A set of training materials for professionals working in intervention epidemiology, public health microbiology and infection control and hospital hygiene.
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Infectious disease epidemiology shares the same general conceptual framework as ‘non-infectious disease’ epidemiology. It seeks to understand the causes and distribution of infectious diseases in populations with the aim of controlling them. However, there are specific epidemiological concepts/terms that are mainly related to infectious diseases:
Agent: A factor, such as a microorganism, chemical substance, or form of radiation, whose presence is essential for the occurrence of a disease.
Chain of transmission: In most outbreak investigations, the principal objective is to identify the source of the infection. For example, an identified 'source' (e.g. a chocolate cake) is usually contaminated by some other source (e.g. the baker of the cake, or the eggs used). Tracing back such a 'chain of transmission' usually leads back to the reservoir.
Contagiousness: Capability of a disease of being passed on by direct contact with a diseased individual or through various transmission routes. The contagiousness of an organism is its capability of harbouring or spreading the causative agent of a transmissible disease.
Epidemic curve: An epidemic curve is a graph in which the number of new cases of a disease is plotted against an interval of time to describe a specific epidemic or outbreak.
Generation time: The time that elapses between onset of symptoms in the primary case and onset of symptoms of the secondary case. It refers to the time it takes for the first group of patients to 'generate' the next group.
Herd immunity: Herd immunity occurs when the vaccination of a significant portion of a population (or herd) provides a measure of protection for individuals who have not developed immunity. For contagious diseases that are transmitted from individual to individual, herd immunity theory proposes that chains of infectionare likely to be disrupted when large numbers of a population are immune or less susceptible to the disease.
Host: Person or other living animal, including birds and arthropods, that offers subsistence or lodging to an infectious agent under natural conditions. A primary host is where a parasite reaches maturity or passes its sexual stage. A secondary host is where a parasite is in a larval or asexual stage.
Incubation period: Period between exposure and onset of clinical symptoms.
Index case: First case of a disease to be identified at the start of an outbreak. The index case is the first patient that indicates the existence of an outbreak. It does not necessarily mean that it was the first case of the outbreak. Earlier cases may be found and are labelled primary case, secondary case, tertiary case, etc.
Latent period: Period between exposure and infection during which there are no clinical symptoms or signs of infection in the host.
Outbreak: Term used in epidemiology to describe an occurrence of disease greater than would otherwise be expected at a particular time and place. It may affect a small and localized group or impact upon thousands of people across an entire continent. Two linked cases of a rare infectious disease may be sufficient to constitute an outbreak.
Epidemic: Generally, ‘epidemic’ refers to large outbreak. But the difference between ‘epidemic’ and ‘outbreak’ remains subjective. Some have proposed that an epidemic is an outbreak that affects a region in a country of a group of countries.
Pandemic: Outbreak of disease around the globe.
Pathogen: Anything that can produce disease. Typically the term is used to mean an infectious agent - a microorganism, such as a virus, bacterium, prion, or fungus that causes disease in its host.
Reproductive rate of an infection: Number of cases one case generates on average over the course of its infectious period.
Transmission routes: Pathway of causative agents from a source to infection of a susceptible host. The characteristic of the transmission route depends mainly on the characteristics of the causative agent and those of the host. Some microorganisms are restricted to a limited number of transition routes, whereas others can follow many different pathways to infect their hosts:
Direct transmission: Direct and immediate transfer of infectious agents to a susceptible host. This may be through direct contact such as touching, biting, kissing or sexual intercourse, or by the direct projection of droplet (droplet spread) spraying onto eyes, nose or mouth of other people. Droplet spread is usually limited to short distances, such as 1 meter or less.
Vertical transmission: Specific form of direct transmission is that between mother and child during pregnancy or childbirth.
Indirect transmission: Transmission of infectious organisms from a source through objects (vehicles) or insects (vectors).
Vehicle-borne: Infectious agents can reach susceptible hosts through transport on inanimate objects (=fomites) such as toys, handkerchiefs, soiled clothes, bedding, medical instruments, food, water, blood products or any other substance that can be contaminated. Some vehicles allow multiplication of the infectious agent (e.g. salmonella in food), though this is not always the case.
Vector-borne: When insects transfer infectious agents to susceptible hosts, they act as 'vectors' of the infection.
Airborne transmission: Microbial aerosols are suspensions of particles (fluid or solid) in the air consisting partially or wholly of microorganisms. They may remain suspended in the air for prolonged periods of time (as opposite to droplets, that are too large in diameter and fall to the ground relatively fast). This transmission route works particularly efficient for viruses such as the measles virus.
Reservoir: The ‘reservoir of infection’ is the principal habitat where a specific infectious agent lives and multiplies and from which it may spread to cause disease. The reservoir is necessary for the infectious agent either to survive or to multiply in sufficient amount to be transmitted to a susceptible host. In a number of articles the concept of 'source' and 'reservoir' are used as synonyms, though strictly speaking they are not. A source usually can be found at a specific time in a specific place; reservoirs are more generic 'homes' to microorganisms.
Susceptibility: A susceptible individual (sometimes known simply as a susceptible) is a member of a population who is at risk of becoming infected by a disease.
Source: The source of infection is the location from which a host acquires the infection, either endogenous (i.e. originating from a person's own commensal microbial flora) or exogenous (i.e. the source is located external to the patient). This means that a source usually can be identified in a specific place and a specific time. Outbreaks can be categorized by the way that the causative agent (usually a microorganism) is spread within the population to reach new susceptible people. There are several ways this source can infect people:
Common source outbreaks: Outbreaks where all (or most) cases were infected by the same source are called common source outbreaks.
Point source outbreaks: Common source outbreaks where the source has infected cases at one particular geographical location and during a short period of time. In such situations the source is located 'at a single point in time and place'. These outbreaks have a typical bell shaped epidemic curve that increases sharply, peaks and then decline sharply, reflecting the normal distribution of the incubation period of the causative agent in humans. For this reason, the epidemic curve of a point source outbreak can help identifying the moment of transmission (i.e. when all cases have been exposed to the source).
Continuing common source outbreaks: Outbreaks where all (or most) cases have been infected by the same source, over a prolonged period of time. The shape of the epidemic curve does not increase that sharply, it does not peak, yet reaches a plateau that is sustained over time, until the source is removed.
Propagated outbreaks: Outbreaks of communicable infectious disease (i.e. can be transmitted from person to person) for which there is no single, common source. The causative agent is propagated within the population through human contact patterns. The shape of the epidemic curve in propagated outbreaks can vary and depends on the contact pattern and the proportion of susceptible individuals.
Traceback: The method used to determine the source and scope of the product/processes associated with the outbreak and document the distribution and production chain of the product that has been implicated in a foodborne illness or outbreak.
Traceforward: Once the source of an implicated food item is established, investigators may do a "traceforward" to document the distribution of all implicated lots of food from the source. This can help epidemiologists with case finding and can be used to test hypotheses about the outbreak. Traceforwards should only be used when there is a reasonable degree of confidence that the traceback correctly identified the source of the implicated product.
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