PREVENTION AND CONTROL OF EPIDERMIC AND ENDERMIC DISEASES

DEFINITION OF TERMS
Prevalence is the proportion of the total number of cases to the total population and is more a measure
of the burden of the disease on society with no regard to time at risk or when subjects may have been
exposed to a possible risk factor. Prevalence can also be measured with respect to a specific subgroup of
a population.
Incidence is the number of newly diagnosed cases of a disease. An incidence rate is the number of new
cases of a disease divided by the number of persons at risk for the disease. If, over the course of one
year, five women are diagnosed with breast cancer, out of a total female study population of 200 (who
do not have breast cancer at the beginning of the study period), then we would say the incidence of
breast cancer in this population was 0.025. (or 2,500 per 100,000 women-years of study)
Sporadic refers to a disease that occurs infrequently and irregularly.
Hyper endemic refers to persistent, high levels of disease occurrence.
Transmission rate - the number of individuals infected by each single infected individual
Cluster refers to an aggregation of cases grouped in place and time that are suspected to be greater
than the number expected, even though the expected number may not be known. 
A Case is defined as a person in the population or study group identified as having the particular disease,
health disorder or condition under investigation. It could be subclinical cases, latent phase in which host
does not shed the infective agent which lies dormant within the host without symptoms.
Reservoir is any person, animal, arthropod, plant, soil, or substance or a combination of these in which
an infectious agent normally lives and multiplies on which it depends primarily for survival, and where it
reproduces itself in such a manner that it can be transmitted to a susceptible host. It is the natural
habitat of the infectious agent.
Types of reservoirs
It includes Human, animal and non-living reservoirs. Four stages are required for successful parasitism
1. Portal of entry
2. Site of election inside the body
3. Portal of exist
4. Survival in external environment
Rehabilitation: is defined as combined and coordinated use of medical, social, educational and
vocational measures for training and retraining of individual. To the highest possible level of
functional ability – 4 types: medical, educational, vocational, and psychosocial.
Epidemiological triad: is based on the model of agent, host and environment within a given time.
Agent: Agents lives and multiple in the reservoir from where it is transmitted to other habitat is the
cause of disease- viral, bacterial, fungal etc
Host: is an organism usually human or animal that harbors' the disease. Types include an obligate host,
definitive (primary) host, intermediate host and a transport host.
Environment: surrounding where disease thrives: Physical, Biological and Psychosocial
Time: incubation period, duration of illness, life expectancy of the host or pathogen, severity of illness
What is an outbreak?
When more cases of a disease than expected are recorded in one area an outbreak is declared. The area
could be a small community or extend to several countries. An outbreak could even be a single case of a
contagious disease new to a community or not seen for a long time. Outbreaks can last for a few days,
weeks or even several years. There are three types of outbreak an endemic, an epidemic or a pandemic
Endemic is the constant presence of a disease within a geographical region. Endemic is an outbreak that
occurs at a predictable rate in a certain area or among a set population. Chickenpox is classed as an
endemic as it occurs at a high but predictable rate amongst youngsters Endemics remain at a steady
state, but do not disappear from a population. It can also be defined as a disease outbreak that is
consistently present but limited to a particular region. This makes the disease spread and rates
predictable. Malaria, for example, is considered an endemic in certain countries and regions.
WHAT IS AN EPIDEMIC?
The Centres for Disease Control and Prevention (CDC) describes an epidemic as an unexpected increase
in the number of disease cases in a specific geographical area i.e. in excess of expected occurrence.
Yellow fever, smallpox, measles, and polio are prime examples of epidemics that occurred throughout
American history. Notably, an epidemic disease doesn't necessarily have to be contagious. For example,
West Nile fever and the rapid increase in obesity rates are also considered epidemics.
In broader terms, epidemics can refer to a disease or other specific health-related behaviour (e.g.,
smoking) with rates that are clearly above the expected occurrence in a community or region. The term
epidemic is not just used with infectious diseases. It is also used with any scenario that leads to a
detrimental rise of health risks within a society e.g. the rise in obesity globally. Epidemics can
follow predictable patterns and these trends are often used to monitor, predict and control the
spread of the infection. A typical example of this is seasonal flu.

WHAT IS A PANDEMIC?
The World Health Organization (WHO) declares a pandemic when a disease’s growth is exponential. This
means growth rate skyrockets, and each day cases grow more than the day prior. Pandemic refers to an
epidemic that has spread over several countries or continents, usually affecting a large number of
people. In being declared a pandemic, the virus has nothing to do with virology, population immunity, or
disease severity. It means a virus covers a wide area, affecting several countries and populations.

WHAT ARE THE DIFFERENCES BETWEEN PANDEMICS AND EPIDEMICS?

The WHO defines pandemics, epidemics, and endemics based on a disease's rate of spread. Thus, the
difference between an epidemic and a pandemic isn't in the severity of the disease, but the degree to
which it has spread. A pandemic cuts across international boundaries, as opposed to regional
epidemics. This wide geographical reach is what makes pandemics lead to large-scale social disruption,
economic loss, and general hardship. It's important to note that a once-declared epidemic can progress
into pandemic status. While an epidemic is large, it is also generally contained or expected in its spread,
while a pandemic is international and out of control.

CAUSES OF DISEASE OUTBREAKS

Several factors contribute to the outbreak of infectious diseases. Contraction can occur as a result of
transmission from people, animals, or even the environment. For example:
 Weather conditions. For example, whooping cough occurs in spring, whereas measles tend to
appear in the winter season.
 Exposure to chemicals or radioactive materials. For example, Minamata is a disease contracted
after exposure to mercury.
 The social aftermath of disasters such as storms, earthquakes, and droughts can lead to high
disease transmission.
 A number of environmental factors such as water supply, food, air quality, and sanitation
facilities can catalyze the spread of infectious diseases.
 Disease origins can also be unknown.

NOTABLE PAST PANDEMICS

Here are just a few examples of past pandemics that have shaped the evolution of outbreaks and human
immunity. 
 The Black Death (1346 - 1353): The Black Death caused an estimated death of 25 million people across
the world in the 14th century. According to scientists, the outbreak was caused by bacteria called
Yersinia pestis. The virus lasted for about four years.
American Plagues (16th Century): A cluster of Eurasian diseases brought to the Americas by European
explorers, smallpox was one of the chief illnesses of the American Plagues, which contributed to the
collapse of the Inca and Aztec civilizations. Some estimates suggest that 90% of the indigenous
population in the Western Hemisphere was killed off as a result. 
The Flu Pandemic (1889 - 1890): New transportation routes made possible in the industrial age made it
easier for influenza viruses to spread widely in the United States and beyond. In the span of months,
influenza travelled around the globe, with the earliest cases reported in Russia. 
Spanish Flu (1918 - 1920): Another massive disease outbreak was the influenza pandemic, popularly
called Spanish flu. This viral pandemic began in 1918, immediately following World War 1. Over 50
million deaths were recorded during this outbreak, with the disease lasting only two years.
The Asian Flu (1957 - 1958): The Asian Flu pandemic, which was a blend of avian flu viruses, began in
China and eventually claimed more than 1 million lives.
AIDS Pandemic and Epidemic (1981 - Present): Since it was first identified, AIDS has claimed an
estimated 35 million lives. Scientists believe that HIV, the virus that causes AIDS, is likely to have evolved
from a virus found in chimpanzees that was transferred to humans in West Africa in the 1920s.
Covid- 19 (201 – Present): The current COVID-19 outbreak is not the only disease to have impacted the
world on a global scale.
Stages of a Pandemic
The WHO has identified six phases that it follows before declaring a pandemic. Phase 1 represents a low
risk and phase 6 is a full-blown pandemic, you can see the phases below:
Phase 1 - a virus is seen in animals but has not been shown to infections in humans
Phase 2 - a known animal virus has caused an infection in humans
Phase 3 - scattered or isolated incidence of cases or small clusters of the disease occurring in
humans; possible cases of human-to-human transmission but not at a level to cause community-
level outbreaks
Phase 4 - human to human transmission at a rate that causes an outbreak in communities
Phase 5 - the spread of the disease between humans is now evident in more than one country
Phase 6 - community-level outbreaks are in at least one additional country other than that seen in
phase 5.Once Phase 6 is reached preparation is then made for a global pandemic.

Preventing a Pandemic
It is important to try to prevent an epidemic from developing into a pandemic. This requires
organizations and nations to act early and be prepared. A set of policies to try to limit the spread of an
infectious agent beyond the initial individual cases and small clusters of infection are
termed Containment. There are several measures that have proven effective in the control and
containment of viruses:
 Controls - application of border controls to limit/prevent movement of individuals to and
from affected areas
 Identify cases - educate the public on the symptoms and risk factors, provide easy access
to testing, flag potential cases in any healthcare encounters, track contact with infected
individuals
 Trace contacts - a labour-intensive process which tracks an infected individual's
movements from the moment of infection to identify all individuals who have been potentially
infected.
 Quarantine - separate an individual suspected of infection from contact with others for a
certain period of time that covers the period of incubation for the disease
 Isolate - separate an individual who has been identified as infected from contact with
others
 Protect - use appropriate equipment (PPE) to protect health care workers who cannot
avoid contact with infected individuals.

Managing a pandemic
Once a significant level of infection is present within a population then reducing this rate of spread
becomes vital. Actions targeted at reducing the transmission rate are termed  Mitigation and can
involve:
 Social distancing (cancel events, closing institutions, work from home etc.)
 Education of the public - to promote actions such as hand washing and avoiding groups etc.
 Economic measures - to provide relief to individuals and businesses and to increase
compliance with social distancing related policies
 Vaccination

Communicable Disease is an illness due to specific infectious (biological) agent or its toxic products
capable of being directly or indirectly transmitted from man to man, from animal to man, from
animal to animal or from environment (through air, water, food etc.) to man through a variety of
ways that include: contact with blood and bodily fluids; breathing in an airborne virus; or by being
bitten by an insect.

MODE OF TRANSMISSION
DIRECT TRANSMISSION:
 Direct contact: skin to skin; mucosa to mucosa; mucosa to skin of the same person or
different person. E.g. STD, AIDS, leprosy, skin and eye infection
 Droplet infection: droplet sprayed into the air from sneezing, coughing or speaking to the
surrounding atmosphere. E.g. respiratory infection, TB, diphtheria, whooping cough,
meningococcal meningitis.
 Contact with soil: e.g. hookworm larva, tetanus
 Inoculation into skin or mucosa: e.g. rabies, infested needles
 Trans placental (vertical): e.g. TORCH syndrome (Toxoplasmosis, Other agent, Rubella also
known as German measles, Cytomegalovirus, Herpes simplex virus), syphilis, HBV, AIDS
INDIRECT TRANSMISSION: pathogens remain on surfaces that were in contact with an infected
person. Traditionally there are 5 ‘F’s in indirect transmission.
 Flies
 Finger
 Fomite
 Food
 Fluids
 Vehicle borne: (water, food, ice, bloods, serum, plasma)
 Vector borne: (germs are spread by an animal or insect, usually through a bite)
 Air borne (germs are spread through air e.g. coughing or sneezing)
 Fomite borne (inanimate article or substance other than water or food contaminated by
infected by infectious agent)
 Unclean hands and finger
Non Communicable Diseases is a miscellaneous group of health related conditions, usually not
communicated through infective pathogens and may cause impairment, disability, handicap or
even premature death. examples of non-communicable diseases include congenital anomalies,
malnutrition (pediatric, geriatric), endocrinal disorders (e.g. diabetes, gout), cardiovascular disease
(e.g. hypertension, atherosclerosis, ischemic heart disease, MI), locomotors system problem e.g.
arthritis (acute, chronic), chronic respiratory condition (e.g. bronchial asthma), occupational
related condition (pneumoconiosis), neoplasm (benign/malignant), injuries, sensory loss (e.g.
deafness, blindness), psychiatric disorders
Preventing of Diseases and Epidemics
There are 4 levels of prevention
1. Primordial level: is directed at susceptible persons before they develop a certain NCD, thus
aims at reducing incidence e.g. tobacco prevention program, promotion of physical
exercise, dietary recommendations etc. It includes the prevention of development of risk
factors among countries or population groups where they are not yet appeared e.g.
Hypertension and obesity in children.
2. Primary level: action taken prior to onset of disease which removes the probability of a
disease occurring. Methods of primary prevention include (a) health promotion and (b)
specific protection such as immunization, use of specific nutrients, chemoprophylaxis,
protection against occupational hazards, carcinogens, accidents (c) Early diagnosis and
treatment: not really prevention but it is (d) Disability limitation (e) Rehabilitation
3. Secondary level: is directed at asymptomatic individuals, but has developed biological
changes resulting from the disease, thus aims at reducing prevalence. E.g. screening
program (for diabetes, hypertension, and cancer), recommended when: natural history
permits early detection, effective management regime. Strategies include early diagnosis
through screening and case finding for treatments. This strategy is rather imperfect, more
expensive. Its less effective than primary prevention
4. Tertiary level: is directed at preventing disabilities in people who have symptomatic
disease, thus aims at trying to improve quality of life. E.g. screening for/management of
diabetic complication (e.g. retinopathy); orthopedic prosthesis (e.g. fracture-hip);
physiotherapy (e.g. cardiovascular stroke/paralysis/sports injuries victims). Activities in the
late pathogenesis stage i.e. limitation of disability and rehabilitation.