EPIDEMIOLOGY 606

Advanced Infectious Disease Epidemiology

Tuesdays, Thursdays 1:30-3:00 P.M. Rm 3040 SPH I

INSTRUCTORS

	Steve Meshnick	Jim Koopman
Office	2039a SPH I	3043 SPH I
Phone/e-mail	7-2406, meshnick@umich.edu	3-5629, jkoopman@umich.edu
Office hours	Tuesdays 3-5	Tuesdays and Thursday mornings 11-12

COURSE DESCRIPTION

This second course in epidemiology will further prepare students to practice infectious disease epidemiology in both developed and developing countries in health departments, NGOs, and academic settings. It addresses the mechanisms and social factors which make infectious disease epidemiology differ from non-infectious disease epidemiology with regard to risk assessment and control program implementation. Focus will be on how risk factors, contact patterns, transmission dynamics, and pathogen evolution determine endemic and epidemic levels of infection. Students will be given an understanding of traits shared by all infectious agents (such as virulence) as well as those that are disease-specific. Students will get practice in presenting an integrative infectious disease analysis approach to a problem of their choosing.

COURSE OBJECTIVES

This course will provide a theoretical framework for understanding the causes of endemic and epidemic infection patterns in terms of a) the biology of infection, b) risk factors for transmission, c) transmission dynamics, and d) evolution dynamics.
It will provide a practical framework for organizing and evaluating infection control efforts that balance and coordinate the contributions made by a variety of control modalities.
Diverse infectious diseases of public health importance will be explored to illustrate these principles of theory and practice.

COMPETENCIES

Students will be prepared to qualitatively assess the effects on endemic and epidemic infection levels of a) risk factor frequencies, b) risk factor distributions to different population segments, c) patterns of immunity in the population, d) contact patterns, and e) temporal changes in a) through d). They will be taught to howgain familiarity with the use of quantitative tools to better understand the epidemiology of infectious diseases and to evaluate interventions. Students will develop criteria to choose and implement surveillance and control activities,
Students will understand the biological, environmental, social and political factors that underlie control of the major infectious diseases

READINGS

Required readings will either be on the Web or on reserve in the SPH library.

GRADING

Midterm 30%

Presentation 30%

Final 40%

CLASS PRESENTATIONS

Students will work in small groups and then give oral presentations in class at the end of the semester. The presentations should focus on specific disease entities or types and take an integrative approach which applies the principles presented in the course. Two weeks before the presentation, students should present a list of readings for other students to read on the topic before it is presented. They should also present a list of questions or topics that will be discussed in their presentation.

The presentations should include:

Descriptive epidemiology	Geographical distribution, risk factors, impact, surveillance and control
Biological issues	Natural history of infection, pathogen factors (virulence, diversity), host factors (immunity, genetics), infection detection methods
Transmission systems	Mode of transmission, R(o) estimates, important variables in the transmission system and how they affect dynamics, effect of asymptomatic infections and carriers, how different the transmission system is between developed and developing countries and how that might affect control.
Open questions	What else needs to be known/investigated?

SYLLABUS

Date	Instructor	Lecture Title	Topics
9/9	Meshnick	History and Overview	Infectious diseases and history Changing paradigms of disease
9/14	Koopman	Microbes and humanity.	How many and what varieties of microbes depend upon us in their competition with other microbes? How important is learning about these to human health? How important is the transmission system circulating these among humans to human health? Readings for Koopman lectures through 9/28 are available on the web or will be handed out. Lecture overheads for the 9-14 lecture are on the web.
9/16	Meshnick	Host response to infection	Introduction to immunology Genetics of susceptibility
9/21	Koopman	Transmission systems	The elements of transmission systems Continuous model approaches to transmission system analysis Discrete transmission system models Lecture notes for this and the next lecture are on the web.
9/23	Meshnick	Biological characteristics of infectious agents and their implications for transmission, disease and control	Evolution of virulence Lifecycles, reservoirs and routes of transmission Micro- vs. Macro-parasites
9/28	Koopman	Assessing Individual and Population Effects of Risk Factors For Transmission	How simple models help conceptualize the task of risk factor assessment
9/30	Meshnick	Vaccines and drugs for infectious disease	Types of vaccines and practical issues Antibiotics & antiparasitics; Evolution of drug resistance Single vs multiple drug therapy
10/5	Koopman	Analysis of Infectious Disease Problems and Data	The dimensions of infectious disease data and the use of transmission system models to integrate the analysis of data Estimating transmission system parameters and R₀
10/7	Meshnick	Water- and food-borne infections	Cholera Bacterial vs. Protozoal
10/12	Koopman	Modeling and Analyzing Vaccine and Drug Effects	Direct effects on susceptibility, course of infection, and contagiousness. All or none and partial susceptibility effects Indirect effects of vaccines How to interpret vaccine effect estimates
10/14		MIDTERM
10/19	Meshnick	Malaria	Epidemiological patterns Interventions
10/21	Koopman	Microbial Risk Assessment for Water-borne pathogens	Determining the role of risk factors or modes of transmission in the transmission system. Dose Response Aspects of Risk Assessment
10/26	Meshnick	AIDS	Differences between rich and poor countries
10/28	Koopman	HIV/STD transmission systems	What determines the rate of epidemic rise and the endemic levels reached? What are the basic differences between heterosexual, IDU, and homosexual transmission systems? What aspects of contact patterns are crucial in determining population levels of infection? How can treatment and vaccination affect the transmission system?
11/2	Meshnick	Mycobacterial diseases	TB pathogenesis: history; changes in transmission patterns, Leprosy, Control strategies
11/4	Koopman	Studying HIV/STD transmission systems and risk factors	Why and how individual level studies need to take transmission system models into account Why and how transmission system studies depend upon individual level studies
11/9	Meshnick	Helminths	Hookworm (history and current unknowns) Guinea Worm Eradication Program Schistosomiasis. Onchocerciasis (OCP and APOC)
11/11	Koopman	Surveillance Systems For Transmission System Control And Detection of Emerging Infections
11/16	Koopman	Human microbial evolution and transmission systems	Using DNA Sequence Data To Describe Transmission Systems Do organisms continually evolve to increase their R₀? If so, how does that affect our health? Why do some infectious disease problems emerge and disappear like Staph phage type 50 or rheumatic fever? How do changing contact patterns and antibiotic use affect microbe evolution?
11/18	Students
11/23	Students
11/30	Carl Simon	Influenza Transmission Systems and Evolution
12/3 Friday	Meshnick	Prions	What is the agent of BSE? Epidemiology and interventions
12/7	Students
12/9	Students