2 Epidemiology is the study of the distribution and determinants of health-related states or events (including disease), and the application of this study to the control of diseases and other health problems.Various methods can be used to carry out epidemiological investigations: surveillance and descriptive studies can be used to study distribution; analytical studies are used to study determinants
3 Morbidity vs. Mortality Morbidity- the incidence of disease in a populationMortality- the incidence of death in a population
4 Epidemiologic basis of public health Incidence =# of New Cases Occurring in a GivenPopulation in a Specified Time Period_Population at Risk in That Time PeriodDetels - PH Sept 2009
5 Epidemiologic basis of public health Prevalence =# of Cases Existing in a GivenPopulation at a Single Point in Time__Population at That TimeDetels - PH Sept 2009
6 Epidemiologic basis of public health Uses of EpidemiologyCommunity diagnosis; i.e., what are the major health problems occurring in a communityEstablishing the history of a disease in a population; e.g., identifying the periodicity of an infectious diseaseDetels - PH Sept 2009
7 Epidemiologic basis of public health Describing the natural history of disease in the individual; e.g., natural history of HIV infection in the individual (infection-acute syndrome-asymptomatic phase-clinical disease-death)Describing the clinical picture of disease; i.e., who gets the disease, who dies from the disease, and what the outcome of the disease isDetels - PH Sept 2009
8 Epidemiologic basis of public health Estimating risk; e.g., what factors increase the risk of heart disease, automobile accidents, and violenceIdentifying syndromes and precursors; e.g., the relationship of high blood pressure to stroke, kidney disease, and heart diseaseEvaluating prevention/intervention programs; e.g., vaccine and clinical trialsInvestigating epidemics/diseases of unknown etiologyDetels - PH Sept 2009
9 Methods of Surveillance Local departments of healthHospital/medical reportsLocal pharmaciesMedia
10 Disease Terms Agent- source of infection Virus, fungus, bacteria, protozoa, carcinogen, etc.Host- person harboring the agentSick individual
11 Incubation period- the time elapsed between exposure to a pathogenic organism, a chemical or radiation, and when symptoms and signs are first apparentExamples:Common cold and influenza 1-3 daysMeasles 9-12 daysSARS 7-10 daysEbola 2-21 days
12 Pathways of Disease Air Water Person to person contact Intimate contactSharing of bodily fluidsSexNeedlesTransfusion
13 Human Health Two indicators of human health Vary greatly between Life expectancy - how long people are expected to liveInfant mortality - how many children die before age of 1 year per 1000 live birthsVary greatly betweencountriesDeveloped countriesDeveloping countriesWorld average- 42
14 Health in Highly Developed Countries Health is generally good in these countriesAverage life expectancyMen = 75 yearsWomen = 80 yearsLeading causes of death in USCardiovascular disease, Cancer, Lung DiseaseWe rank 33rd in infant mortality (6.6)Premature deaths caused by lifestylePoor diet, Lack of exercise, Smoking, Obesity
15 Some U.S. facts:In 1900 life expectancy was 51 for women and 48 for menThe leading causes of death were pneumonia, influenza, tuberculosis, diarrhea (gastritis and colitis)
16 Leading Causes of Death Low income countries (Sub-saharan Africa, South America, etc.)Lower respiratory infections11.3%Diarrhoeal diseases8.2%HIV/AIDS7.8%Ischaemic heart disease6.1%Malaria5.2%
17 High Income Countries (U.S. and Europe) Ischaemic heart disease15.6%Stroke and other cerebrovascular disease8.7%Trachea, bronchus, lung cancers5.9%
20 Emerging and Reemerging Diseases Emerging Disease - notpreviously observed inhumansUsually jumps fromanimal hostEx: AIDS, lime disease,West Nile Virus, Creutzfeldt-JakobReemerging Disease - existed in the past and are recently increasing in incidenceEx: tuberculosis, yellow fever, malaria
21 Reasons for Emergence/Reemergence Evolution of disease so it transitions to human hostEvolution of antibiotic resistance in diseaseUrbanization and overcrowdingIncreased pop. of elderly - susceptible to diseasePollution and environmental degradationGrowth in international travel and commercePoverty and social inequality
22 DiseasesPolio- a viral disease that can damage the nervous system and cause paralysis.The polio virus enters the body through the mouth, usually from hands contaminated with the stool of an infected person.Polio is preventable by immunization.Since polio immunization has become widespread in the United States, cases of polio are rare. However, polio remains a problem in many parts of the worldGreatest risk is in the Indian subcontinent and, to a lesser extent, in West and Central Africa.
23 Small PoxSmallpox is a serious, contagious, and sometimes fatal infectious diseaseThere is no specific treatment for smallpox disease, and the only prevention is vaccinationSmallpox outbreaks have occurred for thousands of yearsDisease is now eradicated after a successful worldwide vaccination programLast case of smallpox in the US-1949Last naturally occurring case in the world was in Somalia in 1977
24 After the disease was eliminated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for preventionGenerally, direct and fairly prolonged face-to-face contact is required to spread smallpox from one person to anotherSmallpox also can be spread through direct contact with infected bodily fluids or contaminated objects such as bedding or clothingRarely, smallpox has been spread by virus carried in the air in enclosed settings such as buildings, buses, and trains. Humans are the only natural hosts of variola (virus that causes is)
26 TuberculosisDisease caused by germs that are spread from person to person through the airTB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spineA person with TB can die if they do not get treatmentSpread through the airEstimated 1.7 million people died from TB in 2009The highest number of deaths was in the Africa Region
27 Influenza Respiratory Viral infection (flu) Spread through droplets in the air or on surfacesHas been around for centuriesNew strains appear yearly and travel quicklyBetween 5%-2-% of the US population contracts the flu each yearFlu season is generally from September to MayAbout 36,000 people die each year in the US
28 Most susceptible are the very young and very old Spanish Flu of 1918 killed 850,000 in the USParticularly virulent strain that killed people equally of all agesIf a similar strain pops up it could kill 3 million people in the US aloneH1N1 (Swine flu strain) was the latest worryMix of human, bird and pig genetic materialRelatively new strain so many people had no immunity
29 Avian Flu- Spread from birds Highly pathogenic Avian Influenza A (H5N1)Difficult to catch but highly dangerousAvian Influenza A (H7N9) VirusHuman infections with a new avian influenza A (H7N9) virus continue to be reported in China. The virus has been detected in poultry in China as well. While mild illness in human cases has been seen, most patients have had severe respiratory illness and some people have died. No cases of H7N9 outside of China have been reported. The new H7N9 virus has not been detected in people or birds in the United States.
30 West Nile Virus Potentially fatal virus Summer seasonal epidemic in North AmericaSpread through mosquitoesMosquitoes can also spread it to birds80% of the infected will have no symptoms1 in 150 will develop severe symptoms
31 MalariaA parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemiaCaused by a parasite that is passed from one human to another by the bite of infected AnophelesmosquitoesAfter infection, the parasites (called sporozoites) travel through the bloodstream to the liver, where they mature and release another form, the merozoitesThe parasites enter the bloodstream and infect red blood cells
32 The parasites multiply inside the red blood cells, which then break open within 48 to 72 hours, infecting more red blood cellsAlso may be transmitted from a mother to her unborn baby (congenitally) and by blood transfusionsmillion cases of malaria each year, and more than 1 million people die from itMalaria, especially Falciparum malaria, is a medical emergency that requires a hospital stayWithout treatment death is almost certain
33 AIDS- Acquired Immune Deficiency Syndrome Caused by HIV virusSpread through fluid contactTransfusionNeedle sharingSexual ContactBreast MilkCurrently 33 million cases worldwide2.5 million children2.6 million new cases in 2009Sub-Saharan Africa is hit the hardest22 million cases
34 Eastern Europe & Central Asia South & South-East Asia Total: 33.3 million [31.4 million – 35.3 million]Western &Central Europe[ – ]Middle East & North Africa[ – ]Sub-Saharan Africa22.5 million[20.9 million – 24.2 million]Eastern Europe & Central Asia1.4 million[1.3 million – 1.6 million]South & South-East Asia4.1 million[3.7 million – 4.6 million]Oceania57 000[ – ]North America1.5 million[1.2 million – 2.0 million]Central &South America[1.2 million – 1.6 million]East Asia[ – 1.0 million]Caribbean[ – ]Adults and children estimated to be living with HIV 2009
35 SARS- Severe Acute Respiratory Syndrome SARS is a viral disease that causes respiratory (lung) symptoms and is spread by close person-to-person contactFirst reported in the Guangdong Province of China in November 2002Spread through air and casual contactMost people who have gotten SARS have recovered, but as many as 10-15% of SARS patients have died. The disease is more severe among older persons and those with other medical problemsNo reported cases in recent years
36 FAQQ: How many people die every year? During 2008, an estimated 57 million people died. Q: What is the number one cause of death throughout the world? Cardiovascular diseases kill more people each year than any others. In 2008, 7.3 million people died of ischaemic heart disease, 6.2 million from stroke or another form of cerebrovascular disease. Q: Isn't smoking a top cause of death? Tobacco use is a major cause of many of the world’s top killer diseases – including cardiovascular disease, chronic obstructive lung disease and lung cancer. In total, tobacco use is responsible for the death of almost one in 10 adults worldwide. Smoking is often the hidden cause of the disease recorded as responsible for death.
37 Q: What are the main differences between rich and poor countries with respect to causes of death? In high-income countries more than two thirds of all people live beyond the age of 70 and predominantly die of chronic diseases: cardiovascular disease, chronic obstructive lung disease, cancers, diabetes or dementia. Lung infection remains the only leading infectious cause of death.In middle-income countries, nearly half of all people live to the age of 70 and chronic diseases are the major killers, just as they are in high-income countries. Unlike in high-income countries, however, tuberculosis, HIV/AIDS and road traffic accidents also are leading causes of death.In low-income countries less than one in five of all people reach the age of 70, and more than a third of all deaths are among children under 15. People predominantly die of infectious diseases: lung infections, diarrhoeal diseases, HIV/AIDS, tuberculosis, and malaria. Complications of pregnancy and childbirth together continue to be leading causes of death, claiming the lives of both infants and mothers.
38 Q: How many young children die each year? More than 8 million deaths in 2008 were among children under five years of age, and 99% of them were in low- and middle-income countries.
39 Why counting the dead matters Measuring how many people die each year and why they have died is one of the most important means – along with gauging how various diseases and injuries are affecting the living – for assessing the effectiveness of a country’s health system. Having those numbers helps health authorities determine whether they are focusing on the right kinds of public health actions. A country where deaths from heart disease and diabetes rapidly rise over a period of a few years, for example, has a strong interest in starting a vigorous program to encourage lifestyles that will help prevent these illnesses. Similarly, if a country recognizes that many children are dying of malaria, but only a small portion of the health budget is dedicated to providing effective treatment, an adjustment can be made. Industrialized countries have systems in place for assessing causes of death in the population. Many developing countries do not have such systems, and the numbers of deaths from specific causes have to be estimated from incomplete data. It is widely acknowledged that progress in this realm is crucial for improving health and reducing preventable deaths in the developing world.
40 Center for Disease Control (CDC) Founded in 1946Headquartered in Atlanta, GeorgiaMore than 15,000 employees in nearly 170 occupationsField staff assigned to all 50 states and more than 50 countriesCDC is our nation’s health protection agency, and our scientists and disease detectives work around the world to track diseases, research outbreaks, and respond to emergencies of all kinds.
41 CDC works with partners around the country and world to: Prepare the US to respond to emergency health threatsInvestigate deadly disease outbreaks around the worldStop disease outbreaks before they spreadDetect harmful germs rapidly in the US food supplyStrengthen the quality, response and effectiveness of America’s laboratoriesProvide critical data that saves lives and protects peoplePut proven prevention strategies to workProvide life-saving vaccines
43 CDC’s MissionCDC works 24/7 keeping America safe from health, safety, and security threats, both foreign and domestic.Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attackCDC fights disease, and supports communities and citizens to do the same.CDC is the nation’s health protection agency — saving lives, protecting people from health threats, and saving money through prevention.