PARAGUAY'S RESILIENCE IN MALARIA ELIMINATION: 24 YEARS OF MALARIA INDICATORS (2000-2024) AND POST-CERTIFICATION CHALLENGES

This study aimed to analyze the evolution of malaria epidemiological indicators in Paraguay (2000-2024), focusing on the elimination of autochthonous transmission and the monitoring of imported cases. The methodology employed an observational, descriptive, retrospective, ecological, and longitudinal study design, utilizing secondary data from scientific literature and SENEPA official records. Malariometric indicators such as annual parasitic incidence (API), autochthonous and imported cases, and blood examinations were analyzed. Results revealed a three-phase epidemiological transition: a drastic reduction in autochthonous cases (2000-2011), culminating in the last recorded case in 2011; and a consolidation phase (2012-2024) without local transmission, but with persistent imported cases. Success was attributed to comprehensive vector control, active surveillance, and sustained financial commitment. The initial increase in imported cases was interpreted as an indicator of effective surveillance. However, the decline in the Annual Blood Examination Index (% IEA) highlights the dilemma between efficiency and sensitivity in post-elimination surveillance, making active case finding for asymptomatic infections crucial for validation. In conclusion, Paraguay's experience demonstrates that malaria elimination is achievable through political commitment, continuous funding, adaptive surveillance, and integrated strategies, serving as a replicable model for other regions. Maintaining malaria-free status will depend on continuous surveillance of imported cases and rapid response capabilities to any reintroduction.