate B cells to tissues, causing swelling. This helps isolate the foreign
produce antibodies that bind to the antigens and substance from further contact with body tissues.
stimulate nonspecific agents (NK and macrophages) to ARTIFICIAL IMMUNITY
destroy the antigens.  Artificial immunity is a mean by which the body is
The chemicals also attract white blood cells called
given immunity to a disease by intentional exposure to
phagocytes that "eat" germs and dead or damaged
NATURAL IMMUNITY small quantities of it.
cells. This process is called phagocytosis. Phagocytes
eventually die. Pus is formed from a collection of dead
 occurs through contact with a disease-causing agent, A. Artificial Passive Immunity
tissue, dead bacteria, and live and dead phagocytes.
when the contact was not deliberate.  is short lived, and usually lasts only a few months
 immediately activate the rest of your immune system
Artificially-acquired passive immunity is an immediate, The simplest definition of inflammation is best stated
to prevent you from getting sick.
but short-term immunization provided by the injection in Latin:
A. Natural Passive immunity of antibodies, such as gamma globulin, that are not
produced by the recipient’s cells. These antibodies are  RUBOR
 Passive immunity develops after you receive developed in another individual or animal and then
antibodies from someone or somewhere else. This injected into another individual. Antiserum is the  CALOR
type of immunity is short-lived, because it doesn’t general term used for preparations that contains  DOLOR
antibodies.  TUMOR
cause your immune system to recognize the pathogen
in the future.  FUNCTIO LAESA
Artificial passive immunization is normally
 Example:
administered by injection and is used if there has
 Maternal antibodies are antibodies that transfer from been a recent outbreak of a particular disease or as
a mother to child. This usually happens across the an emergency treatment for toxicity, as in for
placenta or through breast milk, especially in the first tetanus. The antibodies can be produced in animals,
few days after birth. called ” serum therapy,” although there is a high
 inside or outside human body. example Candidiasis and  Chronic carriers are those who continue to harbor a
Aspergillosis pathogen such as hepatitis B virus or Salmonella
Typhi, the causative agent of typhoid fever, for
MODULE 5.2 Parasitic protozoan diseases – months or even years after their initial infection.
OVERVIEW OF INFECTION They are much larger than bacteria. The simplest
single-celled organism of animal kingdom. They absorb  Frank or Symptomatic persons who have signs and
PROCESS nutrients from the body of the host such as Malaria, symptoms
Giardia and Toxoplasmosis
INFECTIOUS DISEASES B.2. Animal reservoirs.
are caused by pathogenic microorganisms,
How well any pathogen is able to thrive depends on
such as bacteria, viruses, parasites or fungi; the Humans are also subject to diseases that have animal
three factors:
diseases can be spread, directly or indirectly, from reservoirs. Many of these diseases are transmitted
one person to another. Zoonotic diseases are from animal to animal, with humans as incidental hosts.
infectious diseases of animals that can cause disease  Its pathogenicity - its ability to produce disease The term zoonosis refers to an infectious disease
when transmitted to humans.-WHO  Its degree of virulence - its severity or harmfulness that is transmissible under natural conditions from
 Its invasiveness - its tendency to spread vertebrate animals to humans. Long recognized
CHAIN OF INFECTION (SHARE ME) zoonotic diseases include brucellosis (cows and pigs),
2. Reservoir anthrax (sheep), plague (rodents), trichinellosis/
• Susceptible Host trichinosis (swine), tularemia (rabbits), and rabies
The reservoir of an infectious agent is the habitat in
• Infectious Agent (bats, raccoons, dogs, and other mammals).
which the agent normally lives, grows, and multiplies.
• Reservoir
Reservoirs include humans, animals, and the
• Portal of Entry Zoonoses newly emergent in North America include
environment. The reservoir may or may not be the West Nile encephalitis (birds), and monkeypox (prairie
• Mode of Transmission source from which an agent is transferred to a host. dogs). Many newly recognized infectious diseases in
• Portal of Exit For example, the reservoir of Clostridium botulinum is humans, including HIV/AIDS, Ebola infection and
soil, but the source of most botulism infections is SARS, are thought to have emerged from animal
1. Infectious Agent improperly canned food containing C. botulinum spores. hosts, although those hosts have not yet been
is a term that is generally used to describe and identified.
encompass any material that can cause an infection
B.1. Human reservoirs.
that can lead to a disease.
Many common infectious diseases have human B.3. Environmental reservoirs.

Viruses reservoirs. Diseases that are transmitted from person Plants, soil, and water in the environment are also
to person without intermediaries include the sexually reservoirs for some infectious agents. Many fungal
They can’t replicate independently in the host’s cells
transmitted diseases, measles, mumps, streptococcal agents, such as those that cause histoplasmosis, live
and stimulate it to participate in the formation of
infection, and many respiratory pathogens. Because and multiply in the soil. Outbreaks of Legionnaires
additional similar microorganism. They the smallest
humans were the only reservoir for the smallpox virus, disease are often traced to water supplies in cooling
microorgansm. - example Influenza A, shingles and
naturally occurring smallpox was eradicated after the towers and evaporative condensers, reservoirs for the
Hepatitis
last human case was identified and isolated. causative organism Legionella pneumophila.
Bacteria
Types of carrier B.4. Nonliving reservoirs
They are simple, one celled microbe with double cell
 Asymptomatic or passive or healthy carriers are those can include soil and water in the
membrane that protect them from harm. They
who neverexperience symptoms despite being environment. These may naturally harbor the organism
reproduce rapidly and considered as the
infected. because it may grow in that environment.
Fungi  Incubatory carriers are those who can transmit the
agent during the incubation period before clinical
They are found almost everywhere on earth. They live
illness begins. Convalescent carriers are those who c. Portal of exit
in soil, water or animals and plants. They also live
have recovered from their illness but remain capable Portal of exit is the path by which a
of transmitting to others. pathogen leaves its host. The portal of exit usually
corresponds to the site where the pathogen is refers to the transfer of an infectious
localized. agent from a reservoir to a host by suspended air
e. Portal of Entry
For example, influenza viruses and particles, inanimate objects (vehicles), or animate
intermediaries (vectors). The portal of entry refers to the manner in
Mycobacterium tuberculosis exit the respiratory
which a pathogen enters a susceptible host. The portal
tract, schistosomes through urine, cholera vibrios in
of entry must provide access to tissues in which the
feces, Sarcoptes scabiei in scabies skin lesions, and d.4. Airborne transmission
pathogen can multiply or a toxin can act. Often,
enterovirus 70, a cause of hemorrhagic conjunctivitis, occurs when infectious agents are carried by infectious agents use the same portal to enter a new
in conjunctival secretions. Some bloodborne agents dust or droplet nuclei suspended in air. Airborne dust host that they used to exit the source host. For
can exit by crossing the placenta from mother to includes material that has settled on surfaces and example, influenza virus exits the respiratory tract of
fetus (rubella, syphilis, toxoplasmosis), while others become resuspended by air currents as well as the source host and enters the respiratory tract of
exit through cuts or needles in the skin (hepatitis B) infectious particles blown from the soil by the wind.
the new host. In contrast, many pathogens that cause
or blood-sucking arthropods (malaria). Droplet nuclei are dried residue of less than 5 microns
gastroenteritis follow a so-called “fecal-oral” route
in size. In contrast to droplets that fall to the ground
because they exit the source host in feces, are
d. Modes of transmission within a few feet, droplet nuclei may remain
carried on inadequately washed hands to a vehicle
An infectious agent may be transmitted suspended in the air for long periods of time and may
such as food, water, or utensil, and enter a new host
from its natural reservoir to a susceptible host in be blown over great distances. Measles, for example,
through the mouth. Other portals of entry include the
different ways. There are different classifications has occurred in children who came into a physician’s
skin (hookworm), mucous membranes (syphilis), and
for modes of transmission. Here is one classification: office after a child with measles had left, because
blood (hepatitis B, human immunodeficiency virus).
the measles virus remained suspended in the air.
f. Susceptible Host
D.1. Direct The final link in the chain of infection is a
In direct transmission, an infectious agent is d.5. Vehicles
susceptible host. Susceptibility of a host depends on
transferred from a reservoir to a susceptible host by that may indirectly transmit an infectious genetic or constitutional factors, specific immunity,
direct contact or droplet spread. agent include food, water, biologic products (blood), and nonspecific factors that affect an individual’s
and fomites (inanimate objects such as handkerchiefs, ability to resist infection or to limit pathogenicity. An
bedding, or surgical scalpels). A vehicle may passively individual’s genetic makeup may either increase or
Direct contact occurs through skin-to-skin
carry a pathogen — as food or water may carry decrease susceptibility. For example, persons with
contact, kissing, and sexual intercourse. Direct
hepatitis A virus. sickle cell trait seem to be at least partially protected
contact also refers to contact with soil or vegetation
harboring infectious organisms. Thus, infectious Alternatively, the vehicle may provide an environment from a particular type of malaria.
mononucleosis (“kissing disease”) and gonorrhea are in which the agent grows, multiplies, or produces toxin
spread from person to person by direct contact. — as improperly canned foods provide an environment Specific immunity refers to protective
that supports production of botulinum toxin by antibodies that are directed against a specific agent.
Hookworm is spread by direct contact with
Clostridium botulinum. Such antibodies may develop in response to infection,
contaminated soil.
vaccine, or toxoid (toxin that has been deactivated
d.6. Vectors but retains its capacity to stimulate production of
D.2. Droplet spread
such as mosquitoes, fleas, and ticks may toxin antibodies) or may be acquired by
refers to spray with relatively large, short-
carry an infectious agent through purely mechanical transplacental transfer from mother to fetus or by
range aerosols produced by sneezing, coughing, or
means or may support growth or changes in the agent. injection of antitoxin or immune globulin. Nonspecific
even talking. Droplet spread is classified as direct
Examples of mechanical transmission are flies factors that defend against infection include the
because transmission is by direct spray over a few
carrying Shigella on their appendages and fleas skin, mucous membranes, gastric acidity, cilia in the
feet, before the droplets fall to the ground. Pertussis
carrying Yersinia pestis, the causative agent of respiratory tract, the cough reflex, and nonspecific
and meningococcal infection are examples of diseases
plague, in their gut. In contrast, in biologic immune response. Factors that may increase
transmitted from an infectious patient to a
transmission, the causative agent of malaria or guinea susceptibility to infection by disrupting host
susceptible host by droplet spread.
worm disease undergoes maturation in an intermediate
defenses include malnutrition, alcoholism, and disease
host before it can be transmitted to humans (Figure
d.3. Indirect transmission or therapy that impairs the nonspecific immune
1.20).
response.
BREAKING THE CHAIN OF INFECTION
There are many opportunities to stop the
spread of infection. We can interfere in every link in
the chain of infection. See figure below.

MODULE 5.3
EPIDEMIOLOGICAL MODELS IN AND PHILIPPINE
HEALTH SITUATION

Infectious Disease Causation Models

MODE OF EXIT
1. Epidemiologic triad or triangle

the traditional model for infectious

disease. The triad consists of an external agent,
a susceptible host, and an environment that
brings the host and agent together. In this
model, disease results from the interaction
between the agent and the susceptible host in an
environment that supports transmission of the
agent from a source to that host.

Agent, host, and environmental

factors interrelate in a variety of complex ways
to produce disease. Different diseases require
different balances and interactions of these
three components. Development of appropriate,
practical, and effective public health measures
to control or prevent disease usually requires
assessment of all three components and their
interactions.

MODE OF ENTRY
MODE OF TRANSMISSION
 to the previous model, the wheel model distinguishes the host Factors that triggers epidemic
from the environmental factors, thus more useful for 1. A recent increase in amount or virulence of the agent,
epidemiologic analysis. 2. The recent introduction of the agent into a setting
where it has not been before,
3. An enhanced mode of transmission so that more
susceptible persons are exposed,
4. A change in the susceptibility of the host response to
the agent, and/or
5. Factors that increase host exposure or involve
introduction through new portals of entry

 Cluster
o refers to an aggregation of cases grouped in
place and time that are suspected to be
greater than the number expected, even
though the expected number may not be
known.

 Pandemic
3. The web or network of causation model
o refers to an epidemic that has spread
over several countries or continents,
This web of causation explores multiple causative usually affecting a large number of people.
factors, giving each an equal prominence in identifying
determinants and relevant interventions. The model implies
that disease is developed as a result of "chains" of causation.
This model implies that cutting the chains at different points
would interrupt the disease development, even without
complete understanding of causal mechanisms

Epidemiological Level of disease

The amount of a particular disease that is usually present in a
community is referred to as the baseline or endemic level of
the disease.
 Sporadic
o refers to a disease that occurs infrequently
and irregularly.
 Endemic
o refers to the constant presence and/or
usual prevalence of a disease or infectious
agent in a population within a geographic
area.
 Hyperendemic
o refers to persistent, high levels of disease
occurrence.
2. The wheel model  Epidemic
o refers to an increase, often sudden, in the
number of cases of a disease above what is
This model represents the host (man) as the focus, normally expected in that population in that
who has genetic make-up as its core, and is surrounded by the area. Outbreak carries the same definition
of epidemic but is often used for a more
four environmental elements. The relative sizes of the wheel limited geographic area.
components vary from one disease to the other. In contrast
 • Pneumonia can also be classified according to where 1.4.4. Pulse oximetry. This measures the oxygen level
or how it was acquired. in your blood. Pneumonia can prevent your lungs from
PNEUMONIA moving enough oxygen into your bloodstream.
1.2.4. Hospital-acquired pneumonia (HAP)
• This type of bacterial pneumonia is acquired during a 1.5. Signs and Symptoms
hospital stay. • Pathognomonic Sign-Rusty sputum
1.1. DEFINITION
• It can be more serious than other types, as the • coughing that may produce phlegm (mucus)
Other names: Lung-fever, pneumonitis, disease, lobar-
bacteria involved may be more resistant to antibiotics. • fever
pneumonia and croupous pneumonia.
1.2.5. Community-acquired pneumonia (CAP) • sweating or chills
• shortness of breath that happens while doing normal
 Pneumonia is an infection in one or both
• Community-acquired pneumonia (CAP) refers to activities or even while resting
lungs. The infection causes inflammation in
pneumonia that’s acquired outside of a medical or • chest pain that’s worse when you breathe or cough
the air sacs in your lungs, which are called
institutional setting. • feelings of tiredness or fatigue
alveoli. The alveoli fill with fluid or pus,
• loss of appetite
making it difficult to breathe
1.2.6. Ventilator-associated pneumonia (VAP) • nausea or vomiting
• When people who are using a ventilator get • headaches
1.2. CAUSATIVE AGENT pneumonia, it’s called VAP. 1.2.7. Aspiration pneumonia YOUUUUUU uwuuuuuu\
There are several types of infectious agents that can
• Aspiration pneumonia happens when you inhale
cause pneumonia.
bacteria into your lungs from food, drink, or saliva.
• This type is more likely to occur if you have a
1.2.1. Bacterial pneumonia
swallowing problem or if you’re too sedate from the
 The most common cause of bacterial
use of medications, alcohol, or other drugs.
pneumonia is Streptococcus pneumoniae.
1.3. Mode of Transmission Both viral and bacterial
1.2.2. Other causes include:
pneumonia can spread to others through inhalation of
 Mycoplasma pneumoniae
airborne droplets from a
 Haemophilus influenzae
sneeze or cough. You can also get these types of
 Legionella pneumophila
pneumonia by coming into contact with surfaces or
objects that are contaminated with pneumonia-causing
1.2.3. Viral pneumonia
bacteria or viruses. You can contract fungal pneumonia
Respiratory viruses are often the cause of
from the environment. However, it doesn’t spread
pneumonia. Some examples include:
from person to person.
 influenza (flu)
 respiratory syncytial virus (RSV)
1.4. Diagnostic Test
 rhinoviruses (common cold)
 Viral pneumonia is usually milder and can
improve in one to three weeks without 1.4.1. Chest x ray to look for inflammation in your
treatment. lungs. A chest x ray is the best test for diagnosing
pneumonia. However, this test won't tell your doctor
what kind of germ is causing the pneumonia.
1.2.3. Fungal pneumonia
o Fungi from soil or bird droppings can cause
1.4.2. Blood tests such as a complete blood count
pneumonia. They most often cause pneumonia in people
(CBC) to see if your immune system is actively fighting
with weakened immune systems. Examples of fungi
an infection
that can cause pneumonia include:
• Pneumocystis jirovecii
1.4.3. Sputum exam Confirm the type of
• Cryptococcus species
microorganism that causes the pneumonia
• Histoplasmosis species
• Types of pneumonia