TABLE OF CONTENTS TITLE

PAGES 2-4 5 10

INTRODUCTION DESCRIPTION OF DISEASES

RELATION OF THE MADEL TO THE DISEASES

11 - 16 17 18 - 19

CONCLUSION REFERNECES

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INTRODUCTION THE EPIDEMILOGICAL TRAID MODEL

This is a traditional model of infectious disease causation. The triad consists of an external agent; a host and an environment in which host and agent are brought together, causing the disease to occur in the host. A vector, an organism which transmits infection by conveying the pathogen from one host to another without causing disease itself, may be part of the infectious process. The triad model consists of three corners called vertices:

Agent or microbe that cause the disease ( the what of the triangle) Host or organism harbouring the disease ( the who of the triangle) Environment those external factors that cause or allow disease transmission ( the where of the triangle)

Illustrated below is a diagram showing their interrelations:

The AgentWhat

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The agent is the cause of the disease. When studying the epidemiology of most infectious diseases, the agent is a microbean organism too small to be seen with the naked eye. Disease-causing microbes are bacteria, virus, fungi, and protozoa (a type of parasite). They are what most people call germs. Bacteria: Bacteria are single-celled organisms. Bacteria have the tools to reproduce themselves, by themselves. They are larger than viruses (but still much too small to be seen with the naked eye). They are filled with fluid and may have threadlike structures to move themselves, like a tail. Virus: A virus may have a spiny outside layer, called the envelope. Viruses have a core of genetic material, but no way to reproduce it on their own. Viruses infect cells and take over their reproductive machinery to reproduce. Fungi: Fungi are like plants made up of many cells. They are not called plants because they cannot produce their own food from soil and water. Instead, they live off animals, including people, and plants. Mushrooms and yeast are fungi. Protozoa: Protozoa are very small. Most live in water. They are parasites, which mean they live off other organisms, in some cases humans. Malaria is a parasitic protozoan, as is Guardia. The HostWho

Hosts are organisms, usually humans or animals, which are exposed to and harbour a disease. The host can be the organism that gets sick, as well as any animal carrier (including insects and worms) that may or may not get sick. Although the host may or may not know it has the disease or have any outward signs of illness, the disease does take lodging from the host. The host heading also includes symptoms of the disease. Different people may have different reactions to the same agent.

The EnvironmentWhere

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The environment is the favourable surroundings and conditions external to the host that cause or allow the disease to be transmitted. Some diseases live best in dirty water. Others survive in human blood. Still others, like E. coli, thrive in warm temperatures but are killed by high heat. Other environment factors include the season of the year Time In the center of the Triangle is time. Most infectious diseases have an incubation periodthe time between when the host is infected and when disease symptoms occur. Or, time may describe the duration of the illness or the amount of time a person can be Sick before death or recovery occurs. Time also describes the period from an infection to the threshold of an epidemic for a population.

An outbreak or an epidemic exists when there are more cases of a particular disease than expected in a given area, or among a specific group of people, over a particular period of time. Another other term you might come across is endemic, when a population has a high level of the disease all the time. For example, giardiasis and even malaria are endemic in parts of the world.

DECRIPTION OF DISEASES CHOSEN

PERTUSSIS ( INFECTIOUS)
INFECTIOUS DISEASE
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An infectious disease is caused by a pathogen, such as a virus, bacteria or a fungus. This type of disease can be spread from one person to another or from one species to another. The infection can be spread through via air, bodily fluids, food, drink or by touch. PERTUSSIS Pertussis more commonly known as whooping cough is an infection of the upper respiratory tract which is caused by the bacterium Bordetella pertussis, which lives in the mouth, nose and throat. It is a highly contagious thus, making it an infectious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep whooping sound is often heard when the patient tries to take a breather. How is pertussis spread? When an infected person sneezes or coughs tiny droplets containing the bacteria move through the air and the disease is easily spread from person to person. A person may even catch pertussis by standing close (less than 3 feet away) to an infected person who is coughing or sneezing. Infection usually lasts six weeks. An infected person is contagious from just before onset of symptoms until up to three weeks after symptoms start. Treatment with appropriate antibiotics shortens the contagious period to about five days.

Who is susceptible to contracting pertussis? Despite the effectiveness of vaccination, pertussis continues to occur among all age groups. Anyone who has not had pertussis previously or who has not received the pertussis vaccine can get the disease. Immunity following disease or vaccination is not lifelong. Older children, adolescents and adults can become susceptible to pertussis five-to 10-years after their last dose of pertussis-

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containing vaccine. Older children and adults can carry the germ and spread it even though their cold-like symptoms may be so mild they might not seek medical care. Symptoms of Pertussis Symptoms usually appear five-to 10-days after exposure, but can take as long as 21 days. The first symptoms are similar to those of a common cold - a runny nose, sneezing, low-grade fever and a mild, occasional cough. The cough gradually becomes severe and, after one to two weeks, the patient has spasmodic bursts of numerous, rapid coughs. The characteristic high-pitched "whoop," which is more common in children, comes from breathing in after a coughing episode. During such an attack, the patient may turn blue, vomit and become exhausted. Between coughing attacks, the patient usually appears normal. Coughing attacks occur more frequently at night. The attacks increase in frequency for a couple of weeks, remain at the same level for two-to three-weeks, and then gradually decrease. Coughing may last as long as 100 days. Cough medicines usually do not help eliminate this cough. Recovery is gradual, but coughing episodes can recur for months after the onset of pertussis. How is pertussis treated? Pertussis is usually treated with a multi-day course of appropriate antibiotics, such as azythromycin, erythromycin or clarithromycin, or an acceptable alternative. Some children may need to be hospitalized. People in close contact with children or adults with pertussis usually need to be treated with antibiotics and efforts should be taken to minimize an infants exposure to children and adults with cough illnesses.

Atherosclerosis ( NON INFECTIOUS)

What is Atherosclerosis

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Also known as hardening of the arteries, atherosclerosis is a condition that results from the slow build up of plaque on the inside walls of the arteries. As the plaque builds up, it can cause serious health problems, such as heart attack, angina, and sudden death. A person's particular symptoms will depend on which part of the body is not receiving enough blood and oxygen due to the narrowing of arteries. These symptoms take some time to develop, as the disease must progress to the point where an artery is severely narrowed or completely blocked.

Risk Factors That Can Lead to Atherosclerosis

There are certain risk factors that contribute to the development of atherosclerosis. These risk factors are commonly categorized as the following:

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Being male If female, being past menopause High blood pressure High LDL ("bad") cholesterol or triglycerides (fats in the blood) Diabetes Being overweight Smoking A family history of heart disease Elevated homocysteine levels Sedentary lifestyle Diets high in saturated fat and trans fatty acids (trans fats) Depression Obstructive sleep apnoea

Signs and Symptoms

chest pain or chest discomfort (angina) Pain in one or both arms, the left shoulder, neck, jaw, or back

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Shortness of breath Dizziness Faster heartbeats Nausea (feeling sick to your stomach) Abnormal heartbeats Feeling very tired.

Effects of Atherosclerosis

The effects of atherosclerosis differ depending upon which arteries in the body narrow and become clogged with plaque. If the arteries that bring oxygen-rich blood to your heart are affected, you may have coronary artery disease, chest pain, or a heart attack. If the arteries to your brain are affected, you may have a transient ischemic attack (TIA) or a stroke. If the arteries in your arms or legs are affected, you may develop peripheral artery disease. You may also develop a bulge in the artery wall (aneurysm).

Causes

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The formation of plaque referred to as Atherosclerosis may be caused by cholesterol fats, nicotine, high blood pressure or abnormal sugar content in the blood. You become more susceptible to the disease as you grow old or if the disease runs in your family. Obesity and emotional stress also invite the disease.

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RELATION OF THE EPIDEMIOLOGICAL MODEL TO THE DISEASES CHOSEN

Pertussis
Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep "whooping" sound is often heard when the patient tries to take a breath. Pertussis, or whooping cough, is an upper respiratory infection caused by the Bordetella pertussis or Bordetella parapertussis bacteria. It is a serious disease that can cause permanent disability in infants, and even death.

Agent
Bordetella pertussis is the causative agent of the disease pertussis (Whooping cough). Bordetella pertussis is small gram-negative coccobacillus that is non-motile and pathogenic only to humans (Hoppe 1999). The bacteria are observed in culture as single or paired entities which grow slowly and fastidiously (Todar 2004).

Pertussis has a number of different stages. The first stage is the catarrhal or colonization phase. Here, symptoms resemble a cold or an upper respiratory infection, but remain relatively nonspecific. Over the first ten days of infection, coughing, fever, and malaise may be observed (Todar 2004). The toxemic, or paroxysmal, stage is characterized by severe, prolonged coughing. This coughing is accompanied by the aspiratory whoop at this stage (Todar 2004, Wood and

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Friedman 1998). The final, convalescent phase is marked by reduction in attacks of severe coughing over three to four weeks (Wood and Friedman 1998).

Bordetella pertussis can only live independently inside a human host. It infects the upper airway (the throat and nose), as well as the lungs (Jenkinson 2005). Thus, the life cycle of the bacteria must occur within these structures. the bacteria depend upon a high rate of transmission to continue survival. Transmission of the bacteria is via airborne droplets produced by coughing (Bjornstad and Harvill 2005).

Like other bacteria, B. pertussis can divide by binary fission. The growth of a population of these bacteria is slow in culture. Many of the disease pathologies linked to B. pertussis are a result of its many secreted toxins and adherence factors.

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Tozzi et al. 2005

The original organisms die, are killed by an immune response or an antibiotic, or are transmitted to another human, where they will colonize the airways, produce toxin and adhesions, and transmit again.

Host

The bacteria that are shed from the discharges from the nose and throat are spread to others through coughing and sneezing. The bacteria enter the air and can be inhaled by people nearby. An infected person is contagious from just before onset of symptoms until up to three weeks after symptoms start. Whooping cough spreads easily through families, childcare centers and at school.

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Adults are the main transmitter of these bacteria because the symptoms of the illness are usually milder than in children. The characteristic whoop that occurs after paroxysmal bouts of coughing is recognized in only 20%-40% of adults with whooping cough thus making it easy for an infected adult to transmit the bacteria to a child Infected adults are a reservoir (source) of infection for children.

Environment
Any community is a potential place for Pertussis to spread quickly. Because it survives in the human body it can survive anywhere there is humans. Family members are the number 1 transmitter of these bacteria. Child care centers and health facilities are the other transmitters of this disease.

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Arteriosclerosis
Non-infectious diseases to which the disease atherosclerosis belongs are usually caused by multiple agents who are nonliving. Non infectious disease usually develops over time and the end result is often a chronic disease for which you can develop no immunity. Atherosclerosis, as described earlier, is a non-infectious disease resulting from nutritional and lifestyle choices. When being classified according to epidemiology, atherosclerosis is termed the agent. The agent is an element that under a particular condition can initiate a health problem and can be physical, chemical, psychological, and biological or nutrient based. In the case of atherosclerosis, the agent, the disease is perpetuated by an excess of fats in the diet and lack of physical activity. Atherosclerosis is fuelled when a person consumes foods that are high in saturated fats, which in turn causes a build-up of plaque in the arteries. The host is a living organism capable of being infected or affected by an agent. The host reaction is influenced by family history, age, and health habits (Taylor, Lillis, LeMone, Lynn, 69). Atherosclerosis is mainly based on health habits even though genetics may have some part to play in the acquisition of the disease. Genetically an individual may be susceptible to the disease but if that individual monitors their eating habits, the incidence of the disease can be curbed. For example, Shanices mother and grandmother both developed atherosclerosis and died from complications associated with the disease. Shanice, fearful that she may suffer the same fate, monitored her diet eating less fatty and fried foods and more of her raw fruits and vegetables. Along with this healthy diet she also exercised reducing the likelihood that she becomes affected by atherosclerosis. The environment includes all the factors that are external to the host and make the illness more or less likely to occur (Taylor, Lillis, LeMone, Lynn, 69). Social factors heavily influence the risk of
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developing atherosclerosis. In todays world where people tend to socialize with their peers, individuals involve themselves in dining out a lot. Dining out often ends up with a person making an unhealthy food choice. Another influencing social factor is having a job to which you must arrive at a particular time. Struggling to get to work on time, individuals tend to reach for foods that are high in fat. For example, a typical on-the-go breakfast for an American would be a bacon, egg and cheese bagel with coffee. Here in Trinidad, you see the early morning vendors out with their doubles, potato pies and whatever else they can stuff into the deep fried dough and a long line of hungry patrons waiting to sink their teeth into greasy heaven. Agent, host and Environment all interact together to affect a person with atherosclerosis.

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Conclusion

With the growth of vast populations of people across many continents, identifying causal factors leading to illness and disease within target groups has become a difficult undertaking. The accuracy and quality of research findings are only as good as the methods used. The cause-effect model of study used uncovers risk factors and probable points of origin; however, final conclusions can only be based on what is inferred from the data. Diseases shown to have multiple risk factors are more difficult to track and assess within a target population, especially if no cause for the disease is known. Seemingly insignificant risk factors that show a low incidence of occurrence may play a larger part in the cause-effect process than what can be observed from the data. As modern day illnesses and diseases become more contagious and resistant to cures, the methods of epidemiology and its use within the public sectors will need to accommodate a more global approach in its work.

References

Braman SS. Postinfectious cough: ACCP evidence-based clinical practice

guidelines. Chest. 2006; 129(1):138S-146S.

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US Food and Drug Administration. First Combination Vaccine Approved to

Help Protect Adolescents Against Whooping Cough. Rockville, MD: National Press Office; May 3, 2005. Talk Paper T05-17.

Cohn AC, et al. Immunizations in the United States: a rite of passage.Pediatr

Clin North Am.2005; 52(3):669-693.

Module05-Epi-Part2. (n.d.). https://njlmn.rutgers.edu/cdr/docs/. Retrieved April 21, 2012, from https://njlmn.rutgers.edu/cdr/docs/Module05-Epi-Part2.pdf

What is epidemiological triad? | ChaCha. (n.d.). Questions & Answers | ChaCha. Retrieved April 21, 2012, from http://www.chacha.com/question/what-is-epidemiological-triad What is epidemiology. (n.d.). The Q&A wiki. Retrieved April 21, 2012, from http://wiki.answers.com/Q/What_is_an_epidemiology_.

Suzanne C. Smeltzer and others, Brunner & Suddarths Textbook of medical surgical nursing 11th edition. Lippincott Williams and Wilkins, Philadelphia, 2008.

Arteriosclerosis and Atherosclerosis General Overview! retrieved on 20/4/12. http://nomore-heart-disease.com/arteriosclerosis-and-atherosclerosis-%E2%80%93-generaloverview

Signs and symptoms of Arteriosclerosis. Retrieved on 20/04/12. http://arteriosclerosis.org/ http://no-more-heart-disease.com/arteriosclerosis-and-atherosclerosis-%E2%80%93general-overview/

Taylor, C., Lillis, C., LeMone, P., Lynn, P. (2005). Fundamentals of Nursing: The Art and Science of Nursing Care.6e, 69.

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