Principles of Infectious Diseases - 2018-2019 - Albugami

King Abdulaziz University
Faculty of Medicine
Department of Community Medicine
Academic Year 2018-2019
2nd male rotation - 4th Year
General Principles of Communicable Disease

Monday Oct. 29, 2018
Prepared by Hussam Albugami, MD, MPH, PhD (c)
Contents
1. Intended Learning Outcomes

2. Infection and Infectious Diseases
3. Cycle of infection
4. Incubation Period
5. Methods of Prevention and Control
6. Vaccination
7. Cycle of Infection: HIV/AIDS
8. Cycle of Infection: Meningitis
9. Conclusion
10. References
Intended Learning Outcomes (ILOs)
1. To understand the cycle of infection

2. Identify the importance and types of carriers
3. Understand the concept of incubation and period of communicability
4. To understand the diverse method of prevention and control of
infectious diseases
5. To understand the application of cycle f infections in diseases
including Meningitis and HIV/ AIDS
Infection and Infectious Disease
What is meant by Infection?
1. The entry, development and multiplication of-an infectious agent in

the body of human being or animal.
2. A complex process of interaction between the pathogen and human
body
3. Composed of 3 elements: pathogen, host and environment.
4. Infection is different from disease
5. INFECTION is a state of parasitism
6. But DISEASE is a manifestation or appearance of symptoms after
infection.
What is meant by Infectious Disease?

W.H.O Defines it as:
1. A disease of man or animal resulting from infection with a pathogen.

2. Caused by pathogenic microorganisms: bacteria, viruses, parasites or
fungi
3. Spread, directly or indirectly, from one person to another.
4. Communicable disease is caused by an infecting agent or its

product.
5. Transmitted directly or indirectly from the reservoir to a susceptible
host.
Infectious disease is Risky as it transmits from one person to other.

Cycle of Infection
1. Cycle of infection is the processes leading to patients acquiring

infection.
2. Understanding the cycle is essential to know how infection can
occur.
3. Measures to prevent and control infection are based on the
interruption of this cycle.
4. Cycle of Infection include: Agent, Reservoir, exit, inlet, mode of
transmission and susceptibility and resistance.
Cycle of Infection
Cycle of Infection: Infectious Agent
Pathogens include bacteria, viruses, funguses, rickettsiae, protozoa.
1. Bacteria: Includes Cocci (streptococci, staphylococci ,

diplococci),Bacilli (diphtheria, salmonella, shigella, etc),
Vibrio (cholera vibrio, El-Tor vibrio), Rickettsiae(Typhus group of
fevers)
2. Virus: Agents of Measles, small pox, mumps, poliomyelitis, infectious
hepatitis, etc
3. Fungi: Moulds and yeast that cause skin diseases.
4. Protozoa: Entamoeba causing dysentery
5. Parasites: Schistosoma, Taenia, Ancylostoma and Ascaris
Cycle of Infection: Infectious Agent
Cycle of Infection: How agents can cause infection?
Mainly due to their
1. Infectivity: ability of the viable organism to invade the host

causing infection.
2. Pathogenicity: ability to produce tissue reaction in the host.
3. Virulence: is the measure of the reaction produced. Certain strains-
of the agent possess higher, virulence than others.
4. Antigencity the ability to produce anti-bodies in the host.
5. Dose: the larger the dose or size of the agent,
the higher the chance for the agent to overcome host resistance.
Cycle of Infection: Reservoir
1. Definition: The reservoir of an infectious agent is the habitat in

which the agent normally lives, grows, and multiplies( CDC,2012)
2. The human body, animals and environment
3. Human: Patients, staff, visitors
4. Environment: Dust, Furniture, Sink, Water, toilet
5. Fomites or objects contaminated with infectious material that

contains the pathogens.
6. Animals: Cattle in bovine T.B, Goats in brucellosis, Dogs in rabies

and Rats in plague
Two types of Human reservoir: Cases or carriers.
1. Cases:
 Frank illness cases or with sub-clinical infection.
1. Carriers of infection:
 A person or animal that harbors the infectious organisms.
 But, free from clinical manifestation of the disease.

Classification of Carrier
Place of Carrier:
1. Upper respiratory: Treptococcal, staphylococcal, meningococcal and
diphtheria.
2. Fecal carrier: Typhoid and paratyphoid, cholera, amoebic cyst.
3. Urinary carrier: Typhoid, paratyphoid and brucellosis.
4. Skin carrier: Staphylococcal infection.
Duration of carriage:
5. Transient carrier: Few weeks/ days
6. Temporary: 6-12 Months
7. Chronic: More than one year
8. Permanent: Carrier for life(HIV)
Classification of Carrier
Spectrum of infection
1. Incubatory carriers: a carrier that harbor and excretes the infecting

organisms during the incubation period. Mumps, poliomyelitis and measles.
2. Contact carrier: Infects through contact-ship with an infected person as
doctors, nurses and parents. Cholera and typhoid.
3. Convalescent carrier: Shortly after recovery from a clinical attack.
Diphtheria, hepatitis B and Salmonella species.
4. Post-convalescent carrier(chronic): A person who remains to. serve as a
source of infection for long period after complete cure from the clinical
disease. Hepatitis B virus and S. typhi.
Cycle of Infection: Portal of Exit
 Portals of exit are required for microorganisms to be transmitted from

human sources.
1. Respiratory tract: Diphtheria, pneumonia, influenza .common cold,
whooping cough.
2. Intestinal tract: Typhoid, cholera, dysentery, and ascaris.
3. Urinary tract: Typhoid and paratyphoid fevers, undulant. fever,
bilharziasis.
4. Skin and mucous membrane: Erysipelas, septic wounds, conjunctivitis,
small pox, venereal diseases
5. Insect bite: Plague, malaria, Dengue fever etc.
6. Syringes and blood: Viral hepatitis B,C and AIDS.
7. Utero transmission or trans-placental : Syphilis, German measles and
mumps.
Cycle of Infection: Modes of Transmission
1. Direct Contact : Person to person, physical contact, or contact with body

secretions containing the pathogen.
2. Indirect Contact: From contaminated sources such as food, air, soil,
equipment, etc.
3. Droplet contact: From the Droplets coming from an infected person with
coughing, sneezing, laughing or even talking.
4. Tranplacental transmission: Carried from mothers to fetus through
placenta leading to congenital syphilis, German measles, ToRCHS+ HIV/
AIDS+ Congenital Varicella
5. Vehicle transmission: Vehicles-born infection could be by water, milk or
blood.
Cycle of Infection: Modes of Transmission
Cycle of Infection: Portal of Entry
Similar to portal of Exit. These are:
1. Respiratory tract: Influenza, common cold, whooping cough and most of

the respiratory diseases.
2. Gastro-intestinal tract by ingestion: Cholera, typhoid and paratyphoid

and most of the gastro-intestinal infections.
3. Urogenital tract: Venereal diseases.
4. Blood transfusion: Serum hepatitis.
5. Insect bites: Malaria (Insect-borne diseases).

Cycle of Infection: Susceptible Host
1. Susceptible host : Individual who can contract the disease, unless:

2. The host Risk factors affecting the occurrence of a disease are:
 Resistance,
 Genetic factors
 Social & habitual factors
 Physiological factors
 Age & Sex.

Risk Factors affecting disease transmission
Resistance
1. Resistance is the power of the body to -prevent the ding pathogen from
establishing itself.
2. Two Types of Resistance: Natural and Acquired
3. Natural Resistance does not depend on the presence of specific
antibodies for protection.
4. It Depends on natural process in the body like Intact skin and epithelial
surface of the mucous membrane, Tears, Urine etc.
5. Acquired Resistance is called Immunity
6. Acquired resistance can be naturally developed after exposure to a
disease and post-infection immunity. Eg: Small pox, Measles
7. Artificial immunity: Acquired by immunization.
Incubation
 Incubation period: Period between the invasion of the tissue by pathogens

and the appearance of the clinical characteristics of the infection
 The period of infectivity: Duration in which the patient is infectious to others,
 Short Incubation Periods
1. Bacillary dysentery: 1-7 days
2. Cholera: Hours-5 days ( 2-3 hours)
3. Diphtheria: 2-5 days
4. Gonorrhoea: 2-5 days
5. Scarlet fever: 1-3 days
Incubation Period
 Intermediate incubation periods
1. Chickenpox: 14-21 days
2. Measles: 7-14 days
3. Mumps: 12-21 days
4. Poliomyelitis: 3-21 days
5. Rubella: 14-21 days
 Long incubation periods

1. Brucellosis: Days-months
2. Hepatitis B: 6 weeks-6 months
3. Rabies: Variable
4. Tuberculosis: Months-years
Methods of Prevention and Control
Reduction in the reservoirs of infection will reduce the incidence

 Endogenous reservoirs can be reduced by
1. Chemoprophylaxis
2. Physical isolation of infected cases
3. Physical separation of animal sources from human hosts
4. Immediate treatment
 Blockage of transmission
1. Source isolation
2. Vector control
3. Careful infection control
Methods of Prevention and Control
 Avoid Exposure to Risk Factors
1. In STDs: Avoid illegal sex & use safe sex measures

2. In airborne disease: Avoid overcrowding
3. In orally transmitted disease: Avoid contaminated food
4. Practice adequate food hygiene.
Methods of Prevention and Control: Vaccination
Any immuno-biological product & pertinent procedure used in the active

immunization
1. Killed Vaccines: PV, typhoid & paratyphoid, hepatitis A, cholera, whooping

cough, plague & typhus, H1N1.
2. Live attenuated vaccines: MMR, Typhus, HINI Nasal spray vaccine,
Rabies, Yellow fever.
3. Variant forms of living organisms: Small Pox, BCG.
4. Immunization by inoculation of the products: Diphtheria
5. Conjugated Vaccine: Pneumococcal
6. Polysaccharides: Quadrivalent pneumococcal
7. Recombinant Vaccine: Hepatitis B
Vaccines: Ideal Features
1. Antigenic stable
2. Minimal side effects
3. Give immunity for a long period
4. Given at a reasonable cost and available
5. Its keeping quality is good
Cycle of Infection and Control in HIV
Cycle of Infection in Meningitis
Reservoir
Human body Spinal
code
Agent:
Portal of exit
Entrovirus &
Drainage of mucus
Meningococcal
through nasal cavity
bacteria
Transmission
Host
Respiratory droplets and
Young children nasal secretion
Portal of Entry
Upper Respiratory
track
Conclusion
Significance of infectious epidemiology
 To identify the causes of new, emerging infections, e.g. HIV, vCJD, SARS
 To conduct surveillence of infectious disease
 To identify source of outbreaks
 To understand the routes of transmission and natural history of infections
 To explore new interventions in control and prevention
References and Further Reading
ECDC, 2018. Public health risks related to communicable diseases during the 2018 Hajj,
Saudi Arabia. Stockhom: European Centre for Disease Control.
Hammer, C., Brainard, J. & Hunter, P., 2017. Risk factors and risk factor cascades for
communicable disease outbreaks in complex humanitarian emergencies: a qualitative
systematic review. BMJ Global Health, 3(4).
Laoraksawong, P., 2018. Impact of the health education and preventive equipment
package (HEPEP) on prevention of Strongyloides stercoralis infection among rural
communities in Northeast Thailand: a cluster randomized controlled trial. BMC Public
Health, 18(1184).
Long, S.S., Prober, C.G. & Fischer, M., 2018. Principles and Practice of Pediatric
Infectious Diseases. London: Elsevier.
Tyshenko, M., 2016. Chain of Infection. Ottava: University of Ottawa.
WHO, 2015. World Health Organization Best Practices for the Naming of New Human
Infectious Diseases. Geneva: World Health Organisation.
References and Further Reading
 http://www.pitt.edu/~super1/
 http://www.bmj.com/collections/epidem/
 http://www.medicalstudent.com
 http://www.acepidemiology.org

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King Abdulaziz University

General Principles of Communicable Disease

1. Intended Learning Outcomes

1. To understand the cycle of infection

1. The entry, development and multiplication of-an infectious agent in

What is meant by Infectious Disease?

1. A disease of man or animal resulting from infection with a pathogen.

4. Communicable disease is caused by an infecting agent or its

Infectious disease is Risky as it transmits from one person to other.

1. Cycle of infection is the processes leading to patients acquiring

Pathogens include bacteria, viruses, funguses, rickettsiae, protozoa.

1. Bacteria: Includes Cocci (streptococci, staphylococci ,

Mainly due to their

1. Infectivity: ability of the viable organism to invade the host

1. Definition: The reservoir of an infectious agent is the habitat in

2. The human body, animals and environment

3. Human: Patients, staff, visitors

4. Environment: Dust, Furniture, Sink, Water, toilet

5. Fomites or objects contaminated with infectious material that

6. Animals: Cattle in bovine T.B, Goats in brucellosis, Dogs in rabies

Two types of Human reservoir: Cases or carriers.

 Frank illness cases or with sub-clinical infection.

 A person or animal that harbors the infectious organisms.

 But, free from clinical manifestation of the disease.

1. Incubatory carriers: a carrier that harbor and excretes the infecting

 Portals of exit are required for microorganisms to be transmitted from

1. Direct Contact : Person to person, physical contact, or contact with body

Similar to portal of Exit. These are:

1. Respiratory tract: Influenza, common cold, whooping cough and most of

2. Gastro-intestinal tract by ingestion: Cholera, typhoid and paratyphoid

3. Urogenital tract: Venereal diseases.

4. Blood transfusion: Serum hepatitis.

5. Insect bites: Malaria (Insect-borne diseases).

1. Susceptible host : Individual who can contract the disease, unless:

 Social & habitual factors

 Age & Sex.

 Incubation period: Period between the invasion of the tissue by pathogens

 Long incubation periods

Reduction in the reservoirs of infection will reduce the incidence

 Avoid Exposure to Risk Factors

1. In STDs: Avoid illegal sex & use safe sex measures

Any immuno-biological product & pertinent procedure used in the active

1. Killed Vaccines: PV, typhoid & paratyphoid, hepatitis A, cholera, whooping

Significance of infectious epidemiology

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