Lecture 5 - Analytic Epidemiology

Family and community medicine
Epidemiological Models
(Analytic Epidemiology)
Ecological Triad
Assis. Prof. Dr. Nawar Sahib Khalil

Lecture Objectives: At the end of the lecture, the students are expected to
• Identifying the basic elements of Epidemiological model (Analytic

epidemiology) and enumerate it precisely.
• Understand the importance of epidemiological triad in description of
health events.
Analytic epidemiology:
Testing a hypothesis about the cause of disease by studying how

exposure of interest relates to the disease of interest. It observes the Agent,
Host and the Environment {Basic triad of Analytic epidemiology}.
Agent Host
Environment
It also asks: How and Why the disease has occurred?
Epidemiological triangle depicts the relationship among three factors in

the occurrence of disease or injury.
It is used to explain the etiology of infectious diseases, as well as a non-

non- communicable disease e.g. cancer that might be depend to on the
extent of exposure to the carcinogenic agent, the dose of that agent, and the
genetic and environment.
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Agent
An agent is a factor whose presence or absence, excess or deficit is

necessary for a particular disease or injury to occur.
Or “as an organism, a substance or a force, the presence or lack of

which may initiate a disease process or may cause it to continue”. There
may be single or multiple agents for a disease.
Agent could be;
1. Biological agents.
2. Physical agents.
3. Chemical agents.
4. Nutritive agents.
Biological agent:
✓ Virus: Influenza, HIV, Rubella.

✓ Bacterial: T.B., Cholera.
✓ Fungal: Candida albicans.
✓ Protozoa: Entamoeba histolytica, Giardia lamblia
✓ Helminthes: Shistosomes.
Physical agents:
✓ Temperatures: Heat or cold, humidity.

✓ Radiation: UVR, solar, Ionizing (x-ray)
✓ High altitude: Polycythemia
✓ Vibration, Sounds and trauma.
Chemical agents:
They are chemical substances of two types:
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1. Endogenous (Internal agents): produced in the body itself as a result
of metabolic disorders or dysfunction of endocrine glands
(derangement of function). Examples are urea (uremia) in renal
failure, ketone bodies (ketoacidosis) in diabetes mellitus, serum
bilirubin (jaundice), uric acid (Gout), calcium carbonate (kidney
stones).
2. Exogenous (External agents): agents arising outside human host

such as allergens, metal (lead), arsenic, alcohol, dust, tobacco, fumes,
gases insecticides, stone particles, carbon, medications and etc. that
may be acquired by inhalation, ingestion or inoculation.
Chemical and physical agents occur within the broad physical

environment comprising of air, water, food, place of living and place of
work, etc.
Nutritional agent:
The known agents in relation to food and nutrition are energy, protein,
carbohydrate, fat, vitamins, minerals, water and fiber.
Malnutrition:
✓ Excessive nutrition: Obesity

✓ Under nutrition: anemia; IDA
Characteristics of Infectious Disease Agents
Infectivity.
Pathogenicity.
Virulence.
Invasiveness.
Toxigenicity or toxicity.
Immunogenicity.
Number (dose of infection).
Tissue selectivity.
Viability or survival.
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Susceptibility to chemotherapy and antibiotics.
Site of entry.
Site of exit.
Infectivity
Is the capacity of an agent to produce infection or disease. It is measured

by the secondary attack rate.
Pathogenicity
Is the capacity of the agent to cause disease in the infected host. It is

measured by the proportion of individuals with clinically apparent disease.
Which is the property of an infectious agent that determines the extent

to which obvious disease is produced in an infected population, or the power
of the organism to produce the disease.
Virulence
It refers to the severity of the disease. It is measured by the proportion

of severe or fatal cases; if fatal, then use Case fatality rate.
Invasiveness
Is the power of the organism to penetrate into the body fluid and tissues
of the host to live and multiply.
Toxigenicity or Toxicity
Toxigenicity
Is the capacity of the agent to produce a toxin or poisons. e.g.

Staphylococcus aureus, Diphtheria
Toxicity
It is could be defined as ability of organism to affect clinical reaction by

chemical substances which it produces. Toxins produce by pathogens are
either retained within their bodies and liberated after disintegration of the
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organisms, and are called ENDOTOXIN; or are released during the life of
the organisms and are called EXOTOXIN.
Immunogenicity (Antigenic Character and Antigenicity)
Is the ability of the agent to induce antibody production in the host.

Antigenicity is measure of ability of organism to stimulate an immunologic
response in the host.
Infectious dose (ID)
Is the amount of pathogen (measured in number of microorganisms)

required to cause an infection in the host.
Usually it varies according to the pathogenic agent and the consumer's

age and overall health.
Infectious doses for some known microorganisms
Vibrio cholera Relatively large (104 - 106 organisms)
1 – 10 aerosolized organisms are sufficient to cause

Ebola virus
infection in humans
Salmonella typhi 100,000 organisms
Tissue selectivity (Tropism)
It is the inherent capacity of pathogens to invade some particular

tissues. This is the factor that gives each disease its characteristics symptoms
& signs e.g. rabies virus, hepatitis virus.
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Viability or survival
The viability of pathogen is the ability to live and the period of living
outside the body. Is the ability of the agent to survive adverse environmental
conditions.
Susceptibility to chemotherapy and antibiotics. e.g. syphilis by

Treponema pallidum bacteria and Penicillin group.
Site of entry
The portal of entry refers to the manner in which a pathogen enters a

susceptible host. The portal of entry must provide access to tissues in which
the pathogen can multiply or a toxin can act.
Site of exit
Portal of exit is the path by which an agent leaves the source host. The
portal of exit usually the site at which the agent is localized. Pathogens
often leave hosts in materials the body secretes or excretes.
Usually, infectious agents use the same portal to enter a new host that
they used to exit the source host, e.g., influenza virus exits the respiratory
tract of the source host and enters the respiratory tract of the new host.
In contradiction, many pathogens that cause gastroenteritis follow a so-

called “fecal-oral” route because they exit the source host in feces, are
carried on inadequately washed hands to a vehicle such as food, water, or
utensil, and enter a new host through the mouth.
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Host
A person (or animal) that permits lodgment of an infectious disease

agent under natural conditions
The host can be the organism hat gets sick, as well as any animal carrier
(including insect and worms) that may or may not get sick. Although the
host may or may not know it has the disease or have any outward signs of
illness, the disease does take lodging from the host.
Different people may have different reactions to the same agent. For
example, adults infected with the virus varicella (chickenpox) are more
likely than children to develop serious complications.
Host classification
Primary or definitive hosts: hosts in which a parasite attains maturity

or passes its sexual stage.
Secondary or intermediate hosts: those in which a parasite is in a

larval or asexual state.
Transport host: is a carrier in which the organism remains alive but

does not undergo development.
HOSTS FACTOR (INTRINSIC FACTORS)
Host factors are intrinsic factors that influence;
✓ Exposure.
✓ Susceptibility or
✓ Response to a causative agents
These include:
✓ Physiological: e.g. pregnancy

✓ Anatomical
✓ Genetic: e.g. SCA.
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✓ Behavioral: e.g. life-style factors including diet, tobacco use, exercise,
etc.
✓ Occupational: e.g. health worker.
✓ Cultural: Immunologic state.
✓ Other personal characteristics that described under “person”,
including: age, gender, socio-economic status, ethnicity, etc.
Once an agent infects the host the degree and severity of the infection
will depend on the host's ability to fight off the infectious agent.
Two types of defense mechanisms are present in the host
✓ Nonspecific.
✓ Disease-specific.
Environment
The domains external to the host in which the agent may exist, survive,
or originate.
The environment consists of physical, climatologic, biologic, social,

and economic components that affect the survival of the agents and serve to
bring the agent and host into contact.
The environment can act as a reservoir that fosters the survival of

infectious agents, e.g. contaminated water supplies or food, soil, etc.
Environmental Factors
Environmental Factors are extrinsic factors which affect the agent and
the opportunity for exposure. These include:
✓ Physical factors: e.g. temperature, humidity, sunlight, rain, wind, etc)
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✓ Biological factors: e.g. insects that transmit an agent, fish, ducks,
sterilizations.
✓ Chemical factors: antimicrobial, antiseptic, pollution, etc.
✓ Socio-economic factors: e.g. crowding (population density),
sanitation, and the availability of health services (political), etc.
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Family and community medicine

Assis. Prof. Dr. Nawar Sahib Khalil

• Identifying the basic elements of Epidemiological model (Analytic

Testing a hypothesis about the cause of disease by studying how

It also asks: How and Why the disease has occurred?

Epidemiological triangle depicts the relationship among three factors in

It is used to explain the etiology of infectious diseases, as well as a non-

An agent is a factor whose presence or absence, excess or deficit is

Or “as an organism, a substance or a force, the presence or lack of

Agent could be;

✓ Virus: Influenza, HIV, Rubella.

✓ Temperatures: Heat or cold, humidity.

They are chemical substances of two types:

2. Exogenous (External agents): agents arising outside human host

Chemical and physical agents occur within the broad physical

✓ Excessive nutrition: Obesity

Characteristics of Infectious Disease Agents

Is the capacity of an agent to produce infection or disease. It is measured

Is the capacity of the agent to cause disease in the infected host. It is

Which is the property of an infectious agent that determines the extent

It refers to the severity of the disease. It is measured by the proportion

Is the capacity of the agent to produce a toxin or poisons. e.g.

It is could be defined as ability of organism to affect clinical reaction by

Immunogenicity (Antigenic Character and Antigenicity)

Is the ability of the agent to induce antibody production in the host.

Infectious dose (ID)

Is the amount of pathogen (measured in number of microorganisms)

Usually it varies according to the pathogenic agent and the consumer's

Infectious doses for some known microorganisms

Vibrio cholera Relatively large (104 - 106 organisms)

1 – 10 aerosolized organisms are sufficient to cause

Salmonella typhi 100,000 organisms

Tissue selectivity (Tropism)

It is the inherent capacity of pathogens to invade some particular

Susceptibility to chemotherapy and antibiotics. e.g. syphilis by

The portal of entry refers to the manner in which a pathogen enters a

In contradiction, many pathogens that cause gastroenteritis follow a so-

A person (or animal) that permits lodgment of an infectious disease

Primary or definitive hosts: hosts in which a parasite attains maturity

Secondary or intermediate hosts: those in which a parasite is in a

Transport host: is a carrier in which the organism remains alive but

HOSTS FACTOR (INTRINSIC FACTORS)

Host factors are intrinsic factors that influence;

✓ Physiological: e.g. pregnancy

Two types of defense mechanisms are present in the host

The environment consists of physical, climatologic, biologic, social,

The environment can act as a reservoir that fosters the survival of

✓ Physical factors: e.g. temperature, humidity, sunlight, rain, wind, etc)

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