MCB432: EPIDEMIOLOGY AND

PUBLIC HEALTH MICROBIOLOGY

NOTE
 INTRODUCTION
• Public Health is the science and art of (1) preventing
disease, (2) prolonging life, and (3) promoting health and
efficiency through organized community efforts for
✓the sanitation of the environment,
✓the control of community infections,
✓the education of the individual,
✓the organization of medical and nursing service for the early diagnosis and
preventive treatment of disease, and
✓the development of the social machinery which will ensure to everyone a
standard of living adequate for the maintenance of health.
• So organizing these benefits as to enable every citizen to realize
his birthright of health and longevity.
(C.E.A. Winslow, 1920)
 SUB-DISCIPLINES/SCOPE OF PUBLIC HEALTH
• Public health incorporates the interdisciplinary approaches of:
• Environmental Health
• Occupational Health
• Public Health Nutrition
• Family and Reproductive Health, including School Health Service
• Health Education
• International Health
• Epidemiology
• Biostatistics
• Demography
• Health Management and Administration
• Social and Rehabilitative Medicine
• Communicable and Non-communicable Diseases Control
❖Epidemiology has been defined as, ‘The study of distribution and determinants of health-related
states or events in specified populations and application of this study to the control of health
problems’ (John M Last, 1988).
Health Events:
• The health related events are all the conditions of the spectrum of health such as disease, injury,
disability and death.
• These events are with reference to the human population
• (NB: Epidemiology is also studied among animals)
Distribution
• This refers to the pattern of occurrence of disease in the community with reference to time, place
and person.
• This part of the study is known as, ‘Descriptive epidemiology’.
Determinants
• Refers to the etiological or risk factors related to particular disease
Disease Frequency
• This means measuring the magnitude or extent of the health related event or health problem in
the community, in terms of morbidity rates such as incidence and prevalence and also in mortality
rates.
EPIDEMIOLOGICAL TRIAD/TRIANGLE
• The epidemiological triad/triangle consist of an agent, host and
environment that brings the agent and host so that disease can occur
AGENT
1. Biological agents
2. Physical agents
3. Social agents
4. Mechanical agents

HOST ENVIRONMENT
1. Demographic 1. Physical
2. Biological 2. Social
3. Socio-economic 3. Biological
 AGENT
• The agent id the first link in the chain of disease transmission and
development of disease
• The disease agents can be classified in to:
i. Biological Agents which are living organisms such as bacteria, viruses,
fungi, protozoans etc. that are capable of causing disease to humans
ii. Chemical Agents such as poisons, toxins, waste, allergens etc affect
human health and cause disease
iii. Mechanical Agents like accidents and other exposures to chronic
frictions can lead to injuries, dislocation, fractures, exposures to
infectious agent like Clostridium tetani etc.
iv. Physical Agents such as exposure to heat, radiation, cold, pressure,
electricity, humidity etc. can lead to several diseases
 HOST
• This is an individual or an animal that may be susceptible to invasion
by infectious agent
• The host can be
• Definitive or Primary – one in which infectious agent mature and reproduce
in the host
• Intermediate or Secondary – on which harbors the infectious agent for a
short transition period without undergoing reproduction e.g Snail in
Schistosomiasis
• Some of the host factors include:
i. Demographic Characteristics such as age, sex, income, education,
population etc. affect human health
ii. Biological Characteristics which include level of immunity (such as
herd immunity), genetic make-up, allergic reactions, pregnancy,
nutrition etc. determine human health
iii. Socio-economic Characteristic like culture, standard of living,
economic status etc. affect the onset of disease

ENVIRONMENT
• The environment is a medium or pathway through which infectious
disease is transmitted from one person to another
• Some of the environmental factors for disease transmission include:
i. Physical Environment such as water, housing style, climate, air,
waste and refuse disposal are some of the factors that play role in
disease transmission
ii. Biological Environment which include vectors (and other animal)
which can cause or transmit disease agents and susceptible host
that harbor the disease in the environment
iii. Social Environment like customs, religious beliefs, taboo, tradition,
family type etc. affect the onset of disease among the community
members of that environment
 ROUTE OF TRANSMISSION
• This is the medium or pathway through which infectious agent is transferred from
one person to another or from the reservoir to a susceptible host
• To reach the host and infect it, the agent needs a route of transmission. The route
of transmission can be:
i. Fecal-oral (water/food-borne): This occurs mostly through in- apparent fecal
contamination of food, water and hand - the three main items that regularly
make contact with the mouth.
ii. Air-borne (inhalation): Transfer of an infectious agent through inhalation can be
by:
➢ direct droplets from the nose or mouth of infected person or carrier
➢ direct air-borne of tiny droplets suspended in the air for some time
➢ indirect air-borne whereby expelled droplets land on a surface, dry up and are inhaled as
dust.
iii. Vector-borne:
➢Vectors (often arthropod vectors) are responsible for the transmission of
many infectious diseases to the host
➢A vector is an organism which transmits infection by conveying the pathogen
from one host to another
➢The transmissions of most vector-borne diseases are biological, in which case
essential part of the life cycle of the infectious agent takes place within the
body of the vector, e.g. mosquito (biological vector)
➢On the other hand, a mechanical vector transmits the disease by
contamination of the body of the vector with the infectious agent carried to
the person or the food of another host (e.g. housefly and cockroach).
iv. Skin Penetration: This can be directly by the organism itself as e of
schistosome and hookworm or by contaminated stil has object as in
hepatitis B and HIV.
v. Contact: This can be through direct contact with an infected person, eg.
scabies, or by indirect contact with contaminated object or materials as in
conjunctivitis. Some diseases require some more intimate contact for
transmission, e.g. the sexually transmitted infections.
vi. Transplacental: This is the transfer of a disease through the placenta to
fetus in the womb of a pregnant mother. Diseases that are transmitted
transplacental are HIV, hepatitis B, syphilis, rubella, among others.
 CHAIN OF INFECTION
• A chain of infection is a set of links interconnected to each other that allows the
spread of infection
• Each link of the chain is required to effectively transmit disease
• Prevention and control of any infectious disease requires breaking of any link of
the chain
• The chain of infection has six (6) links:
i. Agent
ii. Reservoir
iii. Portal of Exit
iv. Mode of Transmission
v. Portal of Entry
vi. Susceptible Host
 AGENT
• This is the group of microorganisms that are capable of causing
disease (Pathogens)
• These pathogens include:
a. Bacteria
b. Viruses
c. Fungi
d. Protozoans
 RESERVOIR OF INFECTION
• The reservoir of an agent is the habitat in which an infectious agent normally lives, grows, and
multiplies.
• Reservoirs can be divided into:
a. Humans
b. Animals
c. Environment
➢ Human reservoirs
• Two types of human reservoir exist:
• Cases: persons with symptomatic illness
• Carriers: A person or animal without apparent disease who harbors a specific infectious agent and
is capable of transmitting the agent to others which can be Asymptomatic, . Incubatory or
Convalescent
➢ Animal Reservoirs
• Animals harbor the agents and capable of causing zoonoitic diseases
• Zoonoses: Infectious diseases that are transmissible under normal conditions from vertebrate
animals to humans e.g Anthrax, Rabies etc.
➢ Environmental Reservoirs:
• Soil, air and water are the habitat of the agents
• E.g Clostridium tetani, Histoplasma capsulatum etc.
PORTAL OF EXIT
• Portal of exit is the path by which an agent leaves the source host
• Examples:
➢ Respiratory tract
➢ Gastro-intestinal Tract
➢ Skin and mucous membrane
 MODES OF TRANSMISSION
• Direct Transmission
➢ Direct contact: Skin-to-skin contact, kissing, and sexual intercourse etc.
➢ Droplet spread: Transmission by direct spray of relatively large, short-range aerosols over a few
feet, before the droplets fall to the ground by sneezing, coughing, or even talking
• Indirect Transmission
➢ Airborne: occurs by particles that are suspended in air which can be dust or droplet nuclei
➢ Vehicle borne: infectious agent is carried from a reservoir to a susceptible host by an inanimate
intermediary which include Contaminated food and water, Biologic products (blood), Fomites
(inanimate objects such as toys, handkerchiefs, bedding, or surgical instruments)
➢ Vector borne: Vectors are arthropods such as mosquitoes, fleas etc.
 PORTAL OF ENTRY
• An agent enters a susceptible host through a portal of entry
• The portal of entry must provide access to tissues in which the agent can multiply or a toxin can
act
• Often, organisms use the same portal to enter a new host that they use to exit the source host

HOST
• A susceptible host is the final link in the chain of infection
• The host is a person or other living organism that can be infected by an infectious agent under
normal conditions
• Susceptibility of the host depend on the genetic factors, general factor, and specific acquired
immunity
 DISEASE PREVENTION
• Disease prevention is a major aspect of community health or public health
• It is the action to halt or stop the occurrence or manifestation of a disease or its
progression in the community. i.e. actions aimed at eradicating, or eliminating, or
minimizing the impact of disease and disability.
• Traditionally, three levels of disease prevention are recognized in public health,
namely:
i. Primary
ii. Secondary and
iii. Tertiary prevention
• Primary Level or Primary Prevention: is a measure taken before the development or the onset of the
disease or health problem, and involves:
a. General health promotion: i.e. measures taken to prevent exposure to risk factors of the disease or
health problem. Examples of general health promotion are health education, environmental
modifications good housing, good hygiene and good nutrition, adequate ventilation, avoidance of
overcrowding, adequate physical exercise, etc.
b. Specific protection, for example. Immune prophylaxis, and chemoprophylaxis
• Secondary Level or Secondary Prevention: aims at early diagnosis and treatment, i.e. searching for the
disease before it manifests, diagnosing, and treating it at an early stage
• Secondary prevention is based on early detection of disease, through either screening or case-finding.
• Tertiary Level or Tertiary Prevention: this involves measures taken, when the disease process has
advanced beyond its early stage, to reduce or limits impairments or disabilities caused by the disease
• Tertiary prevention thus involves
a. Limitation of disability
b. Rehabilitation
 GENERAL METHODS OF CONTROL OF COMMUNICABLE DISEASES
• Effective measures to prevent and control communicable diseases can be targeted on the various
factors as follows:
A. The Agent
Elimination of the reservoir: if the reservoir is animal, e.g. cattle, bird, etc, depending on disease, destroy
the animal. If the reservoir is man:
i. Early diagnosis and prompt treatment in order to kill the parasite/infectious agent.
ii. Isolation of the ill person, separation of the ill person or animal in order to prevent transmission of
the agent to susceptible hosts. Isolation is necessary for persons suffering from diseases with the
following characteristics:
➢ High morbidity and mortality rates
➢ High infectivity rate
➢ No significant extra human reservoir
➢ Infection easily recognizable
➢ Carriers do not outnumber the ill persons
iii. Quarantine of suspects: the limitation of freedom of movements of such well persons or animals who
have been exposed to the disease or infection in order to prevent contact with those not affected
B. The Host:
• Protection of susceptible hos
i. Chemoprophylaxis:
ii. Immunization to reduce host susceptibility;
iii. Health education.
C. The Environment/Route of Transmission:
• Interruption of transmission of disease agent: use of environmental measures, e.g:
i. Provision of safe water;
ii. Avoidance of overcrowding:
iii. Sanitary disposal of sewage:
iv. Food hygiene;
v. Personal hygiene
vi. Vector control
 Vector Control Methods
• Vector control methods include:
i. Use of Insecticides or Larvicides: This is an accepted means of control of insect-borne diseases
throughout the world. It involves the use of chemicals to kill the inset vectors or their larvae.
ii. Biological Control: This involves the use of other organisms to control the vectors
• These organisms eg. larvivorous fish such as Gambusia and others like Bacillus thuringiensis or fungi,
nematodes and other biological agents compete with the vectors and by so doing reduce vector
population
i. Trapping: This is by catching or collection and destruction of vectors, using various mechanical
devices, e.g. sticky strip.
ii. Contact Barrier: This involves the use of bed nets, protective clothing or screening of house to reduce
man- vector contact
iii. Environmental Control: This involves elimination of breeding places. e.g. filling and drainage of
impounded water, clearing of vegetation and bushes around the houses. application of larvicides to
selected places and use of insecticides, among others