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Table 1 Examples of infectious diseases of varying characteristics, relevant host genomic discoveries and anticipated ELSI issues

From: Genomics and infectious disease: a call to identify the ethical, legal and social implications for public health and clinical practice

Disease example Characteristics Host genetic association(s) Illustrative ELSI issue
Chronicity Contact Severity Treatability Preventability
Ebola Acute Close Unknown; high case fatality in epidemics No No None right now Restricting civil liberties by using genomic information to inform quarantine policy or travel restrictions
Fairness implications of genotype-based triage decisions in resource-limited settings
Pandemic influenza Acute Casual Variable Yes, but variable Yes, but variable Markers associated with increased susceptibility to infection, severity of disease and response to vaccine Imposing workforce restrictions on healthcare personnel or selectively excluding students who are more likely to be super-spreaders from educational settings during a pandemic
Hepatitis B Chronic form Close Often Severe Yes, but no cure Yes (vaccine is 95% effective) Markers associated with vaccine non-response Prioritizing access to therapy for vaccine non-responders based on genotype, particularly in resource-limited settings
Exempting vaccine non-responders from job-dependent mandatory vaccination
Tuberculosis Chronic, active form Casual Variable Yes, but low efficacy, side effects and multidrug resistance Vaccine only 20% effective Markers associated with susceptibility to active disease in particular ethnic or geographic populations Targeting specific, marginalized subgroups for genotyping (for example, prisoners, native populations, inner city communities) and then treating individuals differentially based on their genetic susceptibility to active infection
  1. ELSI, ethical, legal and social implication.