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Epidemiology Midterm
Epidemiology Midterm Definitions, Information, Etc
186
Health Care
Undergraduate 4
03/02/2014

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Term
“Accident” implies
Definition
random events or bad luck
Term
Injury suggests
Definition
predictability in the epidemiologic sense and amenability to prevention
Term
Injury refers directly to
Definition
the health outcome
Term
About _____ people die each year as a result of crashes
Definition
1.2 million
Term
Worldwide, this is the leading cause of death among people aged 15-29
Definition
Road traffic injury
Term
Half of deaths are “vulnerable road users” –
Definition
pedestrians, cyclists, and motorcyclists
Term
the 5 main risk factors of Road traffic injury:
Definition
speed,
drinking/driving,
helmets,
seat belts,
and child restraints.
Term
Burden of road traffic injuries
Definition
Treatment of injuries
Economic losses
Reduced/lost productivity
Disabilities
Term
Decade of Action for Road Safety (2011-2020)
Definition
Created by World Health Organization

Aims to improve safety of roads and vehicles
Changing driving behaviors
Improving emergency services
Term
Highest rate of crashes per vehicle in the world
Definition
India
Term
10-30% of hospital admissions in India are the result of ____
Definition
road traffic injuries.
Term
Spanish (H1N1) influenza virus infected
Definition
500 million people
Term
Spanish (H1N1) influenza virus killed
Definition
between 50-100 million
Term
Agents can be
Definition
biological, chemical, physical, or nutritional
Term
Examples of biologics agents include
Definition
bacteria, viruses, fungi, and protozoa
Term
Examples of chemical agents include
Definition
poisons, alcohol, and smoke
Term
Examples of physical agents include
Definition
trauma, radiation, and fire
Term
Examples of nutritional agents include
Definition
the lack there of or too much.
Term
epidemiologic triangle
Definition
Host, Agent and Environment
Term
Host example
Definition
Human
Term
Agent example
Definition
Microbe (bacteria, virus or parasite)
Term
Environment example
Definition
Extrinsic factors (climate, sanitation)

External conditions
Physical, biological, social
Term
The epidemiologic triad consists of
Definition
an external agent, a susceptible host, and an environment that brings the host and agent together
Term
disease results from
Definition
the interaction between the agent and the susceptible host in an environment that supports transmission of the agent from a source to that host
Term
What makes a human host
Definition
Genetic predisposition
Behaviors
Immunologic factors
Personal traits
ALL influence the risk for occurrence/severity of disease
Term
Malaria
Definition
Mosquito-borne disease (Anopheles)
Term
Malaria Infection occurs when
Definition
a mosquito infected with the malaria parasite bites a human
Term
Malaria Transmission occurs when
Definition
another mosquito bites the human infected with the parasite
Term
How many cases of Malaria each year
Definition
Over 2 million cases per year
Term
the agent-host-environment model did not work well for
Definition
non-infectious diseases
Term
Causal Pies proposed by ____ in ______
Definition
Rothman in 1976
Term
The individual factors in Causal Pies are called _______
Definition
component causes
Term
The complete pie, which might be considered a causal pathway, is called a _______
Definition
sufficient cause
Term
A component that appears in every causal pie or pathway is called a _______
Definition
necessary cause
Term
without a necessary cause
Definition
the disease does not occur
Term
Tuberculosis Causal Pie parts
Definition
Exposure to TB
Poor Nutrition
Poor Ventilation
Absence of BCG
Crowding
Term
____ are smaller than ______
Definition
Viruses; Bacteria
Term
Common bacterial diseases include:
Definition
Strep throat – streptococcus
Tuberculosis – M. tuberculosis
Diarrehea –E. coli
Term
Non-cellular particle
Definition
Virus
Term
Made up of genetic material that can invade living cells
Definition
Virus
Term
Viruses _____ reproduce or replicate
Definition
Cannot
Term
Named for the disease they produce or the organ they infect
Definition
Viruses
Term
Modes of Disease Transmission
Definition
Direct and Indirect
Term
Person-to-person transmission
Definition
direct
Term
Common vehicle transmission
Definition
indirect
Term
vector transmission
Definition
indirect
Term
Common vehicle transmission examples
Definition
Single exposure
Multiple exposures
Continuous exposure
Term
Clinical disease is characterized by
Definition
signs and symptoms
Term
Persistent (chronic) disease
Definition
a disease may persist for life; for example, some adults who recovered from polio as children experience fatigue and weakness
Term
Latent disease
Definition
an infection with no active multiplication of the agent
Term
Non-clinical disease may include the following:
Definition
Pre Clinical
Sub Clinical
Chronic
Latent
Term
Pre-clinical disease
Definition
not yet clinically apparent, but destined to progress to clinical disease
Term
Sub-clinical disease
Definition
not yet clinically apparent and is not destined to become clinically apparent – this type of disease is sometimes diagnosed by serologic or antibody response or culture of the organism
Term
Incubation period
Definition
The time between exposure to the agent and the appearance of the first signs and symptoms
Term
Incubation period is referred to as ______ by infectious disease epidemiologists
Definition
incubation (or induction) period
Term
Incubation period is referred to as ______ by chronic disease epidemiologists
Definition
latent period
Term
Carrier
Definition
Individual harbors the organism, but is not infected as measured by serological studies (no evidence of antibody response) or clinical illness
Term
Status of carrier may be
Definition
limited or chronic
Term
Endemic
Definition
habitual presence of a disease in an specific area

for example, dengue is endemic in the Caribbean
Term
Epidemic
Definition
occurrence of a disease in a population

example is seasonal influenza
Term
Pandemic
Definition
Worldwide epidemic

Example: HIV/AIDS
Term
Common-vehicle exposure Example:
Definition
a group of people who ate a food contaminated with a microorganism
Term
Explosive –
Definition
rapid and sudden in cases of a disease
Term
Cases are limited to people who had a common exposure
Definition
Single-exposure, common-vehicle outbreak
Term
Periodic
Definition
Changes in a water supply system resulting in multiple exposures
Term
Continuous
Definition
Constant leak leading to persistent contamination
Term
Communicability
Definition
Transmittable between persons or species; contagious
Term
Communicable disease:
Definition
an infectious disease that is contagious or capable of being transmitted between people
Term
The common cold has an incubation period of
Definition
between 12 and 72 hours
Term
Vertical transmission
Definition
Transmission from parent to offspring via sperm, placenta, milk, or vaginal fluids
Term
Horizontal transmission
Definition
Transmission from infectious person to susceptible person
Term
Direct contact
Definition
Person-to-person contact
Transmission of secretions, contact with open wounds
Term
Examples of Diseases that spread through direct contact
Definition
STIs
MRSA
Warts (human papilloma virus)
Ringworm (dermatophytosis is actually a fungus, not a parasite)
Term
Fomite
Definition
Inanimate object capable of holding and transmitting disease
Term
Examples of Diseases that spread through indirect contact
Definition
streptococcus, common cold, influenza
Term
Droplet transmission via expelled droplets from
Definition
Coughing, sneezing, and talking
Term
droplet transmission spread through droplets
Definition
droplets landing on/in eyes, nose, or mouth of susceptible host
Term
Droplets are _______
Definition
too large to hang in air and settle quickly
Term
Airborne
Definition
Droplet nuclei (residue from evaporated droplets) or dust particles containing microorganisms can remain suspended in air for long periods of time
Term
How airborne diseases start
Definition
They are breathed into the upper and lower respiratory track and that is often the starting point for disease
Term
Fecal-oral transmission
Definition
Contaminated food and water
Poor hygiene and sanitation
Term
Zoonoses
Definition
Diseases transmitted from animals to humans
Term
Vector-borne diseases are examples of
Definition
zoonoses
Term
Diseases spread from zoonoses examples are
Definition
anthrax, dengue, Ebola, E. coli, giardia, H1N1 flu, plague, rabies, yellow fever
Term
Pathogenicity
Definition
The ability to cause disease
Term
Infectivity
Definition
The ability of the organism to invade the host and reproduce
Term
Virulence
Definition
The severity or extent of disease
Term
Basic reproduction number
Definition
R0
Term
R0
Definition
Number of cases generated by one case in an otherwise uninfected population
Helps determine whether or not a disease will spread and how fast it will spread
Term
R0<1 means
Definition
the disease will die out
Term
R0>1 means
Definition
the disease will be able to spread
Term
Implementing population-level disease prevention includes three primary ideas
Definition
Remove, eliminate, or contain the cause or source of infection (environment)
Disrupt and block the chain of disease transmission (host)
Protect the susceptible population against infection and disease (population)
Term
Host-based control techniques
Definition
Quarantine
Isolation
Term
Quarantine is for _______
Definition
exposed persons (or animals)
Term
First public health measure to be shown to be effective in breaking transmission of disease
Definition
Quarantine
Term
Isolation is for ______
Definition
ill persons (or animals)
Term
_______ typically takes place in hospitals which have special rooms set aside for patients that need it
Definition
isolation
Term
In the past, this might have been as simple as boarding up a house with plague victims inside and leaving them to die.
Definition
Isolation
Term
_______ has relied heavily on the use of isolation
Definition
Leprosy
Term
Hygiene
Definition
Personal cleanliness-host factor
Food Preparation
Term
Provided to naïve individuals, before disease appears
Definition
Vaccinations
Term
Provides active, usually permanent and lifelong immunity
Definition
Vaccinations
Term
________ can be a population-level of disease prevention when used on a large scale or across large groups
Definition
Prophylaxis
Term
Can be either _____ or ______ prophylaxis
Definition
chemical or antibiotic
Term
Examples of prophylaxis use include before ______ and ______
Definition
childbirth and surgery.
Term
Herd immunity
Definition
The resistance of a group of people to an attack by a disease to which a large proportion of the population are immune
Term
The concept that once a certain proportion of the population (or group) is protected from disease by vaccination, the opportunity for transmission is limited
Definition
Herd immunity
Term
vaccination is not recommended for
Definition
Immuno-compromised and
Allergies to vaccine components
Term
Ebola virus/ebola hemorrhagic disease
Definition
Any of 5 viruses
Sudden onset of influenza-like symptoms
CNS is affected
Organ failure
Hemorrhage
Term
Marburg virus
Definition
Small epidemics in Germany (Marburg and Frankfurt) and in Belgrade (formerly Yugoslavia, now Serbia) in 1960s
Reappeared in Africa in 2000
Term
Reston virus
Definition
Same genus as ebola
Discovered in Reston, VA at Hazleton Laboratories
Non-pathogenic to humans
Found in macaques in the lab by a virologist who observed macaque deaths
Term
Population
Definition
A group of people with some common characteristic (age, race, gender, place of residence)
Term
Types of populations
Definition
Dynamic
Fixed
Term
Dynamic populations
Definition
Changing all the time
Movement in and out/migration/births-deaths
Term
Fixed populations
Definition
Confined
No migration
Often assumed for statistical models
Term
Ratio
Definition
A number obtained by dividing one number by another (x/y)
It is the relative magnitude of the entities
Term
Proportion
Definition
A type of ratio
Typically expressed as a percent
Proportion= x/y *100
Term
Rate
Definition
Incorporates a measure of time
Rate=Number events during a period of time / Population at risk during same period of time
Term
Prevalence proportion
Definition
Proportion of people with an existing condition in total population
Term
Measures the extent of the disease in the population in a specified time
Definition
Prevalence proportion
Term
Prevalence proportion Numerator includes
Definition
BOTH new and existing cases
Term
Point prevalence
Definition
The proportion of a population that has the condition at a specific point in time
Term
Period prevalence
Definition
The proportion of a population that has the condition at some time during a given period
Term
Point prevalence Can be
Definition
a calendar time period or an event (birth, death, entry into workforce)
Term
Period prevalence Includes
Definition
people who already have the condition at the start of the study period as well as those who acquire it during that period.
Term
How many people currently have asthma?
is an example of
Definition
Point prevalence
Term
How many people have had asthma during the last five years?
is an example of
Definition
Period prevalence
Term
How many people have ever had asthma?
is an example of
Definition
Cumulative prevalence
Term
A chronic non-curable disease, like diabetes, can have a ______ incidence and a _____ prevalence, because ______
Definition
low; high
the disease is not very fatal, but it cannot be completely cured either.
Term
A short-duration, curable disease, such as the common cold, can have ______ incidence and ______ prevalence.
Definition
high; low
Term
Prevalence
Definition
portion of the population with the disease
Term
the focus of prevalence is
Definition
existing diseases
Term
Live birth rate
Definition
The total number of live births in one year per unit population
Term
Infant mortality rate
Definition
The number of deaths in children under 1 year of age occurring during a one year period per 1000 live births
Term
Autopsy rate
Definition
The proportion of people with a particular finding on postmortem exam
Term
Birth defect rate
Definition
The prevalence of a birth defect at the point of birth.
Term
Sources of morbidity data
Definition
Hospitals and clinics
Disease/cancer registries
Surveillance systems
Surveys, such as NHIS, NHANES
Insurance data
Tax-financed medical plans
Industry
Military data
Term
Prevalence depends on both ____ and _____
Definition
incidence and duration of disease in the population
Term
Prevalence=
Definition
Incidence*Duration of disease
Term
_______ is the foundation of all vital statistics
Definition
Death
Term
The earliest work on vital statistics was done by ______
Definition
John Graunt
Term
John Graunt's work Led to
Definition
the development of statistical methods to analyze mortality data
Term
In most countries, laws require _________
Definition
registration of deaths
Term
Underlying cause of the death is
Definition
the disease or injury that initiated the set of events leading to death
Term
Causes of death are coded according to
Definition
the rules of the International Classification of Disease (ICD)
Term
Death Certificates
Definition
Certifies the causes of death
Certifies the manner of death
Term
Role of World Health Organization
Definition
Plays a major role in collecting, classifying, and tabulating mortality statistics for the U.S. and other countries
Term
Coordinates an international agreement that promotes standardization of mortality statistics through the International Classification of Diseases (ICD)
Definition
World Health Organization
Term
So how useful are death certificates as an indicator of disease frequency?
Definition
They are more accurate when the disease of interest has a very high case fatality rate, is easily diagnosed, and is rapidly fatal.
Term
The strengths of mortality data are that
Definition
death certificate coverage is universal,
great uniformity in the format
required content at the state level
process of collecting, processing and presentation of mortality data is highly standardized.
Term
top 5 causes of death in the US
Definition
heart disease
cancer
cerebrovascular diseases
chronic lower respiratory disease
unintentional deaths
Term
decreasing rate of stomach cancer over the years....
Definition
renamed to multiple different cancers
Term
increase in prostate cancer because
Definition
introduction of prostate specific antigen screening tool
Term
Possible explanations for trends or differences in mortality rates
Definition
Errors in diagnosis
Changes in classification
Errors in counting population
Errors in classifying by demographic characteristics
Change in incidence
Term
in 2010 how many deaths in the US
percent of cancer and heart disease
Definition
2,468,000; 50%
Term
Annual mortality rate
Definition
(total # deaths for all causes / # of persons in the pop at midyear) *1000
Term
Case-fatality rate
Definition
(# of persons dying during a specified period of time after disease onset / # of persons with the disease) *100
Term
Years of potential life lost (YPPL)
Definition
Measure of premature mortality
Term
Years of potential life lost recognizes that
Definition
death occurring in the same person at a younger age involves a greater loss of future productivity
Term
Calculating YPPL
Definition
Each deceased person’s age at death is subtracted from a predetermined age at death (in the US, we usually use 65)
Term
Disease with the most number of years of potential life lost (per year in millions)
Definition
malignant neoplasms
Term
Disease with the most number of years of potential life lost
Definition
homicide and suicide
Term
Outbreak Investigation Steps
Definition
1. Verify Diagnosis
2. Search for Additional Cases
3. Develop a Case Definition
4. Generate Hypothesis
Term
Purpose of verifying the diagnosis
Definition
Make sure illness properly diagnosed
Rule out laboratory and reporting errors
Determine that all cases suffer from same illness
Term
how to verify diagnosis
Definition
Obtain clinical samples for laboratory testing
Review medical records and laboratory results
Discuss with healthcare providers of cases
Interview (and even examine) cases
Consult a qualified microbiologist
Term
Need to actively search for additional cases in order to:
Definition
Determine true magnitude of outbreak
Characterize outbreak accurately
Increase ability of epidemiologic studies to link illness with true cause of outbreak
Term
Ways to search for additional cases
Definition
Contact implicated establishment to identify other ill customers (e.g., reservations)
Contact event organizer for list of attendees
Review foodborne illness complaints and notifiable disease reports
Examine laboratory reports and hospital medical records
Ask local healthcare providers to look for cases
Ask known cases if they know of other cases
Review death certificates
Make announcements through local media
Term
Case Definition
Definition
Standard set of criteria used to classify ill people as being cases associated with a particular outbreak
Term
Case Definition criteria include
Definition
Clinical findings (e.g., signs, symptoms, laboratory results)
Restrictions by time, place, and person
Term
Case definition is _____ and ______
Definition
Objective – Not open to interpretation

Discriminating – Distinguish between individuals with illness associated with outbreak and those with illness not associated with the outbreak
Term
Case Definition does not include
Definition
suspected source of outbreak
Term
case definition can
Definition
change over time as more information about the illness or outbreak is revealed
Term
How to generate a hypothesis
Definition
Use available information to make an educated guess about the cause and source of an outbreak
Term
purpose of generating a hypothesis
Definition
To direct immediate control measures
To narrow focus of subsequent studies
To determine the need to involve others in investigation
Term
hypothesis includes
Definition
likely causative agent, people at risk, mode of transmission, vehicle, and period of interest
Term
Implicated Facility
Definition
Foods produced or served; production, processing, distribution methods; past food safety problems
Help identify high risk foods, likely causative agent, and contributing factors
Term
ONSET OF ILLNESS
Definition
Time or date of onset of symptoms
Relates back to likely period of exposure
Typically presented as epidemic curve (epi curve)
Term
what is typically presented as epidemic curve (epi curve)
Definition
TIME – ONSET OF ILLNESS
Term
Uses of Epi Curve
Definition
Grasp magnitude of outbreak
Clarify outbreak’s time course
Identify cases that are outliers
Draw inferences about pattern of spread
Term
Point Source Outbreak
Definition
Exposure to same source over brief time
Cases rise rapidly to a peak and fall off gradually
Majority of cases within one incubation period
Term
Continuous Common Source Outbreak
Definition
Exposure to same source over prolonged time
Epidemic curve rises gradually
May plateau
Term
Propagated Outbreak
Definition
Spread from person to person
Series of progressively taller peaks
Peaks one incubation period apart
Term
attack rate =
Definition
(# sick / total who ate food ) 100
Term
Relative Risk =
Definition
AR of those who ate food / AR of those who did not eat food
RR > 1 - could be a risk factor
RR < 1- could be a protective factor
Term
attack rate =
Definition
(# sick / total who ate food ) 100
Term
Relative Risk =
Definition
AR of those who ate food / AR of those who did not eat food
RR > 1 - could be a risk factor
RR < 1- could be a protective factor
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