MANAGEMENT OF KALA-AZAR IN BIHAR: SCOPE FOR VACCINE DEVELOPMENT

Leishmania causes a spectrum of diseases globally ranging from self-healing cutaneous to non-healing mucocutaneous and fatal visceral infection forms. Visceral leishmaniasis (VL), caused by the parasite Leishmania donovani, widely affects resource-poor populations in Bihar, India. Post kala-azar dermal leishmaniasis (PKDL) is a sequel of VL. People with PKDL, whose number is gradually on the rise in India, are considered to be a silent parasite pool for transmission of VL. Despite many options, treatment of VL in India is far from satisfactory due to high incidence of PKDL development, drug-resistance, relapse, drug-toxicity, long-dose regimens, need for parenteral administration and high cost. Currently, there is no approved vaccine for human use in leishmaniasis. However, several leishmaniasis vaccine candidates are at various stages of development. Vaccines such as Leish-F1, F2 and F3, are designed based on selected Leishmania antigenic epitopes, have entered the phases of clinical trials. Other groups, including the Sabin Vaccine Institute in collaboration with the National Institutes of Health are working on development of a recombinant Leishmania antigen vaccine with selected sand fly salivary gland antigens targeting to elevate the host immunity status. The state of Bihar in India is heavily affected by VL accounting for over 90% cases of India. In this review, we will discuss the strategies of Leishmaniasis vaccine development, details of vaccines in the developmental pipeline and about future perpectives of an ideal vaccine for effective management of Kala-azar in Bihar.