Box 5.

New targets for vaccination—sandfly saliva

• Sandfly saliva contains a variety of immunogenic proteins, including some that enhance parasite survival by inhibiting macrophage function^w28
• Vaccine induced immunity to saliva stimulates a vigorous delayed type hypersensitivity response after a bite, generating conditions unfavourable for parasite survival^w29
• The effectiveness of this approach in humans remains to be tested
• Epidemiological studies should determine whether natural immunity to saliva dictates patterns of infection