The potential economic value of a cutaneous leishmaniasis vaccine in seven endemic countries in the Americas.
ABSTRACT Cutaneous leishmaniasis (CL) and its associated complications, including mucocutaneous leishmaniasis (MCL) and diffuse CL (DCL) have emerged as important neglected tropical diseases in Latin America, especially in areas associated with human migration, conflict, and recent deforestation. Because of the limitations of current chemotherapeutic approaches to CL, MCL, and DCL, several prototype vaccines are in different states of product and clinical development. We constructed and utilized a Markov decision analytic computer model to evaluate the potential economic value of a preventative CL vaccine in seven countries in Latin America: Bolivia, Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela. The results indicated that even a vaccine with a relative short duration of protection and modest efficacy could be recommended for use in targeted locations, as it could prevent a substantial number of cases at low-cost and potentially even result in cost savings. If the population in the seven countries were vaccinated using a vaccine that provides at least 10 years of protection, an estimated 41,000-144,784 CL cases could be averted, each at a cost less than the cost of current recommended treatments. Further, even a vaccine providing as little as five years duration of protection with as little as 50% efficacy remains cost-effective compared with chemotherapy; additional scenarios resembling epidemic settings such as the one that occurred in Chaparral, Colombia in 2004 demonstrates important economic benefits.
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ABSTRACT: Cutaneous leishmaniasis (CL) is a vector-borne disease of increasing importance in northeastern Brazil. It is known that sandflies, which spread the causative parasites, have weather-dependent population dynamics. Routinely-gathered weather data may be useful for anticipating disease risk and planning interventions.PLoS Neglected Tropical Diseases 10/2014; 8(10):e3283. · 4.49 Impact Factor
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ABSTRACT: Convergence of geographic regions endemic for human immunodeficiency virus (HIV) and cutaneous leishmaniasis (CL) raise concerns that HIV co-infection may worsen CL burden, complicating already lengthy and costly CL treatments and highlighting a need for newer therapies. We constructed two Markov decision models to quantify impact of HIV on CL and help establish a target product profile for new CL treatments, accounting for co-infection. The HIV co-infection increased lifetime cost per CL case 11-371 times ($1,349-45,683) that of HIV-negative individuals ($123) and Brazil's CL burden from $1.6-16.0 million to $1.6-65.5 million. A new treatment could be a cost saving at ≤ $254 across several ranges (treatments seeking probabilities, side effect risks, cure rates) and continues to save costs up to $508 across treatment-seeking probabilities with a drug cure rate of ≥ 50%. The HIV co-infection can increase CL burden, suggesting more joint HIV and CL surveillance and control efforts are needed.The American journal of tropical medicine and hygiene 07/2014; · 2.74 Impact Factor
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ABSTRACT: Arthropods are a significant cause of human skin lesions and infections, especially in Latin America. This review summarizes recent articles on the cutaneous manifestations of arthropod-borne diseases, with an emphasis on those diseases causing direct skin damage but also considering those systemic diseases with cutaneous manifestations. Studies have shown a variety and increase of cutaneous manifestations caused by arthropod-borne infections, including petechiae, purpura, ulcers, nodules, atrophic, miliary and hyperpigmented lesions. Although unspecific, when considering other features they become a useful tool in the diagnostic approach. Unusual cutaneous presentation of these diseases has been found to be associated with development of immunity, virulent strain, drug resistance and immunosuppressive states. Also, because of globalization, climate change and large-scale migration, these manifestations have spread to new areas. Cutaneous manifestations of arthropod-borne infections are varied and nonspecific. Their atypical presentations are mainly related to immune impairment and strain virulence. When considering a patient with skin lesions, other clinical and laboratory features must be taken into account in order to make an accurate diagnostic approach.Current Opinion in Infectious Diseases 03/2014; 27(3):288-294. · 5.03 Impact Factor