ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Schroeder J, Aebischer T, 2011. Vaccine for leishmaniasis from proteome to vaccine candidates. Hum Vaccin 7 (Suppl 1): 6.
-
2.
Alvar J, Velez ID, Bern C, Herrero M, Desjeux P, Cano J, Jannin J, den Boer M; WHO Leishmaniasis Control Team, 2012. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 7: e35671.
-
3.
Singh SP, Reddy DC, Rai M, Sundar S, 2006. Serious underreporting of visceral leishmaniasis through passive case reporting in Bihar, India. Trop Med Int Health 11: 899–905.
-
4.
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: 9–11.
-
5.
WHO, 2014. Leishmaniasis: Magnitude of the Problem. Available at: http://www.who.int/leishmaniasis/burden/magnitude/burden_magnitude/en/.
-
6.
Wagstaff A, 2002. Poverty and health sector inequalities. Bull World Health Organ 80: 97–105.
-
7.
Yamey G, Torreele E, 2002. The world's most neglected diseases. BMJ 325: 176–177.
-
8.
Alvar J, Yactayo S, Bern C, 2006. Leishmaniasis and poverty. Trends Parasitol 22: 552–557.
-
9.
Rijal S, Koirala S, Van der Stuyft P, Boelaert M, 2006. The economic burden of visceral leishmaniasis for households in Nepal. Trans R Soc Trop Med Hyg 100: 838–841.
-
10.
Adhikari SR, Maskay NM, Sharma BP, 2009. Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences. Health Policy Plan 24: 129–139.
-
11.
Uranw S, Meheus F, Baltussen R, Rijal S, Boelaert M, 2013. The household costs of visceral leishmaniasis care in south-eastern Nepal. PLoS Negl Trop Dis 7: e2062.
-
12.
Sarnoff R, Desai J, Desjeux P, Mittal A, Topno R, Siddiqui NA, Pandey A, Sur D, Das P, 2010. The economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India. Trop Med Int Health 15 (Suppl 2): 42–49.
-
13.
Okwa OO, 2007. Tropical parasitic diseases and women. Ann Afr Med 6: 157–163.
-
14.
Velez ID, Hendrickx E, Robledo SM, del Pilar Agudelo S, 2001. Gender and cutaneous leishmaniasis in Colombia [in Spanish]. Cad Saude Publica 17: 171–180.
-
15.
Rathgeber EM, Vlassoff C, 1993. Gender and tropical diseases: a new research focus. Soc Sci Med 37: 513–520.
-
16.
Vlassoff C, Manderson L, 1998. Incorporating gender in the anthropology of infectious diseases. Trop Med Int Health 3: 1011–1019.
-
17.
Vlassoff C, 2007. Gender differences in determinants and consequences of health and illness. J Health Popul Nutr 25: 47–61.
-
18.
Ranjan A, Sur D, Singh VP, Siddique NA, Manna B, Lal CS, Sinha PK, Kishore K, Bhattacharya SK, 2005. Risk factors for Indian kala-azar. Am J Trop Med Hyg 73: 74–78.
-
19.
Bern C, Hightower AW, Chowdhury R, Ali M, Amann J, Wagatsuma Y, Haque R, Kurkjian K, Vaz LE, Begum M, Akter T, Cetre-Sossah CB, Ahluwalia IB, Dotson E, Secor WE, Breiman RF, Maguire JH, 2005. Risk factors for kala-azar in Bangladesh. Emerg Infect Dis 11: 655–662.
-
20.
Barnett PG, Singh SP, Bern C, Hightower AW, Sundar S, 2005. Virgin soil: the spread of visceral leishmaniasis into Uttar Pradesh, India. Am J Trop Med Hyg 73: 720–725.
-
21.
Sheets D, Mubayi A, Kojouharov HV, 2010. Impact of socio-economic conditions on the incidence of visceral leishmaniasis in Bihar, India. Int J Environ Health Res 20: 415–430.
-
22.
Costa CH, Werneck GL, Rodrigues L Jr, Santos MV, Araújo IB, Moura LS, Moreira S, Gomes RB, Lima SS, 2005. Household structure and urban services: neglected targets in the control of visceral leishmaniasis. Ann Trop Med Parasitol 99: 229–236.
-
23.
Tesh RB, 1995. Control of zoonotic visceral leishmaniasis: is it time to change strategies? Am J Trop Med Hyg 52: 287–292.
-
24.
Desjeux P, 2004. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 27: 305–318.
-
25.
Reithinger R, Aadil K, Kolaczinski J, Mohsen M, Hami S, 2005. Social impact of leishmaniasis, Afghanistan. Emerg Infect Dis 11: 634–636.
-
26.
Pascual Martinez F, Picado A, Roddy P, Palma P, 2012. Low castes have poor access to visceral leishmaniasis treatment in Bihar, India. Trop Med Int Health 17: 666–673.
-
27.
Homsi Y, Makdisi G, 2010. Leishmaniasis: a forgotten disease among neglected people. Int J Health 11: 2.
-
28.
Mondal D, Singh SP, Kumar N, Joshi A, Sundar S, Das P, Siddhivinayak H, Kroeger A, Boelaert M, 2009. Visceral leishmaniasis elimination programme in India, Bangladesh, and Nepal: reshaping the case finding/case management strategy. PLoS Negl Trop Dis 3: e355.
-
29.
Zaph C, Uzonna J, Beverley SM, Scott P, 2004. Central memory T cells mediate long-term immunity to Leishmania major in the absence of persistent parasites. Nat Med 10: 1104–1110.
-
30.
Peters NC, Kimblin N, Secundino N, Kamhawi S, Lawyer P, Sacks DL, 2009. Vector transmission of Leishmania abrogates vaccine-induced protective immunity. PLoS Pathog 5: e1000484.
-
31.
Uzonna JE, Wei G, Yurkowski D, Bretscher P, 2001. Immune elimination of Leishmania major in mice: implications for immune memory, vaccination, and reactivation disease. J Immunol 167: 6967–6974.
-
32.
Okwor I, Kuriakose S, Uzonna J, 2010. Repeated inoculation of killed Leishmania major induces durable immune response that protects mice against virulent challenge. Vaccine 28: 5451–5457.
-
33.
Bhowmick S, Mazumdar T, Sinha R, Ali N, 2010. Comparison of liposome based antigen delivery systems for protection against Leishmania donovani. J Control Release 141: 199–207.
-
34.
Doroud D, Zahedifard F, Vatanara A, Najafabadi AR, Taslimi Y, Vahabpour R, Torkashvand F, Vaziri B, Rafati S, 2011. Delivery of a cocktail DNA vaccine encoding cysteine proteinases type I, II and III with solid lipid nanoparticles potentiate protective immunity against Leishmania major infection. J Control Release 153: 154–162.
-
35.
Doroud D, Zahedifard F, Vatanara A, Najafabadi AR, Rafati S. Cysteine proteinase type I, encapsulated in solid lipid nanoparticles induces substantial protection against Leishmania major infection in C57BL/6 mice. Parasite Immunol 33: 335–348.
-
36.
van Thiel PP, Leenstra T, de Vries HJ, van der Sluis A, van Gool T, Krull AC, van Vugt M, de Vries PJ, Zeegelaar JE, Bart A, van der Meide WF, Schallig HD, Faber WR, Kager PA, 2010. Cutaneous leishmaniasis (Leishmania major infection) in Dutch troops deployed in northern Afghanistan: epidemiology, clinical aspects, and treatment. Am J Trop Med Hyg 83: 1295–1300.
-
37.
Glennie JS, Bailey MS, 2010. UK Role 4 military infectious diseases at Birmingham Heartlands Hospital in 2005–9. J R Army Med Corps 156: 162–164.
-
38.
Pavli A, Maltezou HC, 2010. Leishmaniasis, an emerging infection in travelers. Int J Infect Dis 14: e1032–e1039.
-
39.
Herbinger KH, Siess C, Nothdurft HD, von Sonnenburg F, Loscher T, 2011. Skin disorders among travellers returning from tropical and non-tropical countries consulting a travel medicine clinic. Trop Med Int Health 16: 1457–1464.
-
40.
Field V, Gautret P, Schlagenhauf P, Burchard GD, Caumes E, Jensenius M, Castelli F, Gkrania-Klotsas E, Weld L, Lopez-Velez R, de Vries P, von Sonnenburg F, Loutan L, Parola P; EuroTravNet Network, 2010. Travel and migration associated infectious diseases morbidity in Europe, 2008. BMC Infect Dis 10: 330.
-
41.
den Boer M, Argaw D, Jannin J, Alvar J, 2011. Leishmaniasis impact and treatment access. Clin Microbiol Infect 17: 1471–1477.
-
42.
DutchNews, 2008. Dutch Doctors Uncover Fake Bangladesh Medicine. Available at: DutchNews.nl. Accessed March 29, 2014.
-
43.
Sundar S, 2001. Drug resistance in Indian visceral leishmaniasis. Trop Med Int Health 6: 849–854.
-
44.
Bastien P, 2011. Leishmaniases control: what part for development and what part for research? Clin Microbiol Infect 17: 1449–1450.
-
45.
Alvar J, Croft S, Olliaro P, 2006. Chemotherapy in the treatment and control of leishmaniasis. Adv Parasitol 61: 223–274.
-
46.
Desjeux P, 2001. The increase in risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg 95: 239–243.
-
47.
Adhikari SR, Supakankunti S, 2010. A cost benefit analysis of elimination of kala-azar in Indian subcontinent: an example of Nepal. J Vector Borne Dis 47: 127–139.
-
48.
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: 360–364.
-
49.
WHO, 2010. Control of the Leishmaniasis: WHO Expert Committee on the Control of Leishmaniasis. Geneva, Switzerland: World Health Organization.
-
50.
Saberi S, Zamani A, Motamedi N, Nilforoushzadeh MA, Jaffary F, Rahimi E, Hejazi SH, 2012. The knowledge, attitude, and prevention practices of students regarding cutaneous leishmaniasis in the hyperendemic region of the Shahid Babaie Airbase. Vector Borne Zoonotic Dis 12: 306–309.
-
51.
Gouveia C, de Oliveira RM, Zwetsch A, Motta-Silva D, Carvalho BM, de Santana AF, Rangel EF, 2012. Integrated tools for American cutaneous leishmaniasis surveillance and control: intervention in an endemic area in Rio de Janeiro, RJ, Brazil. Interdiscip Perspect Infect Dis 2012: 568312.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1908 | 1517 | 188 |
| Full Text Views | 2239 | 122 | 1 |
| PDF Downloads | 1524 | 55 | 0 |
Social and Economic Burden of Human Leishmaniasis
Ifeoma Okwor
Ifeoma Okwor
Department of Medical Microbiology, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada; Department of Immunology, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
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Jude Uzonna
Jude Uzonna
Department of Medical Microbiology, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada; Department of Immunology, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
Search for other papers by Jude Uzonna in
Current site
Google Scholar
PubMed
Search for other papers by Jude Uzonna in
Current site
Google Scholar
PubMed
Leishmaniasis continues to pose a major public health problem worldwide. With new epidemics occurring in endemic areas and the spread of the disease to previously free areas because of migration, tourism, and military activities, there is a great need for the development of an effective vaccine. Leishmaniasis is a disease of the poor, occurring mostly in remote rural villages with poor housing and little or no access to modern health-care facilities. In endemic areas, diagnosis of any form of leishmaniasis puts a huge financial strain on an already meagre financial resource at both the individual and community levels. Most often families need to sell their assets (land and livestock) or take loans from informal financial outfits with heavy interest rates to pay for the diagnosis and treatment of leishmaniasis. Here, we discuss the disease with special emphasis on its socioeconomic impact on the affected individual and community. In addition, we highlight the reasons why continued research aimed at developing an effective Leishmania vaccine is necessary.
Author Notes
Authors' addresses: Ifeoma Okwor, Department of Medical Microbiology, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada, E-mail: umokwor@myumanitoba.ca. Jude Uzonna, Department of Immunology, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada, E-mail: jude.uzonna@med.umanitoba.ca.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Schroeder J, Aebischer T, 2011. Vaccine for leishmaniasis from proteome to vaccine candidates. Hum Vaccin 7 (Suppl 1): 6.
-
2.
Alvar J, Velez ID, Bern C, Herrero M, Desjeux P, Cano J, Jannin J, den Boer M; WHO Leishmaniasis Control Team, 2012. Leishmaniasis worldwide and global estimates of its incidence. PLoS One 7: e35671.
-
3.
Singh SP, Reddy DC, Rai M, Sundar S, 2006. Serious underreporting of visceral leishmaniasis through passive case reporting in Bihar, India. Trop Med Int Health 11: 899–905.
-
4.
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: 9–11.
-
5.
WHO, 2014. Leishmaniasis: Magnitude of the Problem. Available at: http://www.who.int/leishmaniasis/burden/magnitude/burden_magnitude/en/.
-
6.
Wagstaff A, 2002. Poverty and health sector inequalities. Bull World Health Organ 80: 97–105.
-
7.
Yamey G, Torreele E, 2002. The world's most neglected diseases. BMJ 325: 176–177.
-
8.
Alvar J, Yactayo S, Bern C, 2006. Leishmaniasis and poverty. Trends Parasitol 22: 552–557.
-
9.
Rijal S, Koirala S, Van der Stuyft P, Boelaert M, 2006. The economic burden of visceral leishmaniasis for households in Nepal. Trans R Soc Trop Med Hyg 100: 838–841.
-
10.
Adhikari SR, Maskay NM, Sharma BP, 2009. Paying for hospital-based care of Kala-azar in Nepal: assessing catastrophic, impoverishment and economic consequences. Health Policy Plan 24: 129–139.
-
11.
Uranw S, Meheus F, Baltussen R, Rijal S, Boelaert M, 2013. The household costs of visceral leishmaniasis care in south-eastern Nepal. PLoS Negl Trop Dis 7: e2062.
-
12.
Sarnoff R, Desai J, Desjeux P, Mittal A, Topno R, Siddiqui NA, Pandey A, Sur D, Das P, 2010. The economic impact of visceral leishmaniasis on rural households in one endemic district of Bihar, India. Trop Med Int Health 15 (Suppl 2): 42–49.
-
13.
Okwa OO, 2007. Tropical parasitic diseases and women. Ann Afr Med 6: 157–163.
-
14.
Velez ID, Hendrickx E, Robledo SM, del Pilar Agudelo S, 2001. Gender and cutaneous leishmaniasis in Colombia [in Spanish]. Cad Saude Publica 17: 171–180.
-
15.
Rathgeber EM, Vlassoff C, 1993. Gender and tropical diseases: a new research focus. Soc Sci Med 37: 513–520.
-
16.
Vlassoff C, Manderson L, 1998. Incorporating gender in the anthropology of infectious diseases. Trop Med Int Health 3: 1011–1019.
-
17.
Vlassoff C, 2007. Gender differences in determinants and consequences of health and illness. J Health Popul Nutr 25: 47–61.
-
18.
Ranjan A, Sur D, Singh VP, Siddique NA, Manna B, Lal CS, Sinha PK, Kishore K, Bhattacharya SK, 2005. Risk factors for Indian kala-azar. Am J Trop Med Hyg 73: 74–78.
-
19.
Bern C, Hightower AW, Chowdhury R, Ali M, Amann J, Wagatsuma Y, Haque R, Kurkjian K, Vaz LE, Begum M, Akter T, Cetre-Sossah CB, Ahluwalia IB, Dotson E, Secor WE, Breiman RF, Maguire JH, 2005. Risk factors for kala-azar in Bangladesh. Emerg Infect Dis 11: 655–662.
-
20.
Barnett PG, Singh SP, Bern C, Hightower AW, Sundar S, 2005. Virgin soil: the spread of visceral leishmaniasis into Uttar Pradesh, India. Am J Trop Med Hyg 73: 720–725.
-
21.
Sheets D, Mubayi A, Kojouharov HV, 2010. Impact of socio-economic conditions on the incidence of visceral leishmaniasis in Bihar, India. Int J Environ Health Res 20: 415–430.
-
22.
Costa CH, Werneck GL, Rodrigues L Jr, Santos MV, Araújo IB, Moura LS, Moreira S, Gomes RB, Lima SS, 2005. Household structure and urban services: neglected targets in the control of visceral leishmaniasis. Ann Trop Med Parasitol 99: 229–236.
-
23.
Tesh RB, 1995. Control of zoonotic visceral leishmaniasis: is it time to change strategies? Am J Trop Med Hyg 52: 287–292.
-
24.
Desjeux P, 2004. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 27: 305–318.
-
25.
Reithinger R, Aadil K, Kolaczinski J, Mohsen M, Hami S, 2005. Social impact of leishmaniasis, Afghanistan. Emerg Infect Dis 11: 634–636.
-
26.
Pascual Martinez F, Picado A, Roddy P, Palma P, 2012. Low castes have poor access to visceral leishmaniasis treatment in Bihar, India. Trop Med Int Health 17: 666–673.
-
27.
Homsi Y, Makdisi G, 2010. Leishmaniasis: a forgotten disease among neglected people. Int J Health 11: 2.
-
28.
Mondal D, Singh SP, Kumar N, Joshi A, Sundar S, Das P, Siddhivinayak H, Kroeger A, Boelaert M, 2009. Visceral leishmaniasis elimination programme in India, Bangladesh, and Nepal: reshaping the case finding/case management strategy. PLoS Negl Trop Dis 3: e355.
-
29.
Zaph C, Uzonna J, Beverley SM, Scott P, 2004. Central memory T cells mediate long-term immunity to Leishmania major in the absence of persistent parasites. Nat Med 10: 1104–1110.
-
30.
Peters NC, Kimblin N, Secundino N, Kamhawi S, Lawyer P, Sacks DL, 2009. Vector transmission of Leishmania abrogates vaccine-induced protective immunity. PLoS Pathog 5: e1000484.
-
31.
Uzonna JE, Wei G, Yurkowski D, Bretscher P, 2001. Immune elimination of Leishmania major in mice: implications for immune memory, vaccination, and reactivation disease. J Immunol 167: 6967–6974.
-
32.
Okwor I, Kuriakose S, Uzonna J, 2010. Repeated inoculation of killed Leishmania major induces durable immune response that protects mice against virulent challenge. Vaccine 28: 5451–5457.
-
33.
Bhowmick S, Mazumdar T, Sinha R, Ali N, 2010. Comparison of liposome based antigen delivery systems for protection against Leishmania donovani. J Control Release 141: 199–207.
-
34.
Doroud D, Zahedifard F, Vatanara A, Najafabadi AR, Taslimi Y, Vahabpour R, Torkashvand F, Vaziri B, Rafati S, 2011. Delivery of a cocktail DNA vaccine encoding cysteine proteinases type I, II and III with solid lipid nanoparticles potentiate protective immunity against Leishmania major infection. J Control Release 153: 154–162.
-
35.
Doroud D, Zahedifard F, Vatanara A, Najafabadi AR, Rafati S. Cysteine proteinase type I, encapsulated in solid lipid nanoparticles induces substantial protection against Leishmania major infection in C57BL/6 mice. Parasite Immunol 33: 335–348.
-
36.
van Thiel PP, Leenstra T, de Vries HJ, van der Sluis A, van Gool T, Krull AC, van Vugt M, de Vries PJ, Zeegelaar JE, Bart A, van der Meide WF, Schallig HD, Faber WR, Kager PA, 2010. Cutaneous leishmaniasis (Leishmania major infection) in Dutch troops deployed in northern Afghanistan: epidemiology, clinical aspects, and treatment. Am J Trop Med Hyg 83: 1295–1300.
-
37.
Glennie JS, Bailey MS, 2010. UK Role 4 military infectious diseases at Birmingham Heartlands Hospital in 2005–9. J R Army Med Corps 156: 162–164.
-
38.
Pavli A, Maltezou HC, 2010. Leishmaniasis, an emerging infection in travelers. Int J Infect Dis 14: e1032–e1039.
-
39.
Herbinger KH, Siess C, Nothdurft HD, von Sonnenburg F, Loscher T, 2011. Skin disorders among travellers returning from tropical and non-tropical countries consulting a travel medicine clinic. Trop Med Int Health 16: 1457–1464.
-
40.
Field V, Gautret P, Schlagenhauf P, Burchard GD, Caumes E, Jensenius M, Castelli F, Gkrania-Klotsas E, Weld L, Lopez-Velez R, de Vries P, von Sonnenburg F, Loutan L, Parola P; EuroTravNet Network, 2010. Travel and migration associated infectious diseases morbidity in Europe, 2008. BMC Infect Dis 10: 330.
-
41.
den Boer M, Argaw D, Jannin J, Alvar J, 2011. Leishmaniasis impact and treatment access. Clin Microbiol Infect 17: 1471–1477.
-
42.
DutchNews, 2008. Dutch Doctors Uncover Fake Bangladesh Medicine. Available at: DutchNews.nl. Accessed March 29, 2014.
-
43.
Sundar S, 2001. Drug resistance in Indian visceral leishmaniasis. Trop Med Int Health 6: 849–854.
-
44.
Bastien P, 2011. Leishmaniases control: what part for development and what part for research? Clin Microbiol Infect 17: 1449–1450.
-
45.
Alvar J, Croft S, Olliaro P, 2006. Chemotherapy in the treatment and control of leishmaniasis. Adv Parasitol 61: 223–274.
-
46.
Desjeux P, 2001. The increase in risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg 95: 239–243.
-
47.
Adhikari SR, Supakankunti S, 2010. A cost benefit analysis of elimination of kala-azar in Indian subcontinent: an example of Nepal. J Vector Borne Dis 47: 127–139.
-
48.
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: 360–364.
-
49.
WHO, 2010. Control of the Leishmaniasis: WHO Expert Committee on the Control of Leishmaniasis. Geneva, Switzerland: World Health Organization.
-
50.
Saberi S, Zamani A, Motamedi N, Nilforoushzadeh MA, Jaffary F, Rahimi E, Hejazi SH, 2012. The knowledge, attitude, and prevention practices of students regarding cutaneous leishmaniasis in the hyperendemic region of the Shahid Babaie Airbase. Vector Borne Zoonotic Dis 12: 306–309.
-
51.
Gouveia C, de Oliveira RM, Zwetsch A, Motta-Silva D, Carvalho BM, de Santana AF, Rangel EF, 2012. Integrated tools for American cutaneous leishmaniasis surveillance and control: intervention in an endemic area in Rio de Janeiro, RJ, Brazil. Interdiscip Perspect Infect Dis 2012: 568312.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1908 | 1517 | 188 |
| Full Text Views | 2239 | 122 | 1 |
| PDF Downloads | 1524 | 55 | 0 |