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KONSEP DASAR EPIDEMIOLOGI 2/2014 DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP 2/22/2014PTS-RST-PKH- 2- 20141.

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Presentation on theme: "KONSEP DASAR EPIDEMIOLOGI 2/2014 DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP 2/22/2014PTS-RST-PKH- 2- 20141."— Presentation transcript:

1 KONSEP DASAR EPIDEMIOLOGI 2/2014 DISIAPKAN OLEH PROF. DR.DRH.PRATIWI, TS. MS DRH.ROSITAWATI, I. MP 2/22/2014PTS-RST-PKH

2 Disease is the result of forces within a dynamic system consisting of: agent of infection host environment Epidemiologic Triad 2/22/2014PTS-RST-PKH

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4 Infectious disease Terminology untuk menggambarkan penyakit infeksi berkaitan dengan keadaan dan prevalensi penyakit pada populasi meliputi Infectivity Pathogenicity Virulence 2/22/2014PTS-RST-PKH

5 Agent Host Environment Age Sex Genotype Behaviour Nutritional status Health status Infectivity Pathogenicity Virulence Immunogenicity Antigenic stability Survival Weather Housing Geography Occupational setting Air quality Food (www)www Factors Influencing Disease Transmission 2/22/2014PTS-RST-PKH

6 Infectivity the percentage (or proportion) of individuals exposed to a particular agent who become infected 2/22/2014PTS-RST-PKH No of infected following exposure Total of population at exposure Infectivity =

7 Pathogenicity the percentage of infected individuals who develop clinical disease due to the particular agent 2/22/2014PTS-RST-PKH No of clinically affected following exposure Total of infected at exposure Pathogenicity =

8 Virulence the percentage of individuals with clinical disease who become serious ill or die 2/22/2014PTS-RST-PKH No of severe (fatal) cases following exposure Total of clinically infected cases at exposure Virulence =

9 Agents Biological Viruses Bacteria Parasites or prions Chemical Toxins Man-made (Dioxins and melamine) Inorganic/organic: zearalenone Physical Foreign bodies Trauma Radiation 2/22/2014PTS-RST-PKH

10 Agent FactorsHost Dose Environmental hardiness Virulence (microbial) Infectivity (microbial) Toxicity (poisons) Natural host: agent has adapted itself and co-exists in balance in the host Atypical host: agent is not normally encountered 2/22/2014PTS-RST-PKH

11 Host Demography Age, Sex, Species, Breed Production type / level, Density Biology Genetics, behavior Management Intensive (housing) / extensive (free roaming) Nutrition Hygiene Husbandry Vaccination / medication Herd immunity Innate (genetic capability) Acquired through vaccination or deliberate exposure Proportion of total population that is resistant to a disease agent Susceptibility Lack of resistance to the disease agent 2/22/2014PTS-RST-PKH

12 Host Factors Innate resistance (e.g. gastric barrier, mucocilliary transport mechanism) Previous exposure Passive immune status (neonates) Vaccination status and response Age Gender Behavior (e.g. mutual grooming, dominance, pica) Production status (e.g., lactating vs. non- lactating) Reproductive status (e.g., pregnant vs. non- pregnant, sterile vs. intact) Genetics 2/22/2014PTS-RST-PKH

13 Infectivity (ability to infect) (number infected / number susceptible) x 100 Pathogenicity (ability to cause disease) (number with clinical disease / number infected) x 100 Virulence (ability to cause death) (number of deaths / number with disease) x 100 All are dependent on host factors Epidemiologic Triad-Related Concepts 2/22/2014PTS-RST-PKH

14 Predisposition to Infections (Host Factors) Gender Genetics Climate and Weather Nutrition, Stress, Sleep Smoking Stomach Acidity Hygiene 2/22/2014PTS-RST-PKH

15 Ecological Factors in Infections Altered environment {Air conditioning} Changes in food production & handling {intensive husbandry with antibiotic protection; deep-freeze; fast food industry} Climate changes {Global warming} Deforestation Ownership of (exotic) pets Air travel & Exotic journeys / Global movements Increased use of immunosuppressives/ antibiotics 2/22/2014PTS-RST-PKH

16 Dua (2) Jenis studi epidemiologi Menelaah distribusi suatu penyakit pada suatu populasi & mengamati gambaran mendasar sebarannya menurut waktu – tempat – individu terserang Desain studi: Sigi kesehatan masyarakat ( studi cross sectional, studi deskriptif Menguji hipotesis tentang hubungan antara kejadian penyakit dengan kemungkinan penyebabnya, melalui pelaksanaan studi epidemiologi yang menghubungkan exposure dengan penyakit yang diduga Desain studi: Cohort, case-control 2/22/2014PTS-RST-PKH DeskriptifAnalitik

17 Nutrients Poisons Allergens Radiation Physical trauma Agen Kepadatan Atmosfir Modus komunikasi (vector, vehicle, reservoir) Faktor Lingkungan Genetic endowment Immunologic state Age Personal behaviour Faktor Inang 2/22/2014PTS-RST-PKH

18 KONSEP EPID DALAM POPULASI 2/22/2014PTS-RST-PKH

19 TRIAD dasar epidemiologi deskriptif 2/22/2014PTS-RST-PKH Waktu Tempat Individu Tiga karakteristik esensial kejadian suatu penyakit yang berusaha dielusidasi dalam epidemiologi deskriptif

20 Berubah atau stabil? topografi Variasi musiman Clustered (epidemic) or evenly (endemic) distributed Point source or propagated Waktu Secara geografis terbatas atau tersebar (pandemi) Berhubungan dengan suplai air/pakan? Multiple cluster or one? Tempat Spesies Bangsa/Ras Umur Kelamin Individu 2/22/2014PTS-RST-PKH

21 TRIAD dasar epidemiologi analitik 2/22/2014PTS-RST-PKH Inang Lingkungan Agen Tiga phenomena yang dikaji dalam epidemiologi analitik Catatan: ingat terminologi necessary – sufficient - contributory

22 Nutrients Poisons Allergens Radiation Physical trauma Agen Kepadatan Atmosfir Modus komunikasi (vector, vehicle, reservoir) Faktor Lingkungan Genetic endowment Immunologic state Age Personal behaviour Faktor Inang 2/22/2014PTS-RST-PKH

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24 Penularan Penyakit Vertikal horizontal langsung tidak langsung media penularan vektor mekanik daur hidup 2/22/2014PTS-RST-PKH

25 Definitions Infectious diseases Caused by an infectious agent Communicable diseases Transmission – directly or indirectly – from an infected person Transmissible diseases Transmission – through unnatural routes – from an infected person Note Infections are often subclinical – infections vs infectious diseases! Antonyms not well-defined Non-communicable diseases – virus involved in pathogenesis of diabetes? Chronic diseases – HIV? 2/22/2014PTS-RST-PKH TetanusMeasles vCJD (www)www Infectious Disease

26 Cases Index – the first case identified Primary – the case that brings the infection into a population Secondary – infected by a primary case Tertiary – infected by a secondary case P S S T Susceptible Immune Sub-clinical Clinical S T (www)www Transmission 2/22/2014PTS-RST-PKH

27 Chain of transmission Direct Direct contact Secretions, Blood, Faeces/urine Droplet spread Indirect Food/water Aerosol Animal vectors Fomites Medical devices and treatments Mode of Transmission 2/22/2014PTS-RST-PKH

28 Chain of transmission Reservoir Human Person with symptomatic illness Carriers: Asymptomatic Incubating Convalescent Chronic Animal: zoonosis Environmental: soil, plant, water 2/22/2014PTS-RST-PKH

29 Chain of transmission Human/animal Respiratory tract Genito-Urinary tract Faeces Saliva Skin (exanthema, cuts, needles, blood-sucking arthropods) Conjunctival secretions Placenta Environmental Cooling towers Portal of exit 2/22/2014PTS-RST-PKH

30 Respiratory tract Mouth (faecal-oral transmission) Skin Mucous membranes Blood Portal of entry Chain of transmission 2/22/2014PTS-RST-PKH

31 Chain of transmission Indirect Food/water Aerosol Animal vectors Fomites Medical devices and treatments Mode of Transmission 2/22/2014PTS-RST-PKH

32 Chain of transmission Direct Direct contact Secretions, Blood, Faeces/urine Droplet spread Mode of Transmission 2/22/2014PTS-RST-PKH

33 Chain of Transmission Portal of exit Portal of entry Agent Susceptible Host Mode of transmission Reservoir Person to person transmission 2/22/2014PTS-RST-PKH

34 Chain of transmission Human/animal Respiratory tract Genito-Urinary tract Faeces Saliva Skin (exanthema, cuts, needles, blood-sucking arthropods) Conjunctival secretions Placenta Environmental Cooling towers Portal of exit 2/22/2014PTS-RST-PKH

35 Routes of transmission 2/22/2014PTS-RST-PKH Direct Skin-skin Herpes type 1 Mucous-mucous STI Across placenta toxoplasmosis Through breast milk HIV Sneeze-cough Influenza Indirect Food-borne Salmonella Water-borne Hepatitis A Vector-borne Malaria Air-borne Chickenpox Ting-borne Scarlatina Exposure A relevant contact – depends on the agent Skin, sexual intercourse, water contact, etc (www)www

36 Sampai jumpa minggu ke 3 2/22/2014PTS-RST-PKH


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