DYNAMICS OF DISEASE

TRANSMISSION
Dr. Rajalekshmy.P.R
Dept of Swasthavritta
AVC, CBE
 DISEASE TRANSMISSION
O Communicable diseases are transmitted from the reservoir/
source of infection to susceptible host.
O There are three links in the chain of transmission
O 1. Reservoir
O 2. Mode of transmission
O 3. Susceptible host
 CHAIN OF TRANSMISSION

SOURCE MODE OF SUSCEPTIBL

OR TRANSMISSI E
RESERVOIR ON HOST
 Sources and reservoir
O The source of infection is defined as "the person,
animal, object or substance from which an infectious
agent passes or is disseminated to the host“.
O A reservoir is defined as "any person, animal,
arthropod, plant, soil or substance {or combination of
these) in which an infectious agent lives and
multiplies, on which it depends primarily for survival,
and where it reproduces itself in such manner that it
can be transmitted to a susceptible host“.
O For example, in hookworm infection, the reservoir is
man, but the source of infection is the soil
contaminated with infective larvae.
O In tetanus; the reservoir and source are the same,
that is soil.
O In typhoid fever, the reservoir of infection may be a
case or carrier, but the source of infection may be
faeces or urine of patients or contaminated food,
milk or water.
 CASE
O 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"
 CLINICAL CASE
O The clinical illness may be mild or moderate,
typical or atypical, severe or fatal depending
upon the gradient of involvement.
O Epidemiologically, mild cases may be more
important sources of infection than severe cases
because they are ambulant and spread the
infection wherever they go, whereas severe cases
are usually confined to bed.
 SUBCLINICAL CASE
O The subclinical cases are variously referred to as
inapparent, covert, missed or abortive cases.
O They are equally important as sources of infection. The
disease agent may multiply in the host but does not
manifest itself by signs and symptoms.
O Subclinical cases play a dominant role in maintaining
the chain of infection (endemicity) in the community.
O Subclinical infection can be detected only by laboratory
tests, e.g., recovery of the organism, antibody response,
biochemical and skin sensitivity tests.
 LATENT INFECTION
O In latent infection, the host does not shed the
infectious agent which lies dormant within the
host without symptoms (and often without
demonstrable presence in blood, tissues or
bodily secretions of the host).
 "An infected person or animal that harbours a
specific Infectious agent in the absence of
discernible clinical disease and serves as a potential
source of infection for others" .
 TYPES
A. Type B. Duration
(a) lncubatory (a) Temporary
(b) Convalescent (b) Chronic
(c) Healthy
C. Portal of exit
(a) Urinary
(b) Intestinal
(c) Respiratory
(d) Others
INCUBATORY CARRIERS
O Incubatory carriers are those who shed the
infectious agent during the incubation period
of disease.
O That is, they are capable of infecting others
before the onset of illness.
O This usually occurs during the last few days of
the incubation period,
O e.g., measles, mumps, polio, pertussis,
influenza, diphtheria and hepatitis B.
 DIRECT
CONTACT
 Contact with soil
O The disease agent may be acquired by direct
exposure of susceptible tissue to the disease
agent in soil, compost or decaying vegetable
matter in which it normally leads a
saprophytic existence e.g., hookworm larvae,
tetanus, mycosis etc.
Inoculation into skin or mucosa

O The disease agent may be inoculated directly

into the skin or mucosa e.g., rabies virus by
dog bite, hepatitis B virus through
contaminated needles and syringes etc.,
 Transplacental (or vertical)
transmission
O Disease agents can be transmitted
transplacentally .
O Examples include the so-called TORCH
agents (Toxoplasma gondii, rubella virus,
cytomegalovirus and herpes virus), varicella
virus, syphilis, hepatitis B and AIDS.
Vehicle-borne transmission
O Vehicle-borne transmission implies
transmission of the infectious agent through
the agency of water, food (including raw
vegetables, fruits, milk and milk products),
ice, blood, serum, plasma or other biological
products such as tissues and organs.
O The epidemiological features of vehicle transmission
are :
O If the dose of contamination is heavy, the outbreak
may be explosive as in the case of cholera and hepatitis
A epidemics
O cases are initially confined to those who are exposed to
the contaminated vehicle, in some infections
O the distance travelled by the infectious agent may be
great, e.g., outbreaks of food poisoning
O when the vehicle is controlled or withdrawn, the
epidemic subsides, e.g., epidemics of cholera.
 Vector-borne Transmission

O Vector is defined as an arthropod or any living

carrier (e.g., snail) that transports an infectious
agent to a susceptible individual.
O Transmission by a vector may be mechanical
or biological.
O In biological - the disease agent passes
through a developmental cycle or
multiplication in the vector.
O (a) Mechanical transmission : The infectious agent
is mechanically transported by a crawling or
flying arthropod through soiling of its feet or
proboscis; or by passage of organisms through its
gastrointestinal tract and passively excreted.
O There is no development or multiplication of the
infectious agent on or within the vector.
O (b) Biological transmission : The infectious agent
undergoing replication or development or both in
vector and requires an incubation period before
vector can transmit.
 Airborne Transmission

O (1) Droplet nuclei : "Droplet nuclei" are a type

of particles implicated in the spread of
airborne infection.
O They are tiny particles (1-10 microns range)
that represent the dried residue of droplets.
O (2) Dust : Some of the larger droplets which
are expelled during talking, coughing or
sneezing, settle down by their sheer weight on
the floor, carpets, furniture, clothes, bedding,
linen and other objects in the immediate
environment and become part of the dust.
 Fomite-borne Transmission
O Fomites (singular; fomes) are inanimate articles or substances
other than water or food contaminated by the infectious
discharges from a patient and capable of harbouring and
transferring the infectious agent to a healthy person.
O Fomites include soiled clothes, towels, linen, handkerchiefs,
cups, spoons, pencils, books, toys, drinking glasses, door
handles, taps, lavatory chains, syringes, instruments and
surgical dressings.
O The fomites play an important role in indirect infection.
O Diseases transmitted by fomites include diphtheria, typhoid
fever, bacillary dysentery, hepatitis A, eye and skin infections.
 Unclean hands and fingers
O Hands are the most common medium by which
pathogenic agents are transferred to food from the
skin, nose, bowel, etc as well as from other foods.
O The transmission takes place both directly (hand-to-
mouth) and indirectly.
O Examples include staphylococcal and streptococcal
infections, typhoid fever, dysentery, hepatitis A and
intestinal parasites.
O Unclean hands and fingers imply lack of personal
hygiene.
 INCUBATION PERIOD
O The time interval between invasion by an
infectious agent and appearance of the first
sign or symptom of the disease in question.
O During the incubation period, the infectious
agent undergoes multiplication in the host.