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HEALTHCARE EPIDEMIOLOGY

ASSIGNMENT # 1
Prepared By: Yamna Hasan (20154) Submitted To: Dr. Aftab Ali Mukhi

1. Vectors:
A vector is an organism that does not cause disease itself but which spreads infection by
conveying pathogens from one host to another.

Examples of Vectors and Vector-borne diseases:

 Species of mosquito, for example, serve as vectors for the deadly disease Malaria.

 In gene therapy, a virus itself may serve as a vector, if it has been re-engineered and is used
to deliver a gene to its target cell. A "vector" in this sense is a vehicle for delivering genetic
material such as DNA to a cell.

 Chikungunya and Dengue and Zika viruses are transmitted to people by mosquitoes;
specifically the Aedes aegypti and Aedes albopictus mosquitoes.

 Lyme Disease (LD) is caused by the bacterium Borrelia burgdorferi, and is transmitted to
humans by the bite of an infected western blacklegged tick (Ixodes pacificus)

 Plague, also referred to as bubonic plague, is a disease caused by the bacteria Yersinia pestis,
which is spread by fleas and rodents to human beings.

 Rocky Mountain Spotted Fever (RMSF) and Spotted Fever group (SPG) are diseases caused
by Rickettsia rickettsii bacteria that are transmitted to people through the bite of an infected
tick.
2. Diseases Classification:

Subclinical Diseases Persistent (Chronic) Diseases

An illness that is staying below the surface of Persistent infections are characterized as
clinical detection. those in which the virus is not cleared but
remains in specific cells of infected
Examples: individuals. Persistent infections may
involve stages of both silent and productive
 Chlamydia (STD)
infection without rapidly killing or even
 Diabetes producing excessive damage of the host
cells.
 Hypothyroidism
Examples:
 Hyperthyroidism
 HIV Virus
 Systemic Lupus Erythmatosis
 Herpes Simplex Virus Types 1 and
2

 Measles Virus

 Hepatitis B Virus

 Human Papilloma viruses

 Human T-Cell Leukemia Viruses

 Human Cytomegalovirus

3. The Sufficient-Component Cause Model:


In 1976 Ken Rothman, who is a member of the epidemiology faculty at BUSPH, proposed a
conceptual model of causation known as the "sufficient-component cause model" in an attempt
to provide a practical view of causation which also had a sound theoretical basis.

Rothman recognized that disease outcomes have multiple contributing determinants that may act
together to produce a given instance of disease. For example, exposure to someone who has TB
does not necessarily result in the occurrence of TB. Moreover, the set of determinants that
produce TB in one individual may not be the same set of conditions that were responsible for the
occurrence of TB in others.

Rothman defined a sufficient cause as "...a complete causal mechanism" that "inevitably
produces disease." Consequently, a "sufficient cause" is not a single factor, but a minimum set of
factors and circumstances that, if present in a given individual, will produce the disease.
Aschengrau and Seage use the example of causation of AIDS. A sufficient cause for AIDS might
consist of the following components:

 exposure to an individual with HIV

 repeatedly engaging in risky sexual behavior with that individual

 absence of antiretroviral drugs that reduce viral load of HIV

The pie chart below might be used to represent the sufficient cause model for this scenario.

The model suggests that the presence of these three component causes is sufficient to produce
AIDS in this individual. Note further if any one of these components were absent, AIDS would
not occur. Hence, Rothman's assertion that a cause is an event, condition, or characteristic
without which the disease would not have occurred.

Features of the Sufficient-Component Cause Model

Aschengrau and Seage point out some of the key features of the sufficient-component cause
model:

i. A cause is not a single component, but a minimal set of conditions or events that inevitably
produces the outcome.

ii. Each component in a sufficient cause is called a component cause, and epidemiologists tend
to refer to the components as "causes" because the outcome will not occur by that pathway if
any one of the components is missing (or prevented) within a given sufficient cause model.
Consequently, it is not necessary to identify all of the component causes in order to prevent
the disease outcome.

iii. There may be a number of sufficient causes for a given disease or outcome.

iv. A component cause that must be present in every sufficient cause of a given outcome is
referred to as a necessary cause. For example, HIV exposure is necessary for AIDS to occur,
and TB exposure is necessary for TB infection to occur.

v. The completion of a sufficient cause is synonymous with the biologic occurrence of the
outcome, e.g., the transition to a malignant cancer within a single cell marks the biologic
onset of the cancer.

vi. The components of a sufficient cause do not need to act simultaneously; they can act at
different times. For example, a mutation in a proto-oncogene in a prostate cell may promote
cell replication at one point in time, and it may be some time later when another mutation
diminishes the function of an anti-oncogene in the same cell. Thus, each component cause
may have a different induction period (the interval between the exposure's presence and
disease onset). In contrast, the latent period is the interval between disease onset and the
clinical detection of disease, either by screening or as a result of symptoms and diagnostic
work up. In the context of screening tests the latent period is referred to as the "detectable
pre-clinical phase." In the context of infectious disease, it is the time between initial infection
and the first appearance of symptoms.

4. Great Smog of London:


In the Great Smog of 1952, the city of London was brought to a standstill by a dense blanket of
toxic smog that reduced visibility to a few feet. For five cold December days, started from
December 5 to 9, 1952, a heavy fog combined with sulfurous fumes from coal fires, vehicle
exhaust and power plants, blocking out the sun and creating a public health disaster. The "Big
Smoke" was the worst air pollution crisis in European history, killing an estimated 8,000 to
12,000 people.

The Great Smog of 1952 was much more than a nuisance. It was lethal, particularly for the
elderly, young children and those with respiratory problems. Heavy smokers were especially
vulnerable because of their already-impaired lungs, and smoking was common at the time,
especially among men. Deaths from bronchitis and pneumonia increased more than sevenfold.
The death rate in London’s East End increased ninefold.