Pese a avances en diagnóstico, tratamiento y control vectorial, el país enfrenta un desafío persistente: erradicar todas las formas de transmisión del Chagas antes de 2031. El Ministerio de Salud advierte sobre el riesgo creciente y llama a intensificar las acciones en zonas endémicas.
Un enemigo silencioso con rostro rural y vulnerable
En el marco del Día Mundial de la Enfermedad de Chagas, el Ministerio de Salud y Protección Social de Colombia alertó que más de 12 millones de personas en el país se encuentran en riesgo de contraer esta enfermedad parasitaria, transmitida principalmente por el insecto conocido como “pito” (vector del Trypanosoma cruzi) y presente en regiones cálidas y rurales de Colombia.
Según el último informe de vigilancia, 595 municipios del país presentan condiciones favorables para la transmisión vectorial, lo que mantiene activa la circulación del parásito en gran parte del territorio nacional. Solo en 2024, el sistema de vigilancia SIVIGILA confirmó 947 casos crónicos y 18 agudos, uno de ellos con desenlace fatal.
“Eliminación no significa ausencia total de casos, sino control sostenido y prevención eficaz”, afirmó el ministro de Salud, Dr. Guillermo Alfonso Jaramillo. La meta es ambiciosa: eliminar todas las formas de transmisión del Chagas como problema de salud pública antes de 2031, en consonancia con las metas de la Organización Mundial de la Salud (OMS) y la Iniciativa de Eliminación de Enfermedades Transmisibles en las Américas.
Un sistema de vigilancia en expansión, pero con brechas
El esfuerzo institucional ha logrado certificar 66 municipios como “libres de transmisión vectorial intradomiciliaria”, y otros 34 están en proceso de certificación. Además, Colombia tamiza el 100 % de las unidades de sangre donadas, lo que ha evitado nuevos contagios por transfusiones.
Uno de los avances clave es la implementación de la Ruta Integral de Atención en Salud (RIAS) para Chagas, que promueve el diagnóstico oportuno y el tratamiento desde el primer nivel de atención. Aunque esta ruta aún no tiene cobertura nacional, ha mostrado mejoras en acceso a medicamentos y calidad del tratamiento en las zonas donde está activa.
No obstante, persisten desafíos significativos. En zonas endémicas, el diagnóstico sigue siendo tardío, las condiciones de las viviendas favorecen la presencia del vector, y los equipos de salud carecen en muchos casos de formación específica para el abordaje clínico de la enfermedad.
Chagas congénito: una forma prevenible que aún persiste
Entre 2019 y 2024, se realizaron más de 382.000 tamizajes a mujeres gestantes, lo que permitió detectar 528 casos positivos y reducir el riesgo de transmisión de madre a hijo. Esta forma de transmisión conocida como Chagas congénito sigue siendo una preocupación prioritaria, especialmente en regiones con alta dispersión geográfica y limitada cobertura prenatal.
El Ministerio recomienda realizar controles prenatales sistemáticos en mujeres embarazadas, con énfasis en zonas de alta prevalencia. El tratamiento para madres e hijos está incluido en el Plan de Beneficios en Salud (PBS) y debe garantizarse sin barreras de acceso.
Comunidades indígenas: mayor riesgo, menor protección
Una de las poblaciones más vulnerables frente al Chagas en Colombia es la indígena. Según los reportes de vigilancia, el 28 % de los casos crónicos registrados en 2024 correspondieron a comunidades indígenas, lo que refleja un alto nivel de exposición y una baja capacidad de respuesta institucional en territorios donde las condiciones ambientales y socioeconómicas favorecen la reproducción del vector.
Además de la transmisión por el “pito”, el Ministerio advirtió que el Chagas también puede propagarse por vía oral (alimentos contaminados), transfusiones de sangre inseguras, trasplantes de órganos y durante el embarazo. Esta diversidad en las formas de transmisión exige una estrategia multisectorial, territorial y culturalmente adecuada.
Educación, vivienda digna y control vectorial: claves para la prevención
El control del Chagas requiere más que tamizajes o medicamentos. Exige intervenciones estructurales en el entorno. El Ministerio ha señalado tres medidas clave para la prevención:
- Mejorar las condiciones de las viviendas para impedir la colonización por insectos triatominos, lo que incluye instalación de barreras físicas en puertas y ventanas, manejo del entorno doméstico y control de criaderos.
- Higiene alimentaria estricta, especialmente en áreas rurales, para evitar la transmisión oral del parásito.
- Controles prenatales regulares, enfocados en mujeres embarazadas que viven en zonas de riesgo o pertenecen a comunidades con alta endemicidad.
Desde abril de 2025, el país adelanta jornadas de sensibilización bajo el lema: “Para la prevención, control y eliminación del Chagas, todos somos necesarios”, involucrando actores comunitarios, equipos de salud y gobiernos locales.
Colombia ante el reto 2031: ¿es viable la eliminación?
Eliminar la enfermedad de Chagas como problema de salud pública para 2031, tal como lo plantea la OMS, es una meta ambiciosa pero no inalcanzable. Colombia cuenta con los insumos técnicos, los marcos normativos y el respaldo político para avanzar, pero el éxito dependerá de cinco factores clave:
- Extender la RIAS para Chagas a nivel nacional, con recursos específicos y personal capacitado.
- Asegurar el financiamiento continuo para actividades de control vectorial en municipios con alta transmisión.
- Fortalecer la vigilancia activa en población indígena, rural y dispersa.
- Ampliar los programas de educación comunitaria, con enfoque intercultural.
- Mejorar la articulación entre niveles territoriales de gobierno, asegurando que los planes departamentales y municipales prioricen esta enfermedad.
En palabras del ministro Jaramillo: “No podemos permitir que una enfermedad prevenible siga afectando a los más vulnerables. La eliminación del Chagas es una causa de justicia social y salud pública”.
Del olvido a la acción: el desafío de erradicar el Chagas en Colombia
El Chagas ha sido históricamente una enfermedad “silenciosa”, invisibilizada por su perfil crónico y por afectar principalmente a comunidades empobrecidas y rurales. Pero los datos no mienten: sigue cobrando vidas, mantiene activos cientos de focos de transmisión y compromete la salud de millones de colombianos.
Si Colombia quiere cumplir con las metas del 2031 y consolidar una respuesta efectiva, necesita pasar del control parcial a una estrategia integral, sostenible y basada en la equidad. La enfermedad de Chagas no es solo un problema médico; es un síntoma de desigualdad estructural. Erradicarla será, sin duda, un logro colectivo para la salud pública nacional.
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