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Lecture notes Containment Strategies of Infectious Diseases
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This document contains effects of the Containment Strategies lectures. Immunology self-study is not included, except for 2 types of vaccines.
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Lecture 1: Introduction and Assignment theory Isolation is based on the knowledge that you have the disease.
Quarantine is based on the expectation that you have the disease.
Eradication = the disease is completely gone.
Eliminate = disease got ridden off in certain areas.
Memorize the characteristics that are related to control. Incubation times e.g. are important to know
to design control strategies.
Policy brief: 2000 words + 3 min. video -> designing an intervention strategy in a certain area. The
context is important. Don’t study Ebola in Amsterdam for example.
Evidence Informed Decision Making:
Evidence matters:
o Related to the agent, its causes, and the effectiveness of the solutions
Context matters:
o What contextual issues contribute to the problem?
o What works where for whom?
Theory on designing an intervention
What is the problem? And what causes the problem?
How many people have it? What kind of people have it?
Understanding the size of the problem
Precede/proceed model (insert image):
Behavioral and Environmental assessment: Analysis of behavior -> What causes behavior like
not using a condom for example.
Evaluation of the intervention can be done on behavior or health (with lung cancer for
example it’s better to observe change in behavior (quit smoking) than health (less people
with lung cancer)).
Understanding behavior = knowing what to change.
Steps in health intervention (combination of models):
1. What is the problem? (Does it have priority?)
o Burden of disease + potential burden:
i. Different measures:
1. Mortality/morbidity
2. Incidence/prevalence
3. Quantitative estimates developed by World Bank and WHO
4. Global burden of disease
o For whom is it a problem? Children or minorities?
2. What factors cause the problem (the disease)? = Identifying causes
o Tools to identify causes:
i. Epidemiological triangle:
, 1. The agent: can be a pathogen, but also toxins, stressful events,
shortages of certain nutrients or a combination of events. When
thinking about the agent as a cause, think about transmission and
virulence for example.
2. The host must be considered from several aspects. It can be the
target of disease, but also a contributing cause and perpetuator
(doorzetter). Certain hosts are biologically or behaviorally more
susceptible to an agent. Think of certain risk behaviors.
3. Environment: Certain environmental factors can be favorable to the
onset of the disease. Socio-economic, physical and ideological factors
(ideas towards vaccinations).
a. Epi-triangles are used to identify the cause of the disease
(interaction between agent, host and environment) and
b. understand how we can intervene. Disease rates could be
reduced by appropriate changes in one or more of the three
triangle components.
ii. Problem Tree: to understand the relationship between the underlying causes
of the occurrence of the infectious disease.
o Literature/common sense
3. How can these factors be changed?
o Basic strategies:
i. Remove the agent
ii. Raise host resistance
iii. Modify environment
iv. Separate agent from host
v. Interrupt transmission
o Use epidemiological triangle as mind-map specific for the situation (what is the
causative agent and transmission, which hosts are susceptible, what is the favorable
environment). Relate to where the strategies intervene in the problem tree.
4. What overall intervention strategies are most appropriate and cost effective? (What do
people want and need?)
o Out of a list of interventions you have to select the right ones.
o Comparison of different interventions.
o How effective is the intervention? Criteria to compare different interventions:
i. Medical-technical effectiveness: extent to which the intervention controls
disease.
ii. Organization feasibility: does the intervention fit in with existing services?
iii. Social, cultural and political feasibility: acceptability of intervention to
community and leader.
iv. Financial feasibility: costs for personnel and materials.
o You have to decide which criteria weigh the most.
5. What needs to be done to reach the goals?
Neglected tropical diseases (NTDs) are diseases that are not investigated enough in. Not enough
money can be made from it.
Primary prevention: preventing people from getting sick.
Secondary prevention: early detection, screening (breast cancer).
,Tertiary prevention: preventing further disability.
Policy brief
It serves to bridge the gap between researchers and policy makers.
What is it?
o Evidence-based policy briefs bring together global research evidence and local
evidence to inform deliberations about health policies and programs.
o They begin with a description of a policy problem, then summarize the best available
evidence to clarify the size and nature of the problem. Then, describe the impacts of
options for addressing the problem. They also inform considerations about potential
barriers to implementing the options, but also strategies for addressing these
barriers.
o Present a problem, its context and the recommended action.
The purpose:
o Advocacy: to convince people action is needed.
o Neutral: to inform on options.
A good policy brief should:
o Provide enough background for the reader to understand the problem.
o Convince the reader that the problem must be addressed urgently.
o Provide information about alternatives (an objective brief).
o Provide evidence to support one alternative (an advocacy brief).
o Stimulate the reader to make a decision.
The audience:
o What do they already know?
o What is their organizational culture and capacity to change?
o Are they open to change?
o Who else do they influence?
Main elements:
o Title:
Less than 12 words.
Catchy: it should grab the reader’s attention. Try to include relevant key
words.
o Key messages (in a box):
Focus on the recommendations and the problem.
Not more than five.
At the start or the end.
o Introduction:
Grab the reader’s attention.
Introduces the topic.
It tells the reader why he/she should do something about the problem.
It provides evidence on the size of the problem and its causes.
o Policy implications:
What are the policy options?
What are the effects of the options? How will the policy changes improve the
situation? Give examples.
, Advantages and disadvantages of each policy option.
Issues for implementation.
Weigh the policy options against each other using the criteria described
under bullet point 4 above.
o Recommendations:
Serves to facilitate policy making.
o Authors (at the top), acknowledgements and references (as appendix).
Lecture 3: Control of Infectious Diseases - Basic
principles
Weber, H3 + 4
Infection: When a microorganism is present in a host, in places where it is not normally found
(replicating).
Bacteria: Viruses: Protozoa:
Cholera HIV Malaria
TB HPV Giardia
E. coli Hepatitis
Transmission
A Vector borne diseases is usually used for diseases that need a biological vector (such as malaria) ->
The mosquito is necessary for transmission.
Direct: Indirect: Exposure:
Skin-Skin (Herpes) Food-borne (salmonella) A relevant contact
Blood/mucous-mucous (STI) Water-borne (Hep. A)
Across placenta (toxoplasmosis) Vector-borne (malaria)
Through breast milk (HIV) Air-borne (chickenpox)
Sneeze-cough (influenza)
Spread of infections
Epidemiology:
Identification (many people dying) -> setting up a case definition (typical symptoms)
Disease etiology (causes) = outbreak investigation
o Common event shared by all cases.
o What are the exceptions?
o Changes that have occurred in the environment.
o Hypothesis of cause, route of transmission and method of control.
Interruption of transmission (often emergency methods, which are non-specific)
Reporting to authorities (book -> the essential steps of control)
Disease screening/surveillance (monitoring infectious diseases)
Comparisons of treatment and effect
What can happen when you are exposed to an agent?:
1. No infection (nothing happens)
2. Clinical (having symptoms)
3. Sub-clinical (no symptoms)
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