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Introduction to Epidemiology
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At the end of this lesson, students are able to:
1. State Father of Occupational Medicine, Father of Immunology,
Father of Modern Epidemiology and Typhoid Mary
2. Define epidemiology
3. State the uses of epidemiology
4. Describe the natural history of disease
5. Illustrate the epidemiologic triangle
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LESSON OUTLINE
1. History / evolution of epidemiology
2. Terminology in Epidemiology
3. Uses of epidemiology
4. Natural history of disease
5. Epidemiologic triangle
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History / Evolution of
Epidemiology
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Father Of Occupational
Medicine
Occupational diseases
What is your occupation?
Bernardino Ramazzini
(1633 - 1714) Italy
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Edward Jenner (17491823) England
Father of Immunology
Pioneer of smallpox vaccine
Saved more lives than the work of
any other man"
In 1979, the World HealthOrganization declared smallpox an
eradicated disease
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John Snow (18131858) England
Father of Modern Epidemiology
Mapping of cholera cases in East
London during cholera epidemic in 1854
Traced source to a single well on Broad
Street that had been contaminated by
sewage
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Source of
outbreak
Dot / Spot Map
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Known as Typhoid Mary
Asymptomatic / healthy carrier Cook
Typhoid fever
Mary Mallon (18691938) US
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Typhoid Mary
Mary Mallon, a cook responsible for 1904 typhoid fever epidemic
When source of disease was traced, Mary had disappearedonly to
resurface in 1907 when more cases occurred
Again Mary fled, but authorities led by George Soper, caught her and
had her quarantinedon North Brother Island
In 1910 the health department released her on condition that shenever accept employment involving the handling of food
Four years later, Soper began looking for Mary again when two new
epidemics broke out; Mary had worked as a cookat both places
She was found and returned to North Brother Island, where sheremained the rest of her life until a paralytic stroke in 1932 led to her
slow death, six years later
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Statistics & Biostatistics
Statisticsthe science and art of dealing with variation ofdata in order to obtain reliable results and conclusions
Biostatisticsthe application of statistics to problems in
the biological sciences, health and medicine
Eg:
Computing age-adjusted cancer incidence rates to
determine trends over time and locality
Calculating statistical measures of the risk of developingbrain tumors following cell phone use
Quantifying the relationship between use of Cox-2
inhibitors and quality of life
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Epidemiology is a word with Greek origins:
epi, meaning on, upon or befall,
demos, meaning people, and
logos, meaning the study of.
The study of what is upon the people
Epidemiology
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The study of the distribution and
determinants of health-relatedstates
or events in specified populations,and the application of this study to
the controlof health problems
(WHO)
Definition of Epidemiology
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Distr ibut ion
the frequency and pattern of health events
in a population.
Frequencyrefers to the numberof health
events
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Patternrefers to the occurrence of health-
related events by time, place, and person.
Time patterns may be annual, seasonal, weekly,
daily, hourly, that may influence health events
occurrence.
Place patterns include geographic variation,
urban/rural differences, and location of work sites or
schools.
Personal characteristics include demographic
factors such as age, sex, marital status,
socioeconomic status, behaviors and environmental
exposures.
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Frequency & Pattern
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Determinants
Are the causes and factors that influence the
occurrence of health-related events.
Eg. Eating contaminated food causes
diarrhea
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Health-related events
Anything that affects the well-beingof a population.
disease epidemic
endemic diseases
chronic diseases
occupational health & safetyinjury, disease
environmental healthwater supply, foods
behaviorslack of exercise, unhealthy eating,
smoking
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1. To determine the etiologicalor causal factorsofdiseases
2. To determine the frequency and distributionof a diseasein a community
3. To evaluate preventive,therapeuticand interventionactivities
4. To develop publichealth policies and regulations
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5. To solve epidemics/outbreaks.
6. To predictdisease occurrence, impact and distribution in
a community.
7. Surveillancefor new disease and changes in old ones.
8. To plan current and future health care needs.
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It is important to know about the natural history of a disease to help
prevent, treat and control a disease
It is the description of the progression of a disease from the first sign
or manifestation of the disease until recovery or death
Incubation Period
EndingBeginning
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The Triangle has three components:
Agent, or microbe that causesthe disease (the what
of the Triangle)
Host, or organism harbouringthe disease or carrier
(the who of the Triangle)
Environment, or those external factors that cause or
allow disease transmission(the where of the Triangle)
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It is the model of infectious disease causation.
It has 3 components: an external agent, a susceptiblehostand environmentthat brings the agent and the
host together. Disease has been classically described as the result of
an epidemiologic triangle.
Infectious diseases result from the interaction of agent,
host, and environment
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1. US Department of Health and Human Services, Center forDisease Control and Prevention, 2012. Principles of
Epidemiology in Public Health Practice,3rdEdition, Atlanta.
2. R. Bonita, R. Beaglehole and T. Kjellstrom, 2006. Basic
Epidemiology, 2nd
Edition, World Health Organization,Geneva.
3. Karuthan C. and Krishnakumari K., 2009. Biostatistics for the
Health Sciences. Mc Graw Hill.