Beyond dengue: arbovirus surveillance and laboratory diagnostic strategies in Panama

Abstract

Dengue is the most important arboviral disease in Panama and represents a growing challenge for epidemiological surveillance, diagnosis, and public health response. This narrative review describes the historical and epidemiological evolution of dengue in the country, as well as the development of virological surveillance and laboratory diagnostic strategies. Official epidemiological reports from the Ministry of Health, national regulatory documents, and peer-reviewed scientific literature retrieved through searches of PubMed, Scopus, and Google Scholar were integrated. Following the reinfestation by Aedes aegypti in 1985 and confirmation of the first autochthonous case in 1993, Panama experienced recurrent epidemics and the successive or simultaneous circulation of all four dengue virus serotypes. The epidemiological situation reached critical levels between 2023 and 2025: in 2024, 32,077 cases, 252 severe cases, and 52 deaths were confirmed. Concurrently, the introduction of chikungunya and Zika and the re-emergence of Oropouche virus increased the complexity of differential diagnosis. Diagnostic capacity evolved from a centralized model at the Gorgas Memorial Institute for Health Studies to a national network coordinated with the Ministry of Health, incorporating decentralized serological testing, molecular platforms at strategic sites, and genomic surveillance. The current national algorithm prioritizes RT-PCR or NS1 antigen detection during the acute phase and IgM/IgG serology during the convalescent phase, followed by the sequential investigation of other arboviruses. Panama has substantial laboratory capacity for dengue surveillance; however, the proportion of laboratory-confirmed cases varies by reporting period and should be presented with an explicit denominator and source.Panama has substantial laboratory capacity for dengue surveillance; however, the proportion of laboratory-confirmed cases varies by reporting period and should be presented with an explicit denominator and source.