1.2 - Epidemiologic Triad

A traditional model of infectious disease causation, known as the Epidemiologic Triad is depicted in Figure 2. 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. A vector, an organism that transmits infection by conveying the pathogen from one host to another without causing the disease itself, could 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 is 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 is 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)).

Epidemiological Triad
Figure 2: Epidemiologic Triad of Disease Causation (Historical)

Further example here: Egger G, Swinburn B, Rossner S. Dusting off the epidemiological triad: could it work with obesity? Obesity Reviews 2003;4:115-9.

Can the epidemiologic triad be applied to a disease that is not infectious? Consider a smoking-related disease (Figure 3). 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 the host to the agent. Conversely, increased advertising from cigarette manufacturers or increased numbers of vendors would increase the exposure of the host to the agent.

Triad diagram
Fig. 3: 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.