Chagas disease remains a public health problem in Ecuador, with active transmission in several provinces and complex vector dynamics. Its control depends on an epidemiological surveillance system that integrates case reporting, diagnostic confirmation according to the stage of the disease, epidemiological investigation, treatment and clinical follow-up of patients, as well as entomological surveillance, vector control and prevention.

In this context, the laboratory plays a strategic role in transforming clinical suspicion into diagnostic confirmation and generating reliable information for health decision-making.

The presence of Chagas disease in Ecuador dates back to the early 20th century. Seventeen species of triatomine bugs have been identified in the country, of which 13 are epidemiologically relevant to the transmission of the disease (1,2), reflecting the ecological and entomological complexity of Chagas in this context.

Currently, the disease is endemic in Ecuador and mainly affects rural and suburban areas. The distribution of cases shows a higher incidence in the provinces of El Oro, Guayas, Manabí, Pichincha, Loja, Sucumbíos and Orellana (3).

Between 2015 and 2025, 1,187 confirmed cases of Chagas disease were reported, with annual variations in the number of cases. The highest number was recorded in 2021, with 172 cases, corresponding to an approximate rate of 1.01 cases per 100,000 inhabitants. In 2025, 154 cases were reported, with a rate of 0.90 per 100,000 inhabitants. Overall, during the period studied, an average annual number of 108 cases was observed, equivalent to an average reporting rate of approximately 0.63 cases per 100,000 inhabitants. (4).

Epidemiological surveillance is the responsibility of the Ministry of Public Health, through its National Directorate of Epidemiological Surveillance. Case follow-up, in both the acute and chronic phases, is carried out through the Epidemiological Surveillance System (SIVE), in coordination with the “Leopoldo Izquieta Pérez” National Institute of Public Health Research (INSPI), established in 2012 by decree as the successor to the Dr. Leopoldo Izquieta Pérez National Institute of Hygiene and Tropical Medicine. 

This entity participates, through the National Reference Centre for Parasitology and Mycology, in the confirmation of cases in humans and, through the National Vector Centre, in vector control activities. It has offices in Guayaquil (Central), Quito (Northern Region), Cuenca (Southern Region) and Tena (Amazon Region), enabling it to provide a response commensurate with the country’s climatic, ecological and epidemiological diversity.

My professional experience has been built at this level, within the national surveillance system.

The Reference Centre for Parasitology and Mycology in Cuenca was established in 2015 with the aim of strengthening the surveillance and diagnosis of parasitic and fungal diseases. This centre covers the provinces of Azuay, Cañar and Loja (Sierra region); El Oro (Costa region); and Morona Santiago and Zamora Chinchipe (Amazon region).

I was responsible for the implementation of this centre. To get it up and running, a process was developed that included training in various laboratory techniques, the gradual equipping of the facility, the implementation of a Quality Management System in accordance with ISO standards, and the promotion of the service to all units of the Ministry of Public Health in southern Ecuador.

The Centre’s functions were focused on carrying out specialised tests to confirm parasitic and fungal diseases, and on training Ministry of Public Health (MSP) staff in epidemiological surveillance, diagnosis and control of diseases such as Chagas and Leishmania. Furthermore, manuals were developed for the correct collection, storage and dispatch of samples; opportunities for the continuous training of MSP staff were strengthened—particularly in the diagnosis of leishmaniasis—and the development of research proposals in collaboration with national and international institutions was promoted.

During the Reference Centre’s eleven years of operation, various initiatives have been implemented to strengthen epidemiological surveillance, diagnosis and awareness of Chagas disease in southern Ecuador. Some of the key outcomes achieved during this period are outlined below:

  • Having healthcare staff trained in the epidemiological surveillance of Chagas disease.
  • Establishing an epidemiological baseline for Chagas disease in the south of the country, which enabled the characterization of positive cases according to demographic and epidemiological variables such as age group, sex, occupation and place of origin, amongst other relevant factors.
  • Supporting the active case finding of Chagas disease through interventions in population groups in endemic areas, in coordination with health personnel from the Ministry of Public Health (MSP).
  • Strengthen epidemiological surveillance of Chagas disease in pregnant women and in newborns of positive mothers, as well as in organ transplant units and blood banks.

Ecuador tackles Chagas disease through multilateral technical cooperation aligned with the strategies of the Pan American Health Organization and the World Health Organization, complemented by regional networks and international research projects.

At the same time, the epidemiological dynamics of the disease in the country have changed due to environmental, social and demographic factors that have altered traditional patterns of transmission.

Added to this is the rise in eco-tourism and sporting activities in natural environments, which draw people with no prior exposure to highly endemic areas, often without any knowledge of the disease or preventive measures. Furthermore, forest fires and ecosystem disruption encourage the movement of vectors towards peri-urban areas and human dwellings, increasing the risk of contact with the population.

From the perspective of epidemiological surveillance, these changes necessitate a rethinking of traditional control strategies. The risk of contracting Chagas disease is no longer limited exclusively to historically endemic rural communities, but extends to new territories and populations, reinforcing the need for dynamic, cross-sectoral surveillance adapted to the country’s environmental and social changes.

Throughout my professional career, I have also learnt that no health system is perfect in absolute terms; all have room for improvement. Building a more robust system depends not only on technology, but also on teams that are more human, approachable and empathetic.

Today we live in an era of major technological advances that have transformed the diagnosis of infectious diseases. Tools such as molecular biology, big data analysis and predictive systems offer unprecedented opportunities. However, in diseases such as Chagas, where treatment remains a challenge, diagnostic innovation must be accompanied by new therapeutic approaches.

Laboratory practice shows that a result does not represent the end of the road, but a starting point. Diagnosing Chagas is more than just identifying a parasite: it brings to light a historically neglected disease and opens the door to a more timely, equitable and humane healthcare response. 

References:

  1. Grijalva MJ, Villacís AG, Ocaña-Mayorga S, Yumiseva CA, Baus EG. Limitations of selective deltamethrin application for triatomine control in central coastal Ecuador. Parasites & Vectors. 2011; 4:20. 
  2. Soto-Vivas A, Reyes-Lugo M, et al. Triatominae (Hemiptera: Reduviidae) and their epidemiological importance in Latin America. 2018.
  3. Ministerio de Salud Pública del Ecuador. MSP intensifica estrategias para prevenir la enfermedad de Chagas[cited 11 March 2026]. Available from: https://www.salud.gob.ec/msp-intensifica-estrategias-para-prevenir-la-enfermedad-de-chagas/
  4. Ministerio de Salud Pública del Ecuador. Gacetas vectoriales [Internet]. Quito: Ministerio de Salud Pública [cited 12 March 2026]. Available from: https://www.salud.gob.ec/gacetas-vectoriales/