Chapter 5 : Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555817688/9781555812683_Chap05-1.gif /docserver/preview/fulltext/10.1128/9781555817688/9781555812683_Chap05-2.gif


This chapter emphasizes the idea that outbreaks provide opportunities to evaluate the utility of new strain-typing systems applied to an infectious disease epidemiologic investigation. It shows that much of what we have come to know about transmission dynamics of infectious diseases was derived from attempts to better define relationships among seemingly unrelated individual, sporadic cases of the disease in community or institutional settings. Specific examples of the application of molecular strain-typing methods to differentiate between epidemic and endemic occurrences of infectious disease are discussed to illustrate these concepts. Through such applications, several new paradigms that determine infectious disease distribution and transmission have emerged. This chapter shows that efforts made to distinguish epidemic from endemic will identify features of an infectious disease process that are more complex, though often not recognized or considered. This idea is illustrated in the description of two common infectious disease epidemiologic problems: antimicrobial resistance and infectious disease transmission in community settings. The chapter provides examples of studies of the spatial distribution of drug-resistant infections. It also focuses on bacterial pathogens as examples to illustrate the epidemiologic concepts. These concepts should be applicable to other groups of infectious agents, including viral, fungal, and parasitic organisms for which discriminating strain-typing methods have been developed.

Citation: Riley L. 2004. Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases, p 125-148. In Molecular Epidemiology of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817688.ch5

Key Concept Ranking

Clinical and Public Health
Human Infectious Diseases
Infectious Diseases
Restriction Fragment Length Polymorphism
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


Image of Figure 5.1
Figure 5.1

(A) Proportion of serotype Typhimurium isolates resistant to ampicillin from selected counties in the United States, 1979 to 1990. There appears to be a gradual increase in the prevalence of ampicillin resistance in this serotype of over time. (B) This observation is compared with that of serial studies from New York State, where serotype Typhimurium ampicillin resistance appears to show no temporal trend in prevalence. Possible explanations for these two observations based on plasmid profile analysis are discussed in the text.

Citation: Riley L. 2004. Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases, p 125-148. In Molecular Epidemiology of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817688.ch5
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 5.2
Figure 5.2

Plasmid electrophoretic profile analysis of selected serotype Typhimurium isolates resistant to AKSSuT isolated from nine states in the 1979–1980 antimicrobial drug resistance study ( ). Note the identical or very similar patterns shown in lanes 1, 3, 4, and 9.

Citation: Riley L. 2004. Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases, p 125-148. In Molecular Epidemiology of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817688.ch5
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 5.3
Figure 5.3

Plasmid profile analysis of selected serotype Typhimurium isolates resistant to AKSSuT from a CDC collection of isolates from a 1974–1975 antimicrobial drug resistance study in the United States. Lanes 2, 3, 6, 7, and 9 show identical or very similar patterns. This single clone was responsible for a large proportion of the study isolates during this period.

Citation: Riley L. 2004. Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases, p 125-148. In Molecular Epidemiology of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817688.ch5
Permissions and Reprints Request Permissions
Download as Powerpoint
Image of Figure 5.4
Figure 5.4

Plasmid profile analysis of serotype Typhimurium isolates from family members (lanes 1 to 4), a calf (lane 5), and calf feed (lane 6) obtained during a salmonellosis outbreak on a calf farm in Mobile, Ala., in December 1973. A serotype Typhimurium isolate with an identical plasmid profile pattern was isolated from a calf in New York State in April 1974 (lane 7). This pattern is the same predominant pattern observed among serotype Typhimurium isolates from the 1974–1975 CDC collection ( Fig. 5.3 ).

Citation: Riley L. 2004. Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases, p 125-148. In Molecular Epidemiology of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817688.ch5
Permissions and Reprints Request Permissions
Download as Powerpoint


1. Angulo, F. L.,, K. R. Johnson,, R. V. Tauxe,, and M. L. Cohen. 2000. Origin and consequences of antimicrobial-resistant nontyphoidal Salmonella: implications for the use of fluoroquinolones in food animals. Microb. Drug Resist. 6:7783.
2. Bender, J. B.,, C. J. Hedberg,, D. J. Boxrud,, J. M. Besser,, J. H. Wicklund,, K. E. Smith,, and M. T. Osterholm. 2001. Use of molecular subtyping in surveillance for Salmonella enterica serotype Typhimurium. N. Engl. J. Med. 344:189195.
3. Bifani, P. J.,, B. B. Plikaytis,, V. Kapur,, K. Stockbauer,, X. Pan,, M. L. Lutfey,, S. L. Moghazeh,, W. Eisner,, T. M. Daniel,, M. H. Kaplan,, J. T. Crawford,, J. M. Musser,, and B. N. Kreiswirth. 1996. Origin and interstate spread of a New York City multidrug resistant Mycobacterium tuberculosis clone family. JAMA 275:452457.
4. Carranminana, J. J.,, F. Humbert,, G. Ermel,, and P. Colin. 1997. Molecular epidemiological investigation of Salmonella typhimurium strains related to an eggborne outbreak. Res. Microbiol. 148:633636.
5. Casper, C.,, S. P. Singh,, S. Rane,, C. R. Daley,, G. S. Schecter,, L. W. Riley,, and P. M. Small. 1996. Transcontinental transmission of tuberculosis? A molecular epidemiological assessment. Am. J. Public Health 86:551553.
6.Centers for Disease Control and Prevention. 1997. Multidrug resistant Salmonella serotype Typhimurium—United States, 1996. Morb. Mortal. Wkly. Rep. 46:308310.
7.Centers for Disease Control and Prevention. 1999. National Antimicrobial Resistance Monitoring System for Enteric Bacteria. 1999 Annual Report. Centers for Disease Control and Prevention, Atlanta, Ga.
8.Centers for Disease Control and Prevention. 2003. Summary of notifiable diseases, United States, 2001. Morb. Mortal. Wkly. Rep. 50:1021.
9.Centers for Disease Control and Prevention. 2002. Outbreak of multidrugresistant Salmonella Newport—United States, January-April 2002. Morb. Mortal. Wkly. Rep. 51:545548.
10. Chalker, R. B.,, and M. J. Blaser. 1988. A review of human salmonellosis. III. Magnitude of Salmonella infections in the United States. Rev. Infect. Dis. 9:111124.
11. Cherubin, C. E. 1981. Antibiotic resistance of Salmonella in Europe and the United States. Rev. Infect. Dis. 3:11051126.
12. Cherubin, C. E.,, J. F. Timoney,, M. F. Sierra,, P. Ma,, J. Marr,, and S. Shin. 1980. A sudden decline in ampicillin resistance in Salmonella typhimurium. JAMA 243:439442.
13. Cohen, M. L.,, and R. V. Tauxe. 1986. Drug-resistant Salmonella infections in the United States: an epidemiologic perspective. Science 234:964969.
14. Corso, A.,, E. P. Severina,, V. F. Petruk,, Y. R. Mauriz,, and A. Tomasz. 1998. Molecular characterization of penicillin-resistant Streptococcus pneumoniae isolates causing respiratory disease in the United States. Microb. Drug Resist. 4:325337.
15. Dalmau, D.,, F. Navarro,, B. Mirelis,, J. Blanco,, J. Garau,, and G. Prats. 1996. Escherichia coli bacteraemia: serotype O15:K52:H1 as a urinary pathogen. J. Hosp. Infect. 34:233234.
16. Fey, P. D.,, T. J. Safranek,, M. E. Rupp,, E. F. Dunne,, E. Ribot,, P. C. Iwen,, P. A. Bradford,, F. J. Angulo,, and S. H. Hinrichs. 2000. Ceftriaxone-resistant Salmonella infection acquired by a child from cattle. N. Engl. J. Med. 342:12421249.
17. Fone, D. L.,, and R. M. Barker. 1994. Associations between human and farm animal infections with Salmonella typhimurium DT104 in Herefordshire. Commun. Dis. Rep. CDR Rev. 4:R136R140.
18. Foxman, B.,, L. Zhang,, P. Tallman,, B. C. Andree,, A. M. Geiger,, J. S. Koopman,, B. W. Gillespie,, K. A. Palin,, J. D. Sobel,, C. K. Rode,, C. A. Bloch,, and C. F. Marrs. 1997. Transmission of uropathogens between sex partners. J. Infect. Dis. 175:989992.
19. Frieden, T. R.,, L. F. Sherman,, K. L. Maw,, P. I. Fujiwara,, J. T. Crawford,, B. Nivin,, V. Sharp,, D. Hewlett, Jr.,, K. Brudney,, D. Alland,, and B. N. Kreisworth. 1996. A multi-institutional outbreak of highly drug-resistant tuberculosis: epidemiology and clinical outcomes. JAMA 276:12291235.
20. Frieden, T. R.,, P. I. Fujiwara,, R. M. Washko,, and M. A. Hamburg. 1995. Tuberculosis in New York City—turning the tide. N. Engl. J. Med. 333:229233.
21. Frieden, T. R.,, T. Sterling,, A. Pablos-Mendez,, J. O. Kilburn,, G. M. Cauthens,, and S. W. Dooley. 1993. The emergence of drug-resistant tuberculosis in New York City. N. Engl. J. Med. 328:521526.
22. Friedman, C. R.,, G. C. Quinn,, B. N. Kreiswirth,, D. C. Perlman,, N. Salomon,, N. Schluger,, M. Lutfey,, J. Berger,, N. Poltoratskaia,, and L. W. Riley. 1997. Widespread dissemination of a drug-susceptible strain of Mycobacterium tuberculosis. J. Infect. Dis. 176:478484.
23. Friedman, C. R.,, M. Y. Stoeckle,, B. N. Kreiswirth,, W. D. Johnson,, S. M. Manoach,, J. Berger,, K. Sathianathan,, A. Hafner,, and L. W. Riley. 1995. Transmission of multidrug-resistant tuberculosis in a large urban setting. Am. J. Respir. Crit. Care Med. 152:355359.
24. Glynn, M. K.,, C. Bopp,, W. Dewitt,, P. Dabney,, M. Mokhtar,, and F. G. Angulo. 1998. Emergence of multidrug-resistant Salmonella enterica serotype Typhimurium DT104 in the United States. N. Engl. J. Med. 338:13331338.
25. Gorbach, S. L. 2001. Antimicrobial use in animal feed—time to stop. N. Engl. J. Med. 345:12021203.
26. Hall, R. M.,, and C. M. Collis. 1995. Mobile gene cassettes and integrons: capture and spread of genes by site-specific recombination. Mol. Microbiol. 15:593600.
27. Holmberg, S. D.,, M. T. Osterholm,, K. A. Senger,, and M. L. Cohen. 1984. Drug-resistant Salmonella from animals fed antimicrobials. N. Engl. J. Med. 311:617622.
28. Ko, A. I.,, J. N. Reis,, S. J. Coppola,, E. L. Gouveia,, S. M. Cordeiro,, T. S. Lobo,, R. M. Pinheiro,, K. Salgado,, C. M. R. Dourado,, J. Tavares-Neto,, H. Rocha,, M. G. Reis,, W. D. Johnson,, and L. W. Riley. 2000. Clonally related penicillin-nonsusceptible Streptococcus pneumoniae serotype 14 from cases of meningitis in Salvador, Brazil. Clin. Infect. Dis. 30:7886.
29. Lee, L. A.,, N. D. Puhr,, E. K. Maloney,, N. H. Bean,, and R. V. Tauxe. Increase in antimicrobial-resistant Salmonella infections in the United States, 1989-1990. J. Infect. Dis. 170:128134.
30. Levy, S. B. 1984. Playing antibiotic pool: time to tally the score. N. Engl. J. Med. 311:663665.
31. Levy, S. B. 1998. Multidrug resistance—a sign of the times. N. Engl. J. Med. 338:13761378.
32. Ling, J. M.,, I. C. Koo,, K. M. Kam,, and A. F. Cheng. 1998. Antimicrobial susceptibilities and molecular epidemiology of Salmonella enterica serotype Enteritidis strains isolated in Hong Kong from 1986 to 1996. J. Clin. Microbiol. 36:16931699.
33. Manges, A. R.,, J. R. Johnson,, B. Foxman,, T. T. O’Bryan,, K. E. Fullerton,, and L. W. Riley. 2001. Widespread distribution of urinary tract infections caused by a multidrug-resistant Escherichia coli clonal group. N. Engl. J. Med. 345:10071013.
34. McDonald, K. L.,, M. L. Cohen,, N. Hargrett-Bean,, J. G. Wells,, N. D. Puhr,, S. F. Collin,, and P. A. Blake. 1987. Changes in antimicrobial resistance of Salmonella isolated from humans in the United States. JAMA 258:14961499.
35. McGee, L.,, L. McDougal,, J. Zhou,, B. G. Spratt,, F. C. Tenover,, R. George,, R. Hakenbeck,, W. Hryniewicz,, J. C. Lefévre,, A. Tomasz,, and K. P. Klugman. 2001. Nomenclature of major antimicrobial-resistant clones of Streptococcus pneumoniae defined by the Pneumococcal Molecular Epidemiology Network. J. Clin. Microbiol. 39:25652571.
36. Molbak, K.,, L. B. Dorte,, F. M. Aarestrup,, J. M. Ebbesen,, J. Engberg,, K. Frydendahl,, P. Gerner-Smidt,, A. M. Petersen,, and H. C. Wegener. 1999. An outbreak of multidrug-resistant, quinolone-resistant Salmonella enterica serotype Typhimurium DT104. N. Engl. J. Med. 341:14201425.
37. Moss, A. R.,, D. Alland,, E. Telzak,, D. Hewlett, Jr.,, V. Sharp,, P. K. Chiliade,, V. LaBombardi,, D. Kabus,, B. Hanna,, L. Palumbo,, K. Brudney, A. Weltman,, K. Stoeckle,, K. Chirgwin,, M. Simberkoff,, S. Moghazeh,, W. Eisner,, M. Lutfey,, and B. N. Kreiswirth. 1997. A city-wide outbreak of a multiple-drug-resistant strain of Mycobacterium tuberculosis in New York. Int. J. Tuberc. Lung Dis. 1:115121.
38. Munoz, R. T.,, J. Coffey,, M. Daniels,, C. G. Dowson,, G. Laible,, J. Casal,, R. Hakenbeck,, M. Jacobs,, J. M. Musser,, G. B. Spratt,, and A. Tomasz. 1991. Intercontinental spread of a multiresistant clone of serotype 23F Streptococcus pneumoniae. J. Infect. Dis. 164:302306.
39. Neter, E.,, W. Westphal,, O. Luderitz,, R. M. Gino,, and E. A. Gorzynski. 1955. Demonstration of antibodies against enteropathogenic Escherichia coli in sera of children of various ages. Paediatrics 16:801807.
40. O’Brien, T. F.,, J. D. Hopkins,, E. S. Gilleece,, A. A. Medeiros,, R. L. Kent,, B. O. Blackburn,, M. B. Holmes,, J. P. Readon,, J. M. Vergeront,, W. L. Schell,, E. Christenson,, M. L. Bissett,, and E. V. Morse. 1982. Molecular epidemiology of antibiotic resistance in salmonella from animals and human beings in the United States. N. Engl. J. Med. 307:16.
41. Phillips, I.,, S. Eykyn,, A. King,, W. R. Gransden,, B. Rowe,, J. A. Frost,, and R. J. Gross. 1988. Epidemic multiresistant Escherichia coli infection in West Lambeth Health District. Lancet i:10381041.
42. Prager, R.,, A. Liesegang,, W. Rabsch,, B. Gericke,, W. Thiel,, W. Voigt,, R. Helmuth,, L. Ward,, and H. Tschaepe. 1999. Clonal relationship of Salmonella enterica serovar Typhimurium phage type DT104 in Germany and Austria. Zentbl. Bakteriol. 289:399414.
43. Prats, G.,, F. Navarro,, B. Mirelis,, D. Dalmau,, N. Margall,, P. Coll,, A. Stell,, and J. R. Johnson. 2000. Escherichia coli serotype O15:K52:H1 as a uropathogenic clone. J. Clin. Microbiol. 38:201209.
44. Recchia, G. D.,, and R. M. Hall. 1995. Gene cassettes: a new class of mobile element. Microbiology 141:30153027.
45. Ridley, A.,, and J. E. Threlfall. 1998. Molecular epidemiology of antibiotic resistance genes in multiresistant epidemic Salmonella typhimurium DT104. Microb. Drug Resist. 4:113118.
46. Riley, L. W.,, M. L. Cohen,, J. E. Seals,, M. J. Blaser,, K. A. Birkness,, N. T. Hargrett,, S. M. Martin,, and R. A. Feldman. 1984. Importance of host factors in human salmonellosis caused by multiresistant strains of Salmonella. J. Infect. Dis. 149:878883.
47. Robins-Browne, R. M. 1987. Traditional enteropathogenic Escherichia coli of infantile diarrhea. Rev. Infect. Dis. 9:2852.
48. Seyfarth, A. M.,, H. C. Wegner,, and N. Frimodt-Moeller. 1997. Antimicrobial resistance in Salmonella enterica subsp. Enterica serovar typhimurium from humans and production animals. J. Antimicrob. Chemother. 40:6775.
49. Spika, J. S.,, S. H. Waterman,, G. W. Soo Hoo,, M. E. St. Louis,, R. E. Pacer,, S. M. James,, M. L. Bissett,, L. W. Mayer,, J. Y. Chiu,, B. Hall,, K. Greene,, M. E. Potter,, M. L. Cohen,, and P. A. Blake. 1987. Chloramphenicol resistant Salmonella Newport traced through hamburger on dairy farms. N. Engl. J. Med. 316:565570.
50. Stenderup, J.,, and F. Orskov. 1983. The clonal nature of enteropathogenic Escherichia coli strains. J. Infect. Dis. 148:10191024.
51. Stokes, H. W.,, and R. M. Hall. 1989. A novel family of potentially mobile DNA elements encoding site-specific gene-integration functions: integrons. Mol. Microbiol. 3:16691683.
52. Stokes, H. W.,, D. B. O’Gorman,, G. D. Recchia,, M. Parsekhian,, and R. M. Hall. 1997. Structure and function of 59-base element recombination sites associated with mobile gene cassettes. Mol. Microbiol. 26:731745.
53. Swartz, M. 2002. Human diseases caused by foodborne pathogens of animal origin. Clin. Infect. Dis. 34(Suppl. 3):S111S122.
54. Tacket, C. O.,, L. B. Dominguez,, H. J. Fisher,, and M. L. Cohen. 1985. An outbreak of multiple-resistant Salmonella enteritis from raw milk. JAMA 253:20582060.
55. Threlfall, E. J.,, M. D. Hampton,, S. L. Schofield,, L. R. Ward,, J. A. Frost,, and B. Rowe. 1996. Epidemiological application of differentiating multiresistant Salmonella typhimurium DT104 by plasmid profile. Commun. Dis. Rep. CDR Rev. 6:R155R159.
56. Threlfall, E. J.,, J. A. Frost,, L. R. Ward,, and B. Rowe. 1995. Epidemic in cattle of S. typhimurium DT 104 with chromosomally-integrated multiple drug resistance. Vet. Rec. 134:577.
57. Threlfall, E. J.,, L. R. Ward,, J. A. Skinner,, and B. Rowe. 1997. Increase in multiple antibiotic resistance in nontyphoidal salmonellas from humans in England and Wales: a comparison of data for 1994 and 1996. Microb. Drug Resist. 3:263266.
58. Tullus, K.,, K. Horlin,, S. B. Svenson,, and G. Kallenius. 1984. Epidemic outbreaks of acute pyelonephritis caused by nosocomial spread of P fimbriated Escherichia coli in children. J. Infect. Dis. 150:728736.
59.U.S. Congress, Office of Technology Assessment. 1995. Impacts of Antibiotic-Resistant Bacteria. Publication no. OTA-H-629. U.S. Government Printing Office, Washington, D.C.
60. Wall, P. G.,, D. Morgan,, K. Lamden,, M. Ryan,, M. Griffin,, E. J. Threlfall,, L. R. Ward,, and B. Rowe. 1994. A case control study of infection with an epidemic strain of multiresistant Salmonella typhimurium DT104 in England and Wales. Commun. Dis. Rep. CDR Rev. 4:R130R135.
61. Wegener, H. C. 2003. Ending the use of antimicrobial growth promoters is making a difference. ASM News 69:443448.
62. White, D. G.,, S. Zhao,, R. Sudler,, S. Ayers,, S. Friedman,, S. Chen,, P. F. McDermott,, S. McDermott,, D. D. Wagner,, and J. Meng. 2001. The isolation of antibioticresistant Salmonella from retail ground meats. N. Engl. J. Med. 345:11471154.


Generic image for table
Table 5.1

Antimicrobial drug susceptibility patterns of serotype Typhimurium isolates obtained from rural and urban counties in the United States from 1979 to 1980

Citation: Riley L. 2004. Distinguishing between Epidemic and Endemic Occurrences of Infectious Diseases, p 125-148. In Molecular Epidemiology of Infectious Diseases. ASM Press, Washington, DC. doi: 10.1128/9781555817688.ch5

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error