Genomics and infectious disease: a call to identify the ethical, legal and social implications for public health and clinical practice.
Genomics and infectious disease: a call to identify the ethical, legal and social implications for public health and clinical practice.
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DOI：
10.1186/s13073-014-0106-2
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发表时间：
2014
期刊：
影响因子：
12.3
通讯作者：
Kahn JP
中科院分区：
文献类型：
--
作者：
Geller G;Dvoskin R;Thio CL;Duggal P;Lewis MH;Bailey TC;Sutherland A;Salmon DA;Kahn JP
基因组学的进步有助于开发更有效、个性化的传染病预防和治疗方法。基因测序技术正在加深我们对人类和病原体基因组因素及其相互作用如何导致对疫苗、感染和药物治疗的免疫反应的个体差异的理解。这种理解将影响未来传染病管理的政策和程序。由于有可能针对特定个人、人群或亚人群进行量身定制的干预措施，因此可能会对公共卫生和临床实践产生伦理、法律和社会影响 (ELSI)。潜在的考虑因素包括平衡个人和更大社区之间与健康相关的利益和危害，最大限度地减少对个人隐私和自主权的威胁，以及确保稀缺资源的公正分配。在本意见中，我们考虑了病原体和宿主基因组信息在特定病毒感染中的潜在应用，这些病毒感染具有大规模的公共卫生后果，但在 ELSI 相关特征方面有所不同，例如传播的难易程度、慢性性、严重性、可预防性和可治疗性。我们主张在新的科学发现之前预测这些 ELSI 问题的重要性，并呼吁制定战略来识别和探索伦理问题，这些问题在做出临床、公共卫生和政策决策时应予以考虑。
Advances in genomics are contributing to the development of more effective, personalized approaches to the prevention and treatment of infectious diseases. Genetic sequencing technologies are furthering our understanding of how human and pathogen genomic factors - and their interactions - contribute to individual differences in immunologic responses to vaccines, infections and drug therapies. Such understanding will influence future policies and procedures for infectious disease management. With the potential for tailored interventions for particular individuals, populations or subpopulations, ethical, legal and social implications (ELSIs) may arise for public health and clinical practice. Potential considerations include balancing health-related benefits and harms between individuals and the larger community, minimizing threats to individual privacy and autonomy, and ensuring just distribution of scarce resources. In this Opinion, we consider the potential application of pathogen and host genomic information to particular viral infections that have large-scale public health consequences but differ in ELSI-relevant characteristics such as ease of transmission, chronicity, severity, preventability and treatability. We argue for the importance of anticipating these ELSI issues in advance of new scientific discoveries, and call for the development of strategies for identifying and exploring ethical questions that should be considered as clinical, public health and policy decisions are made.
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