Lectures Containment Strategies:
Lecture 1: Introduction (1 sept)
Multiple outbreaks and diseases will be discussed. Current disease burden /
deal with outbreaks / prevent outbreaks
Small pox / cowpox is the first disease which was eliminated and eradicated by
vaccinations. Threat for new pandemic: Planning / scenario for global/
European / national response
For the exam (60%)
- Lectures
- Chapter 1-6
- List of infectious diseases
- Literature on canvas
Assignment: develop/select an
evidence informed intervention strategy to ‘control’ a specific infectious
disease in a certain region.
Evidence informed: trying to put together some evidence informed by
literature. It’s much more nuanced.
Evidence based: put together evidence based on solid literature.
5 steps in health intervention (Jenkins 2003):
1. What is the problem
2. What factors cause the problem
3. How can these factors be changed
4. What overall intervention strategies are most appropriate and cost-
effective?
5. What needs to be done to reach the goals
Step 2&4 are the hardest. Step 5 is less evidence informed. This assignment is a
desk study. And in practice, it is done as a qualitative study.
,Epidemiological triangle:
1. Environment (cause of the disease) –
transmission, infectivity,
pathogenicity, virulence
2. Agent (favorable) socio-economic
factors, physical factors, cultural
factors
3. Host (susceptibility) biological,
behavior
Sometimes there is a Vector (Teak by lime
disease). Is the result of an intervention
between host, agent (vector) and environment.
Web of etiology = high level of uncertainty and complexity
Five basic strategies (how factors can be changed)
1. Remove the agent
2. Raise host resistance
3. Modify environment
4. Separate agent from host
5. Interrupt transmission
Criteria for picking the best intervention:
1. Medical-technical effectiveness
2. Organization feasibility
3. Social, cultural and political feasibility
4. Financial feasibility
Lecture 2: Refresh of immunology (1 sept)
Vaccine immunology – is placed on Canvas as literature. Then you will
understand enough for understanding this course.
Immunology = the study of host defence mechanisms
Immunity = the ability of the host to protect itself against foreign organisms
Immune system = comprises the tissues, cells & molecules which mount the
immune response
,Two types of immune systems!
Innate immunity (natural immune systems) >
physical barriers(skin/tears/saliva/mucus/acids),
inflammations (early), first rapid line of defence
and non-specific.
Acquired immunity (adaptive immune systems)
> specialist cells (cytokines, antibodies),
specialized mucosal lymphoid tissue, second line
of defence (slow), specific and has memory,
second exposure induces a rapid anamnestic
response.
At the end of this lecture this image should be
clear →
The innate immune system
- Synonyms are natural or native immune
system
- Rapidly mobilized first line of defence
- Non-dependent on prior exposure to a
foreign invader
- Non-specific, no memory
- May not be sufficient to prevent foreign
material persisting in the host
Consists of:
➢ Physicochemical barriers
➢ Molecules present in body fluids (lysosome,
complement, chemokines)
➢ Phagocytic & cytotoxic cells such as neutrophils, macrophages, natural
killer cells
The complement system:
- At least 9 plasma proteins & regulatory factors, that mediate several
functions of the inflammatory process
- Synthesized by macrophages or hepatocytes
- Circulate as inactive pro-enzymes.
→ Activation:
- Cascade of sequential activation converts each proenzyme (C1-C9) to its
active state and amplifies the response (two ways!)
, o Classical (indirect): bound to IgG or IgM
o Alternative (direct): by certain bacterial components such as LPS
- Each protein has its own function: chemotaxis (cells are coming),
immune adherence (staying at side of inflammation), acceleration of
acute inflammation (versnelling), immune cytolysis (down-regulation),
bacterial killing/lysis, virus neutralization.
Bridge between innate and adaptive system:
APCs / dendritic cell presents the antigen.
The acquired immune system:
- Adaptive immune response
- It’s specific and has immunologic memory
- Dedicated immune cells (lymphoid cells) > B en T-
lymphocytes
- Molecules that specifically counteract antigens
(antibodies and immunoglobulins)
- Associated with mucosal barrier surfaces, NALT, GALT (nasal/gut
associated lymphoid tissue) etc.
- Lymphocyte secreted cytokines (messages to other cells for actions)
- Antigen must be a peptide!
Innate:
- Granulocyte
- Mast cell
- Monocyte
- Dendritic cell
- Macrophage (also used in
adaptive immune response)
- Natural killer cell
Adaptive:
- CD4+ T cell + memory
variant (so called: T-helper
cells)
- CD8+ T cell + memory
variant (so called: cytotoxic T-cells)
- B cell + memory variant
- Plasma cell
