Volume 86, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Visceral leishmaniasis (VL) is responsible for substantial morbidity and mortality and current available treatments have many limitations. The ability of VL infection to generate life-long immunity offers promise for the development of a VL vaccine. A VL vaccine candidate has recently completed phase I clinical trials. We constructed a computer simulation model to determine the potential economic value of a VL vaccine in the endemic region of Bihar state, India. Results found a potential vaccine to be cost-effective (and in many cases economically dominant, i.e., saving costs and providing health benefits) throughout a wide range of vaccination costs and vaccine efficacies, and VL risks. Overall, our study strongly supports the continued development of a VL vaccine.


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  1. Hotez PJ, Ferris MT, , 2006. The antipoverty vaccines. Vaccine 24: 57875799.[Crossref] [Google Scholar]
  2. Vanlerberghe V, Diap G, Guerin PJ, Meheus F, Gerstl S, Van der Stuyft P, Boelaert M, , 2007. Drug policy for visceral leishmaniasis: a cost-effectiveness analysis. Trop Med Int Health 12: 274283.[Crossref] [Google Scholar]
  3. Berman JD, Badaro R, Thakur CP, Wasunna KM, Behbehani K, Davidson R, Kuzoe F, Pang L, Weerasuriya K, Bryceson AD, , 1998. Efficacy and safety of liposomal amphotericin B (AmBisome) for visceral leishmaniasis in endemic developing countries. Bull World Health Organ 76: 2532. [Google Scholar]
  4. Ahluwalia IB, Bern C, Costa C, Akter T, Chowdhury R, Ali M, Alam D, Kenah E, Amann J, Islam M, Wagatsuma Y, Haque R, Breiman RF, Maguire JH, , 2003. Visceral leishmaniasis: consequences of a neglected disease in a Bangladeshi community. Am J Trop Med Hyg 69: 624628. [Google Scholar]
  5. Meheus F, Boelaert M, Baltussen R, Sundar S, , 2006. Costs of patient management of visceral leishmaniasis in Muzaffarpur, Bihar, India. Trop Med Int Health 11: 17151724.[Crossref] [Google Scholar]
  6. Joshi A, Prasittisuk C, Bhatia R, Hashim G, Jorge A, Banjara M, Kroeger A, , 2008. Can visceral leishmaniasis be eliminated from Asia? J Vector Borne Dis 45: 105111. [Google Scholar]
  7. World Health Organization, 2007. WHO Special Programme for Research and Training in Tropical Diseases (TDR): research to support the elimination of visceral leishmaniasis. Geneva: WHO. [Google Scholar]
  8. Berman J, , 2009. ABLE: a new and improved amphotericin B for visceral leishmaniasis? Am J Trop Med Hyg 80: 689690. [Google Scholar]
  9. Sundar S, More DK, Singh MK, Singh VP, Sharma S, Makharia A, Kumar PC, Murray HW, , 2000. Failure of pentavalent antimony in visceral leishmaniasis in India: report from the center of the Indian epidemic. Clin Infect Dis 31: 11041107.[Crossref] [Google Scholar]
  10. Kumar V, Kesari S, Kumar AJ, Dinesh DS, Ranjan A, Prasad M, Sinha NK, Kumar R, Das P, , 2009. Vector density and the control of kala-azar in Bihar, India. Mem Inst Oswaldo Cruz 104: 10191022.[Crossref] [Google Scholar]
  11. Kumar V, Kesari S, Dinesh DS, Tiwari AK, Kumar AJ, Kumar R, Singh VP, Das P, , 2009. A report on the indoor residual spraying (IRS) in the control of Phlebotomus argentipes, the vector of visceral leishmaniasis in Bihar (India): an initiative towards total elimination targeting 2015 (Series-1). J Vector Borne Dis 46: 225229. [Google Scholar]
  12. Joshi AB, Banjara MR, Pokhrel S, Jimba M, Singhasivanon P, Ashford RW, , 2006. Elimination of visceral leishmaniasis in Nepal: pipe-dreams and possibilities. Kathmandu Univ Med J 4: 488496. [Google Scholar]
  13. Kedzierski L, , 2010. Leishmaniasis vaccine: where are we today? J Glob Infect Dis 2: 177185.[Crossref] [Google Scholar]
  14. Nagill R, Kaur S, , 2011. Vaccine candidates for leishmaniasis: a review. Int Immunopharmacol 11: 14641488.[Crossref] [Google Scholar]
  15. Coler RN, Reed SG, , 2005. Second-generation vaccines against leishmaniasis. Trends Parasitol 21: 244249.[Crossref] [Google Scholar]
  16. Velez ID, Gilchrist K, Martinez S, Ramirez-Pineda JR, Ashman JA, Alves FP, Coler RN, Bogatzki LY, Kahn SJ, Beckmann AM, Cowgill KD, Reed SG, Piazza FM, , 2009. Safety and immunogenicity of a defined vaccine for the prevention of cutaneous leishmaniasis. Vaccine 28: 329337.[Crossref] [Google Scholar]
  17. Olliaro P, Darley S, Laxminarayan R, Sundar S, , 2009. Cost-effectiveness projections of single and combination therapies for visceral leishmaniasis in Bihar, India. Trop Med Int Health 14: 918925.[Crossref] [Google Scholar]
  18. 2008. Open-Label Safety Study of Three-Antigen Leishmania Polyprotein with Adjuvant MPL-SE in Healthy Adults in India.Available at: http://www.ClinicalTrials.gov. Accessed June 5, 2010. [Google Scholar]
  19. Coler RN, Goto Y, Bogatzki L, Raman V, Reed SG, , 2007. Leish-111f, a recombinant polyprotein vaccine that protects against visceral Leishmaniasis by elicitation of CD4+ T cells. Infect Immun 75: 46484654.[Crossref] [Google Scholar]
  20. Lee BY, Burke DS, , 2010. Constructing target product profiles (TPPs) to help vaccines overcome post-approval obstacles. Vaccine 28: 28062809.[Crossref] [Google Scholar]
  21. World Health Organization, 2008. Global Health Observatory: World Health Organization. Geneva: WHO. [Google Scholar]
  22. Bern C, Maguire JH, Alvar J, , 2008. Complexities of assessing the disease burden attributable to leishmaniasis. PLoS Negl Trop Dis 2: e313.[Crossref] [Google Scholar]
  23. Ahluwalia IB, Bern C, Wagatsuma Y, Costa C, Chowdhury R, Ali M, Amann J, Haque R, Breiman R, Maguire JH, , 2004. Visceral leishmaniasis: consequences to women in a Bangladeshi community. J Womens Health (Larchmt) 13: 360364.[Crossref] [Google Scholar]
  24. Bern C, Joshi AB, Jha SN, Das ML, Hightower A, Thakur GD, Bista MB, , 2000. Factors associated with visceral leishmaniasis in Nepal: bed-net use is strongly protective. Am J Trop Med Hyg 63: 184188. [Google Scholar]
  25. Salotra P, Singh R, , 2006. Challenges in the diagnosis of post kala-azar dermal leishmaniasis. Indian J Med Res 123: 295310. [Google Scholar]
  26. Ministry of Finance Government of India, 2010. Economics Survey 2009–2010. Available at: http://indiabudget.nic.in/es2009-10/esmain.htm. Accessed June 3, 2010. [Google Scholar]
  27. Singh VP, Ranjan A, Topno RK, Verma RB, Siddique NA, Ravidas VN, Kumar N, Pandey K, Das P, , 2010. Estimation of under-reporting of visceral leishmaniasis cases in Bihar, India. Am J Trop Med Hyg 82: 911.[Crossref] [Google Scholar]
  28. Khalil EA, Zijlstra EE, Kager PA, El Hassan AM, , 2002. Epidemiology and clinical manifestations of Leishmania donovani infection in two villages in an endemic area in eastern Sudan. Trop Med Int Health 7: 3544.[Crossref] [Google Scholar]
  29. Thakur CP, Singh RK, Hassan SM, Kumar R, Narain S, Kumar A, , 1999. Amphotericin B deoxycholate treatment of visceral leishmaniasis with newer modes of administration and precautions: a study of 938 cases. Trans R Soc Trop Med Hyg 93: 319323.[Crossref] [Google Scholar]
  30. Piscopo TV, Mallia Azzopardi C, , 2007. Leishmaniasis. Postgrad Med J 83: 649657. [Google Scholar]
  31. ter Horst R, Tefera T, Assefa G, Ebrahim AZ, Davidson RN, Ritmeijer K, , 2009. Field evaluation of rK39 test and direct agglutination test for diagnosis of visceral leishmaniasis in a population with high prevalence of human immunodeficiency virus in Ethiopia. Am J Trop Med Hyg 80: 929934. [Google Scholar]
  32. Ritmeijer K, Melaku Y, Mueller M, Kipngetich S, O'Keeffe C, Davidson RN, , 2006. Evaluation of a new recombinant K39 rapid diagnostic test for Sudanese visceral leishmaniasis. Am J Trop Med Hyg 74: 7680. [Google Scholar]
  33. Sundar S, Singh RK, Maurya R, Kumar B, Chhabra A, Singh V, Rai M, , 2006. Serological diagnosis of Indian visceral leishmaniasis: direct agglutination test versus rK39 strip test. Trans R Soc Trop Med Hyg 100: 533537.[Crossref] [Google Scholar]
  34. Sundar S, Chatterjee M, , 2006. Visceral leishmaniasis—current therapeutic modalities. Indian J Med Res 123: 345352. [Google Scholar]
  35. Sundar S, Maurya R, Singh RK, Bharti K, Chakravarty J, Parekh A, Rai M, Kumar K, Murray HW, , 2006. Rapid, noninvasive diagnosis of visceral leishmaniasis in India: comparison of two immunochromatographic strip tests for detection of anti-K39 antibody. J Clin Microbiol 44: 251253.[Crossref] [Google Scholar]
  36. Roy P, Noad R, , 2008. Virus-like particles as a vaccine delivery system: myths and facts. Hum Vaccin 4: 512.[Crossref] [Google Scholar]
  37. Maltezou HC, , 2010. Drug resistance in visceral leishmaniasis. J Biomed Biotechnol 2010: 617521. [Google Scholar]
  38. Sarnoff R, Desai J, Desjeux P, Mittal A, Topno R, Siddiqui NA, Pandey A, Sur D, Das P, , 2010. Visceral Leishmaniasis Supplement: The Economic Impact of Visceral Leishmaniasis on Rural Households in One Endemic District of Bihar, India. San Francisco, CA: Institute for OneWorld Health. [Google Scholar]
  39. Brenzel L, Wolfson LJ, Fox-Rushby J, Miller M, Halsey NA, Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, , 2006. Vaccine-preventable diseases. eds. Disease Control Priorities in Developing Countries. Second edition. Washington, DC: World Bank, Chap. 20. [Google Scholar]
  40. Lee BY, Norman BA, Assi TM, Chen SI, Bailey RR, Rajgopal J, Brown ST, Wiringa AE, Burke DS, , 2010. Single versus multi-dose vaccine vials: an economic computational model. Vaccine 28: 52925300.[Crossref] [Google Scholar]
  41. PACIFIC Exchange Rate Service, , 2010. Today's Exchange Rates: Thursday, June 3, 2010. Vancouver: Bank of Canada. [Google Scholar]
  42. Shepard DS, Gold MR, Siegel JE, Russell LB, Weinstein MC, , 1999. Cost-effectiveness in Health and Medicine. , eds. New York: Oxford University Press. J Ment Health Policy Econ 2: 9192.[Crossref] [Google Scholar]
  43. Sundar S, Mehta H, Suresh AV, Singh SP, Rai M, Murray HW, , 2004. Amphotericin B treatment for Indian visceral leishmaniasis: conventional versus lipid formulations. Clin Infect Dis 38: 377383.[Crossref] [Google Scholar]
  44. Singh UK, Prasad R, Jaiswal BP, Singh PK, Thakur CP, , 2010. Amphotericin B therapy in children with visceral leishmaniasis: daily vs. alternate day, a randomized trial. J Trop Pediatr 47: 749751. [Google Scholar]
  45. World Health Organization, 2004. Global Burden of Disease 2004 Update: Disability Weights for Diseases and Conditions. Geneva: World Health Organization. [Google Scholar]
  46. World Health Organization, 2010. Health statistics and health information systems: Disability weights, discounting and age weighting of DALYs. Available at: http://www.who.int/healthinfo/global_burden_disease/daly_disability_weight/en/index.html. Accessed May 25, 2010. [Google Scholar]
  47. Lopez AD, Ezzati M, Jamison DT, Murray CJL, , 2006. Global Burden of Disease and Risk Factors. Washington, DC: The World Bank and Oxford University Press.[Crossref] [Google Scholar]
  48. Sundar S, Chakravarty J, Agarwal D, Rai M, Murray HW, , 2010. Single-dose liposomal amphotericin B for visceral leishmaniasis in India. N Engl J Med 362: 504512.[Crossref] [Google Scholar]
  49. Croft SL, Sundar S, Fairlamb AH, , 2006. Drug resistance in leishmaniasis. Clin Microbiol Rev 19: 111126.[Crossref] [Google Scholar]
  50. Picado A, Das ML, Kumar V, Kesari S, Dinesh DS, Roy L, Rijal S, Das P, Rowland M, Sundar S, Coosemans M, Boelaert M, Davies CR, , 2010. Effect of village-wide use of long-lasting insecticidal nets on visceral leishmaniasis vectors in India and Nepal: a cluster randomized trial. PLoS Negl Trop Dis 4: e587.[Crossref] [Google Scholar]
  51. Mathur P, Samantaray JC, Vajpayee M, Samanta P, , 2006. Visceral leishmaniasis/human immunodeficiency virus co-infection in India: the focus of two epidemics. J Med Microbiol 55: 919922.[Crossref] [Google Scholar]

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  • Received : 22 Jul 2010
  • Accepted : 27 Nov 2011
  • Published online : 01 Mar 2012

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