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Epidemics

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Epidemics

For other uses, see Epidemic (disambiguation).

In epidemiology, an epidemic (from επί (epi), meaning "upon or above" and δήμος (demos), meaning "people") occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience.[1]:354[2] Epidemiologists often consider the term outbreak to be synonymous to epidemic, but the general public typically perceives outbreaks to be more local and less serious than epidemics.[1]:55, 354[2]

Epidemics of infectious disease are generally caused by a change in the ecology of the host population (e.g. increased stress or increase in the density of a vector species), a genetic change in the parasite population or the introduction of a new parasite to a host population (by movement of parasites or hosts). Generally, an epidemic occurs when host immunity to a parasite population is suddenly reduced below that found in the endemic equilibrium and the transmission threshold is exceeded.[3]

An epidemic may be restricted to one location; however, if it spreads to other countries or continents and affects a substantial number of people, it may be termed a pandemic.[1]:55 The declaration of an epidemic usually requires a good understanding of a baseline rate of incidence; epidemics for certain diseases, such as influenza, are defined as reaching some defined increase in incidence above this baseline.[2] A few cases of a very rare disease may be classified as an epidemic, while many cases of a common disease

Causes

There are several changes that may occur in an infectious agent that may trigger an epidemic these include:[1]:55

  • Increased virulence
  • Introduction into a novel setting
  • Changes in host susceptibility to the infectious agent

An epidemic disease is not required to be contagious,[2][4] and the term has been applied to West Nile fever[2] and the obesity epidemic, among others.[4]

The conditions which govern the outbreak of epidemics include infected food supplies such as contaminated drinking water and the migration of populations of certain animals, such as rats or mosquitoes, which can act as disease vectors. Certain epidemics occur at certain seasons: for example, whooping-cough occurs in spring, whereas measles produces two epidemics, one in winter and one in March. Influenza, the common cold, and other infections of the upper respiratory tract, such as sore throat, occur predominantly in the winter. There is another variation, both as regards the number of persons affected and the number who die in successive epidemics: the severity of successive epidemics rises and falls over periods of five or ten years.[5]

Types

Common source outbreak

In a common source outbreak, the affected individuals had an exposure to a common agent. If the exposure is singular and all of the affected individuals develop the disease over a single exposure and incubation course, it can be termed a point source outbreak. If the exposure was continuous or variable, it can be termed a continuous outbreak or intermittent outbreak, respectively.[1]:56

Propagated outbreak

In a propagated outbreak, the disease spreads person-to-person. Affected individuals may become independent reservoirs leading to further exposures.[1]:56

Many epidemics will have characteristics of both common source and propagated outbreaks. For example, secondary person-to-person spread may occur after a common source exposure or an environmental vectors may spread a zoonotic diseases agent.[1]:56–58

Transmission

  • Airborne transmission: Airborne transmission is the spread of infection by droplet nuclei or dust in the air. Without the intervention of winds or drafts the distance over which airborne infection takes place is short, say 10 to 20 feet.
  • Arthropod transmission: Arthropod transmission takes place by an insect, either mechanically through a contaminated proboscis or feet, or biologically when there is growth or replication of an organism in the arthropod.
  • Biological transmission: Involving a biological process, e.g. passing a stage of development of the infecting agent in an intermediate host. Opposite to mechanical transmission.
  • Colostral transmission: A form of vertical transmission via successive generations.
  • Contact transmission: The disease agent is transferred directly by biting, sucking, chewing or indirectly by inhalation of droplets, drinking of contaminated water, traveling in contaminated vehicles.
  • Cyclopropagative transmission: The agent undergoes both development and multiplication in the transmitting vehicle.
  • Developmental transmission: The agent undergoes some development in the transmission vehicle.
  • Fecal-oral transmission: The infectious agent is shed by the infected host in feces and acquired by the susceptible host through ingestion of contamined material.
  • Horizontal transmission: Lateral spread to others in the same group and at the same time; spread to contemporaries.
  • Mechanical transmission: The transmitter is not infected in that tissues are not invaded and the agent does not multiply.
  • Propagative transmission: The agent multiplies in the transmission vehicle.
  • Vertical transmission: From one generation to the next, perhaps transovarially or by intrauterine infection of the fetus. Some retroviruses are transmitted in the germ line, i.e. their genetic material is integrated into the DNA of either the ovum or sperm.

[6]

Etymology

The term epidemic derives from a term first attributed to Homer's Odyssey, which later took its medical meaning from a treatise by Hippocrates, Epidemics.[4] Prior to Hippocrates, epidemios, epidemeo, epidamos and other variants had meanings similar to the current definitions of "indigenous" or "endemic".[4] Thucydides's description of the Plague of Athens is considered one of the earliest accounts of a disease epidemic.[4] By the very early 17th century, the terms endemic and epidemic were considered as contrasting conditions of diseases, with the endemic condition at low levels and epidemic condition widespread. [7]

See also

Organizations:

Notes

External links

  • European Centre for Disease Prevention and Control
  • International Epidemiological Association (IEA)
  • A Dictionary of Epidemiology (IEA)
  • People's Epidemiology Library
  • Video Discussion of the Prostate Cancer Epidemic
  • Monash Virtual Laboratory - Simulations of epidemic spread across a landscape
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