EPIDEMIOLOGICAL TRIAD

In our earlier discussion of sufficient

cause, three factors were mentioned
- agent, host and environment. These
three factors constitute the
epidemiologic triad. They interact in
a variety of ways that result in
various states of health in an
individual or a community.

 A traditional model of infectious

disease causation, known as the
Epidemiologic Triad. 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.

Agent
In infectious disease models, the term "agent"
originally referred to the entity or microorganism (e.g. virus, bacterium) capable of
causing the disease. As a general rule, the agent
must be present for the disease to occur.
However, the mere presence of the agent is not
always sufficient for the disease to occur.
As the scope of epidemiology has expanded, the
concept of "agent" has also grown to include
chemical and physical components. This model
works well with infectious diseases and
accidents/injuries and most non-infectious
diseases.

Host

"Host" refers to the organism (e.g.

human) capable of being infected by
a specific agent. There are intrinsic
factors that influence an individual's
exposure, susceptibility or response
to a causative agent. These factors
include socio-economic status,
lifestyle, behaviours, and
psychological characteristics. Can you
think of other factors that could be
considered "host" factors?

Environment
The environment is all that is e xternal to the host.
Environmental factors are extrinsic factors that
affect the agent and the opportunity for exposure.
They can be physical factors (e.g. climate),
biological factors (e.g. insects) or socio-economic
factors (e.g. sanitation, access to health services).
The diagram on the next tab sets out the agent,
host and environmental factors related to the
sexual transmission of HIV infection in a
community. Take a moment to consider an
example from your own work environment - what
would be some of the agent, host and
environmental factors for your example?

VECTOR
. 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.

 A classic example of a vector is the Anopheles

mosquito. As the mosquito ingests blood from
an infected host, it picks up the parasite
plasmodium. The plasmodium are harmless
to the mosquito. However, after being stored
in the salivary glands and then injected into
the next human upon which the mosquito
feeds, the plasmodium can cause malaria in
the infected human. Thus, the Anopheles
mosquito serves as a vector for malaria.
Another familiar example of a vector are
ticks of the genus Ixodes which can be
vectors for Lyme disease.

 In the traditional epidemiologic triad model,

transmission occurs when the agent leaves its
reservoir or host through a portal of exit,
is conveyed by a mode of transmission to
enter through an appropriate portal of entry
to infect a susceptible host. Transmission
may be direct (direct contact host-to-host,
droplet spread from one host to another) or
indirect (the transfer of an infectious agent
from a reservoir to a susceptible host by
suspended air particles, inanimate objects
(vehicles or fomites), or animate
intermediaries (vectors)).

 Can the epidemiologic triad can be

applied to a disease that not infectious?
Consider a smoking-related disease .If
smoking (or more specifically, a
carcinogen in the smoke of the cigarette)
causes the disease, those who
manufacture, sell and distribute
cigarettes are vectors, bringing the
disease-causing agent to the susceptible
host. Diagramming the epidemiologic
triad also indicates potential interventions
to reduce disease in the population.

 In this example, clean indoor air

legislation, advertising potential
harm from smoking or establishing
workplace smoking cessation
programs could change the
environment and reduce the
exposure of host to agent.
Conversely, increased advertising
from cigarette manufacturers or
increased numbers of vendors would
increase exposure of host to agent.

Epidemiologic Triad Applied to

Smoking-related Disease

 Thus, the traditional model of

disease transmission can be useful to
identify areas of potential
intervention to reduce disease
prevalence, whether infectious or
non-infectious.