Nationwide Seroprevalence Study of Hepatitis B and Hepatitis C Viruses Among Blood Donors in Paraguay

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DI LELLO, Nelson MARQUEZ, Nathalia P. NAVARRO, Liz Carolina LEÓN, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8071757/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 27 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted 15 You are reading this latest preprint version Abstract The true burden of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in Paraguay remains poorly defined, hindering effective public health planning toward the WHO's 2030 elimination goal. This cross-sectional study aimed to establish a comprehensive, nationally representative epidemiological baseline among blood donors. We prospectively analyzed 85,811 blood donor samples. Screening involved chemiluminescent immunoassays for anti-HBc, HBsAg, and anti-HCV, followed by confirmatory Nucleic Acid Amplification Testing (NAT) for HBV-DNA and HCV-RNA. Overall seroprevalence was low: 1.35% for anti-HBc, 0.086% for HBsAg, and 0.267% for anti-HCV. However, significant regional variations were noted, with anti-HBc prevalence ranging from 0.70% to 3.86% (p < 0.001). Anti-HBc also increased with age (0.27% in 50 years). Critically, no HBV markers were detected in donors born after the national 2003 vaccination program. Only 1 of 229 anti-HCV reactive samples was HCV-RNA positive. While low overall seroprevalence confirms blood safety standards, pronounced regional disparities require targeted public health interventions focused on specific epidemiological hotspots. The absence of HBV markers in the post-vaccination cohort provides strong evidence of the national immunization program's success, offering an invaluable baseline for future elimination strategies. Health sciences/Diseases Health sciences/Gastroenterology Biological sciences/Immunology Health sciences/Medical research Biological sciences/Microbiology Hepatitis B virus hepatitis C virus Seroprevalence Blood donors Public Health Paraguay Figures Figure 1 Figure 2 INTRODUCTION Viral hepatitis, particularly that caused by the hepatitis B (HBV) and hepatitis C (HCV) viruses, represents a life-threatening liver infection and, despite the progress made in recent decades, continues to be a major global health problem. 1 The World Health Organization identifies these viruses as the leading causes of liver cirrhosis and hepatocellular carcinoma worldwide. Consequently, the Global Health Sector Strategy on Viral Hepatitis 2016–2021 was introduced in 2016 as part of efforts to eliminate viral hepatitis as a public health threat by 2030. 2 The strategy outlines key actions, including vaccination, diagnostic testing, treatment, and national awareness campaigns. Paraguay, a landlocked South American country bordering Brazil, Bolivia, and Argentina. It has a population of approximately 7.2 million and is administratively divided into the capital district of Asunción and 17 departments. Geographically, the country is characterized by two distinct regions separated by the Paraguay River, each with unique epidemiological profiles. The Eastern region is the most densely populated, home to 97.3% of the population, while the Western region (Chaco) accounts for just 2.7%, and features vast plains and lower population density. In 2019, national health authorities approved the National Strategic Plan for the Response to HIV/AIDS and Other Sexually Transmitted Infections (STIs) 2019–2023. This plan adopts a comprehensive approach to key issues and guides the health sector's response through an integrated, multi-sectoral strategy. Through cross-sector collaboration, it aims to build an effective, integrated, and well-structured public health framework. 3 The hepatitis B vaccine is currently administered to newborns within 24 hours of birth, followed by additional doses at 2, 4, and 6 months as part of the pentavalent vaccine. While the 2, 4, and 6 month doses were incorporated into the vaccination schedule in 2003, the birth dose was introduced more recently in 2017. By 2023, coverage for the newborn dose had reached 96%, and 89% of infants had received all three doses by six months of age. 4 Assessing the prevalence and distribution of HBV and HCV infections is essential for planning preventive measures and, in the case of HBV, for monitoring vaccination programs. 5 While sampling the general population is the most accurate method for determining seroprevalence, the typically low prevalence of these infections makes large-scale cohort studies impractical. Although studies on blood donors tend to underestimate seroprevalence in the general population, they remain the most widely used approach, offering valuable insights into long-term trends and the impact of health policies. Furthermore, altruistic repeat donors in Paraguay are the exception, accounting for only about 14%, with most blood donations coming from one-time donors. 6 This should be taken into account, since the prevalence of positive serological tests for infectious diseases is usually higher among one-time donors than among recurrent volunteers, who undergo periodic testing. 7 Despite being notifiable infections, the burden of HBV and HCV in Paraguay remains poorly understood due to the absence of population-based studies. Consequently, available data are scarce, fragmented, and often outdated, primarily derived from studies on specific groups rather than the general population. This study therefore aimed to establish a comprehensive and nationally representative epidemiological baseline of hepatitis B virus and hepatitis C virus seroprevalence among blood donors in Paraguay, thereby providing valuable insights into the prevalence and distribution of these infections. RESULTS The analyzed cohort included 85,811 blood donors (1.20% of the country's population) from the 17 departments and Asunción. Mean age was 35.3 ± 10.6 years (range: 16.6–75.3; IQR1: 29.6 -IQR3: 42.4) and 33,171 (38.7%) were women, (Table 1). Seroprevalence of HBV markers The overall anti-HBc prevalence was 1.35%, (1,159 out of 85,811; CI95%: 1.27–1.42%) ranging among the different departments from 0.70 to 3.86% (Fig. 1). Due to the limited number of samples from the Alto Paraguay and Boquerón departments, these were excluded from further analyses. A significant progressive increase in anti-HBc seroprevalence was observed, correlating strongly with donor age. This rate ranged from 0 27% in the < 20 age group to 3.10% in the over- 50 age group, p < 0.001 (Fig. 2). Furthermore, the prevalence was significantly lower in women than in men (1.06% vs 1.53%, p < 0.001). The national prevalence of HBsAg was 0.086% (74 out of 85,811; CI95%: 0.067–0.108%), distributed unevenly across the country's different departments, from 0.0 to 0.38% positivity (Table 2) and did not strictly follow the anti-HBc rates in the different departments. Particularly, the seroprevalence of HBsAg in the 35–40 age group (0.16%) was significantly higher than the national average (p = 0.001). Conversely, donors under the age of 25 exhibited notably lower rates (p = 0.001) (Fig. 2). Similarly, seroprevalence was substantially lower in women compared to men (0.048% vs 0.110%, p = 0.003). Table 2 Seroprevalence of anti-HBc, HBsAg and anti-HCV by departments (n = 85,811). Department data was available on 17,165 blood donors. * Due to the limited number of samples from the Alto Paraguay and Boquerón departments, they were excluded from the analyses. n/a: Department not available. Department Population (n) Donors (n) F/M Age (mean ± SD) Anti-HBc (%) HBsAg (%) Anti-HCV (%) Asunción 541,133 6,795 0.66 36.4 ± 10.7 1.26 0.04 0.23 Alto Paraguay* 20,130 9 0.50 38.4 ± 10.3 22.22 0 0 Alto Paraná 894,046 11,615 0.72 34.3 ± 10.1 1.74 0.17 0.33 Amambay 210,033 2,299 0.95 33.6 ± 10.7 1.09 0.04 0.09 Boquerón* 83,209 79 1.14 34.0 ± 9.5 3.80 0 0 Caaguazú 505,168 5,334 0.46 36.0 ± 10.5 1.29 0.17 0.21 Caazapá 163,284 1,752 0.50 35.5 ± 10.6 2.68 0.23 0.40 Canindeyú 223,732 1,321 0.66 35.1 ± 10.5 3.86 0.38 0.30 Central 2,205,465 31,796 0.64 35.1 ± 10.5 1.18 0.07 0.24 Concepción 241,371 219 0.40 31.5 ± 10.0 0.91 0 0.46 Cordillera 313,784 3,007 0.62 35.0 ± 10.3. 0.70 0 0.33 Guairá 210,200 2,247 0.65 34.8 ± 10.4 1.02 0 0.40 Itapúa 526,384 5,271 0.61 35.6 ± 10.8 1.42 0.08 0.28 Misiones 130,111 2,261 0.58 38.2 ± 10.9 0.75 0 0.27 Ñeembucú 89,813 769 0.50 38.7 ± 11.6 1.17 0 0.26 Paraguarí 234,687 2,674 0.57 36.5 ± 10.9 0.86 0.07 0.26 Presidente Hayes 144,359 1,130 0.81 34.9 ± 10.3 1.77 0.09 0.35 San Pedro 415,794 3,242 0.44 37.0 ± 11.0 1.85 0.03 0.28 n/a 3,991 0.68 34.0 ± 10.9 1.25 0.05 0.28 TOTAL 7,152,703 85,811 0.63 35.3 ± 10.6 1.35 0.086 0.267 Among the 1,248 individuals who tested positive for at least one HBV serological marker (anti-HBc, HBsAg, or HBV-DNA), seven distinct patterns were identified (Table 3). The most common pattern indicated past infections, characterized by reactive anti-HBc only. Less frequently, ongoing infections (all markers reactive) and occult infections (reactive anti-HBc with detectable HBV-DNA) were observed. Interestingly, eight cases presented with detectable HBV-DNA in the absence of HBsAg, while five exhibited both HBsAg and HBV-DNA, suggesting recent infections. Lastly, it is worth noting that isolated HBsAg reactivity-potentially consistent with false positives in the absence of confirmatory testing-was observed in 76 samples. (Table 3). Table 3 Hepatitis B Virus serological marker patterns. Among the 1,248 individuals who tested positive for at least one HBV serological marker (anti-HBc, HBsAg, or HBV-DNA), seven distinct patterns were identified. OBI: Occult hepatitis B infection, NR: No Reactive. Pattern Anti-HBc HBsAg HBV-DNA n % Past infection Reactive NR NR 1,066 85.4 Ongoing infection Reactive Reactive Reactive 67 5.4 OBI Reactive NR Reactive 24 1.9 Recent infection NR NR Reactive 8 0.6 NR Reactive Reactive 5 0.4 Undetectable HBV-DNA Reactive Reactive NR 2 0.2 False positive NR Reactive NR 76 6.1 TOTAL REACTIVES 1,159 150 104 1,248 100 The impact of the national vaccine schedule's implementation on HBV marker seroprevalence was also assessed. The study cohort comprised 7,412 individuals (8.6%) born after the vaccine rollout and 78,399 (91.4%) born before its implementation. Anti-HBc seroprevalence was notably lower in the post-implementation birth group compared to the pre-implementation group (0.27% vs 1.45%, p < 0.001). Furthermore, no HBsAg-positive donors were identified in the post-implementation group, in contrast to the 74 positive donors (0.094%) observed among those born prior to vaccine introduction (p = 0.008). Anti-HCV seroprevalence The nationwide prevalence of anti-HCV was 0.267% (229 out of 85,811; CI95%: 0.205–0.304%). Seroprevalence varied across departments, ranging from 0.09% in Amambay to 0.46% in Concepción (Table 2). Importantly, no significant differences in anti-HCV seroprevalence were observed across age groups or sex. Among the 229 individuals who tested reactive for anti-HCV, only one was confirmed positive for HCV-RNA. Furthermore, four cases consistent with the viral window period were identified, characterized solely by the presence of HCV-RNA. DISCUSSION Seropositivity rates in blood donors are key indicators of blood safety and the effectiveness of donor selection and screening protocols. Highly sensitive diagnostic tests have revolutionized blood safety, minimizing the risk of parenterally transmitted infections like HBV and HCV 8 . However, maintaining and improving this security requires continuous monitoring and adaptation to territorial variations. To our knowledge, this study represents the most comprehensive assessment of HBV and HCV prevalence among Paraguayan blood donors to date, offering crucial insights into the current epidemiological landscape. However, notable disparities across age groups, sex and geographic regions highlight the need for targeted interventions and region-specific awareness campaigns to effectively address the disease burden. The limited availability of detailed epidemiological data from population-based studies on HBV and HCV in Paraguay has hindered public health planning. Previous reports indicate that HBsAg prevalence ranges from 0.4% among women of reproductive age to 4.5% in clinically suspected hepatitis cases, 9,10 underscore the critical need for more representative and robust data. Furthermore, a recent investigation involving 278 blood donors, primarily from the Central Department and Asunción, reported HBV and HCV marker rates consistent with our findings. 11 In response to this critical gap, our national-scale cohort study provides a significantly more comprehensive understanding of HBV and HCV seroprevalence. Additionally, the absence of HBV infection markers among donors vaccinated through Paraguay's childhood immunization programs, launched in 2003, offers evidence of their effectiveness. Another finding of our study is that 76 out of 150 HBsAg-reactive samples showed no reactivity for anti-HBc or HBV DNA. In low-prevalence cohorts, such as blood donors, this result is consistent with false reactivity. This issue has been documented in other studies and represents a challenge that cannot be ignored. 12 Similarly, HBV DNA was detected in 24 of the 1,090 donors (2.2%) who were anti-HBc reactive but HBsAg negative, indicating occult HBV infection. 13 While reported OBI rates in blood donors vary widely 14 -largely influenced by the overall prevalence of the infection in the population- several studies have reported findings similar to those presented here. 15 , 16 Additionally, the decreasing prevalence of anti-HBc across age groups, from older to younger individuals, indicates a decline in HBV circulation over time. This trend has been widely documented in regions where preventive public health measures have been effectively implemented to control the infection. 17 – 19 The anti-HCV seroprevalence rates observed in our study are substantially lower than those reported in neighboring countries. 5 , 20 , 21 Notably, only two other studies -one conducted in indigenous communities in the eastern Paraguayan Chaco in 1998 and another among individuals attending the Institute of Health Sciences Research in 2009- reported significantly higher anti-HCV prevalence (14.9% and 6.6%, respectively). 10,22 Interestingly, in contrast to several studies where older individuals usually have significantly higher seroprevalence rates than younger individuals, 23,24 this cohort showed no age-related differences in anti-HCV rates. Furthermore, unlike what was observed for HBV, no differences in anti-HCV seroprevalence were found between men and women. This contrasts with findings from other regions, where men, who are more likely to engage in high-risk behaviors such as intravenous drug use, exhibit higher rates. 25 , 26 These results suggest that the impact of risk behavior and exposure factors varies across different contexts. HCV-RNA was detected solely in one of the 229 anti-HCV reactive samples (0.44%). While it is well-established that 20% to 50% of HCV infections resolve spontaneously, which may partially explain these results, 27 the high sensitivity of screening assays can sometimes come at the expense of specificity, particularly in the case of anti-HCV tests, which have been widely scrutinized. 28 , 29 The issue is especially pronounced in populations with low infection rates, such as blood banks, where a low signal-to-cutoff ratio (S/Co) further exacerbates the challenge. 28 Nucleic acid testing was partially implemented in 2022; subsequently, all donations within the public system have been screened since 2024, significantly reducing the risk of transfusion-transmitted infectious diseases and enhancing the safety of the blood supply. Importantly, the analyzed cohort identified eight potential cases of HBV infection during the eclipse period and four cases of HCV infection in the window period. While these findings require confirmation, they strongly support the routine implementation of NAT assays. In conclusion, HBV and HCV seroprevalence among Paraguayan blood donors remains low. However, achieving the WHO’s goal of eliminating viral hepatitis by 2030 requires extensive large-scale studies and targeted research on high-risk groups. As the WHO emphasizes, robust strategic data is essential for guiding effective public health interventions. In this context, the strength of this study lies in the fact that it was based on a nationwide representative cohort of over 85,000 donors, encompassing data from all departments across the country. Identifying “epidemiological hotspots” enables the efficient allocation of resources and enhances health policy development. Furthermore, understanding HBV and HCV infections across regions and age groups is keystone for refining public health strategies, optimizing prevention efforts, and addressing disparities in disease burden. METHODS Population A prospective, cross-sectional study was carried out from 1 June 2024 to 31 July 2025, on the serological markers of HBV, and HCV. Serum samples from 85,811 blood donors who attended blood banks across the country's 17 departments and the capital district of Asunción were analyzed. Donors completed a routine questionnaire to identify potential risks that could affect the safety and quality of donated blood and underwent a physical examination conducted by trained physicians. These assessments included measuring blood pressure, body temperature, pulse and respiratory rate. Eligible participants were donors aged between 18 and 65 years, and weighed at least 50 kilograms, and appeared to be in good general health. People under 18 years of age can only donate blood with the consent of their parents, while those over 65 were exceptionally allowed to donate if they were repeat donors. Data collected included only age, sex, and donation location to ensure anonymity. After obtaining consent, each donor completed the form and had a blood sample drawn in a plain (non-anticoagulated) tube for serological testing. The cohort was categorized into the following age groups: individuals under 20 years, 5-year intervals for those aged 20 to 50, and individuals over 50. Serological assays Hepatitis B virus core antibody (anti-HBc), HBV surface antigen (HBsAg), and hepatitis C antibody (anti-HCV) testing was performed on the ARCHITECT i2000 fully automated chemiluminescent microparticle immunoassay platform (Abbott Diagnostics, Abbott Park, IL), according to the manufacturer's instructions. Nucleic Acid Amplification Test (NAT) Assays Samples were tested for HBV and HCV nucleic acids on a fully automated Roche Cobas 6800 system using a multiplex polymerase chain reaction kit (Cobas MPX test), following the manufacturer's instructions. Statistical analysis Data were compiled and analyzed using IBM SPSS Statistics version 23.0 for iOS (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages. Comparisons between qualitative variables were performed using the Chi-square test or Fisher’s exact test, as appropriate. A p-value below 0.05 was considered statistically significant. Prevalence estimates were reported with their corresponding 95% confidence intervals (CI) to assess statistical precision. Declarations Acknowledgment DMF, MME, PB, and FAD are members of the National Research Council (CONICET). The authors would like to thank Maria Ferreyra and Victoria Ceñal Filotti for their technical assistance. Author Contributions DMF, NM and FAD conceptualization and design, data collection, reviewing and editing; LCN, NPN, DF, MME, APM designed the study protocol and carried out the clinical assessment; PB, APM, DMF and FAD made the analysis and interpretation of the database. DMF and FAD drafted the manuscript; PB, APM, ACM and NM critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. DMF, NM and FAD are guarantors of the paper. Funding The authors received no financial support. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests On behalf of all authors, the corresponding author states that there is no competing interests. Ethical aspects This study was approved by the Ethics Committee of the School of Pharmacy and Biochemistry, University of Buenos Aires (EX-2022-01463207- -UBA-DME#SSA_FFYB). During the study period, informed consent was obtained from all donors. The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. References Hsu, Y. C., Huang, D. Q. & Nguyen, M. H. 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Cite Share Download PDF Status: Published Journal Publication published 27 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 12 Dec, 2025 Reviews received at journal 11 Dec, 2025 Reviewers agreed at journal 09 Dec, 2025 Reviewers agreed at journal 08 Dec, 2025 Reviews received at journal 07 Dec, 2025 Reviewers agreed at journal 05 Dec, 2025 Reviews received at journal 04 Dec, 2025 Reviewers agreed at journal 03 Dec, 2025 Reviewers agreed at journal 20 Nov, 2025 Reviewers agreed at journal 13 Nov, 2025 Reviewers invited by journal 12 Nov, 2025 Editor invited by journal 12 Nov, 2025 Editor assigned by journal 11 Nov, 2025 Submission checks completed at journal 11 Nov, 2025 First submitted to journal 09 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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01:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8071757/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8071757/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-48872-x","type":"published","date":"2026-04-27T15:56:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":96614578,"identity":"5fcef0c2-dd50-4864-8633-818f2104bea4","added_by":"auto","created_at":"2025-11-24 10:05:24","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":410058,"visible":true,"origin":"","legend":"","description":"","filename":"NationwideseroprevalenceofHBVandHCVinParaguay.docx","url":"https://assets-eu.researchsquare.com/files/rs-8071757/v1/253fbd65b7a98004fc549e31.docx"},{"id":96614601,"identity":"88a42d42-36fe-45eb-a96e-3752f1ed1a25","added_by":"auto","created_at":"2025-11-24 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10:05:24","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97756,"visible":true,"origin":"","legend":"","description":"","filename":"c5568adbcfe04c92b765e16f91ab4f1d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8071757/v1/929f3bbc6f08c4f4769fb40b.xml"},{"id":96614627,"identity":"8b6b8919-e01d-4e7a-8c58-375455b6be40","added_by":"auto","created_at":"2025-11-24 10:05:24","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":108980,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8071757/v1/647b15d665a37f2cd3954142.html"},{"id":96708189,"identity":"2df8dc61-a1f2-45e1-849c-5fb9682e1275","added_by":"auto","created_at":"2025-11-25 09:58:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":136288,"visible":true,"origin":"","legend":"\u003cp\u003eSeroprevalence of anti-HBc, HBsAg, and anti-HCV across Departments.\u003c/p\u003e\n\u003cp\u003eDepartments are color-coded based on seroprevalence relative to the interquartile range (IQR 3): Green (≤ IQR 3), Yellow (within IQR 3), and Red (\u0026gt; IQR 3).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8071757/v1/191261b5d1c1a1f1e41807e8.png"},{"id":96614590,"identity":"c419e661-f986-4101-84fa-59b69d74e06f","added_by":"auto","created_at":"2025-11-24 10:05:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":244342,"visible":true,"origin":"","legend":"\u003cp\u003eSeroprevalence of Anti-HBc, HBsAg and Anti-HCV by age group (n: 85,811).\u003c/p\u003e\n\u003cp\u003eThe cohort was categorized into the following age groups: individuals under 20 years, 5-year intervals for those aged 20 to 50, and individuals over 50.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8071757/v1/c48970e43dd1d09bcdc3d480.png"},{"id":108437604,"identity":"26faacd5-6ff5-400d-a8f7-6f16b2e1ebd6","added_by":"auto","created_at":"2026-05-04 16:00:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":716161,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8071757/v1/959bbf88-6b8d-4416-9073-29e62629f455.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eNationwide Seroprevalence Study of Hepatitis B and Hepatitis C Viruses Among Blood Donors in Paraguay\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eViral hepatitis, particularly that caused by the hepatitis B (HBV) and hepatitis C (HCV) viruses, represents a life-threatening liver infection and, despite the progress made in recent decades, continues to be a major global health problem.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e The World Health Organization identifies these viruses as the leading causes of liver cirrhosis and hepatocellular carcinoma worldwide. Consequently, the Global Health Sector Strategy on Viral Hepatitis 2016\u0026ndash;2021 was introduced in 2016 as part of efforts to eliminate viral hepatitis as a public health threat by 2030.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The strategy outlines key actions, including vaccination, diagnostic testing, treatment, and national awareness campaigns.\u003c/p\u003e\u003cp\u003eParaguay, a landlocked South American country bordering Brazil, Bolivia, and Argentina. It has a population of approximately 7.2\u0026nbsp;million and is administratively divided into the capital district of Asunci\u0026oacute;n and 17 departments. Geographically, the country is characterized by two distinct regions separated by the Paraguay River, each with unique epidemiological profiles. The Eastern region is the most densely populated, home to 97.3% of the population, while the Western region (Chaco) accounts for just 2.7%, and features vast plains and lower population density.\u003c/p\u003e\u003cp\u003eIn 2019, national health authorities approved the National Strategic Plan for the Response to HIV/AIDS and Other Sexually Transmitted Infections (STIs) 2019\u0026ndash;2023. This plan adopts a comprehensive approach to key issues and guides the health sector's response through an integrated, multi-sectoral strategy. Through cross-sector collaboration, it aims to build an effective, integrated, and well-structured public health framework.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe hepatitis B vaccine is currently administered to newborns within 24 hours of birth, followed by additional doses at 2, 4, and 6 months as part of the pentavalent vaccine. While the 2, 4, and 6 month doses were incorporated into the vaccination schedule in 2003, the birth dose was introduced more recently in 2017. By 2023, coverage for the newborn dose had reached 96%, and 89% of infants had received all three doses by six months of age.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAssessing the prevalence and distribution of HBV and HCV infections is essential for planning preventive measures and, in the case of HBV, for monitoring vaccination programs.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e While sampling the general population is the most accurate method for determining seroprevalence, the typically low prevalence of these infections makes large-scale cohort studies impractical. Although studies on blood donors tend to underestimate seroprevalence in the general population, they remain the most widely used approach, offering valuable insights into long-term trends and the impact of health policies.\u003c/p\u003e\u003cp\u003eFurthermore, altruistic repeat donors in Paraguay are the exception, accounting for only about 14%, with most blood donations coming from one-time donors.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e This should be taken into account, since the prevalence of positive serological tests for infectious diseases is usually higher among one-time donors than among recurrent volunteers, who undergo periodic testing.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eDespite being notifiable infections, the burden of HBV and HCV in Paraguay remains poorly understood due to the absence of population-based studies. Consequently, available data are scarce, fragmented, and often outdated, primarily derived from studies on specific groups rather than the general population.\u003c/p\u003e\u003cp\u003eThis study therefore aimed to establish a comprehensive and nationally representative epidemiological baseline of hepatitis B virus and hepatitis C virus seroprevalence among blood donors in Paraguay, thereby providing valuable insights into the prevalence and distribution of these infections.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe analyzed cohort included 85,811 blood donors (1.20% of the country\u0026apos;s population) from the 17 departments and Asunci\u0026oacute;n. Mean age was 35.3 \u0026plusmn; 10.6 years (range: 16.6\u0026ndash;75.3; IQR1: 29.6 -IQR3: 42.4) and 33,171 (38.7%) were women, (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cimg 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qTnXskkJ3u0iN4ORok3EWjLCEWF2IzokXeB4sZRT+iXVJBtt0w3Nz58/b44gJzDO6CCruMHZGGOMMcMZ5MAwADNjgNOBg4DzIlgWkQOBY4PTQpybN282zoFgX0lc7mE2guvcTAVcv379+FdIJeIsCmlqQ++QGSFBmSmHfm3EBl6lBzge+/v7zXkXlIW8tUyUwmwLMzSqPw5M1wZlY4wxxpTZGDsmM/8HKzgwQ5ZtzhI4Zjh6OEdDZpOMMcYYM5y5/ArJzsu/f+KAJSQcGDsvxhhjzPyZywyMOYLlrvjrIs++GGOMMYvBDowxxhhjqmMuS0jGGGOMMcvEDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqY+NwTHteZGNjoz0zxhhjjDl9BjkwxhhjjDGrhJeQjDHGGFMddmCMMRPx7NmzZll5XkvLV65c6Uwr9/zt27fNPcoSr3Phx48fTRzzl4cPHzay+fz5c3tn1MiJe7dv3z5xnQvIe1L0rnRmukE3klnU07TkdB4Z0iZEzt70nvqHVM9KC3ueF3ZgjDET8erVq/bsqCObFDo6OstFsLu7O2JVXAFu3rzZHM103Lp164RMub53795EjmFsJ7H9mDJv3rxpz06eT8I8nQWBY4L+9/b2jtvEzs7OaGtrq9HznTt3mnipnr9+/doc52mPdmCMMYPB+fj+/XvTYcHr16+b41B4n44u8u3bt6YTXAQMtpTXzI8bN240xz9//jTHIaid0G7QR/zKN3levnzZtN/Lly8355PCbEfkxYsXjZ1tbm62dyYHp/Xx48eNHu/evdve/Zs29y5dutSUGT1HJ3d/f7853r9/vznOAzswxpjB6EuQTojO9cOHD821YGCi42SGRUs/6kjpzOS80CHrft8S0ixQPsoZieVaxBfquvPp06fmqIFQSwMlmfJcetDg9eXLl+YYiWn0LXesO5qxwll88OBBc57KQrKWrKK8pAOcCN2fh0w1i3L9+vXmWEJlVnyQEzaLA5ViB8YYM5iPHz82X1d0QvoSzy0jEY+ZFaaZgc6TL7ODg4Pmmi+4SWdd1EkTmMLOwddhjAd8HQp17ORNoINP1/fPEjiUkhV6zYHzEWXKtfQK6BaQJ/pFproHGsS2t7ePB690eUE64F3SmWbGYZ3QbAXLMdeuXWvOc8tIyOu///5rjoCMAdsDdIo8J3EautrEr1+/muP58+ebYwmVWTNvcpo0czsv7MAYYwZBJ0RHqTVsrXXnlpEU5+rVq81xHsjpIMQBNJLugaEDJlB2lV9fh0Cc9+/ft1dnDxwOyUqDYAozJ4pDYBDCgdQmTQ2WDHjnzp1r4kSnUe1DbSFdRoozNDi5MO+BrjZw4Gi3yAPng/OcU6c4WraZB0PaRB9ymNAraMatb+ZmUuzAGGMGEZePQJ2mOqku4lr4Mnn69Glz/P37dxPM7PDFDz9//myO0YGlPeDIaFYu55xoEEuXkfT8rCPZRUdbHwRy+kpM63AM5cKFC81xiC3JCaXMmnGL+2bmgR0YY8wgWBaCOMWsDjO3jJSDL/Qu9BNMhXmiaW8NvGY+8LUdZ2dAS3xaPsKJkU71LF1GOi0nd9XQ8lFcDtXsyyS/RuqakcGpUNqEPsdIaBZNZexCjiofEfQT6V60eWAHxqwc6SBGmKRzYz190ndMN3RwdEIMUBqsCNrTkltGmoZHjx6dSH9W4vJFbiqeduKNvJPx7t275qgBKsqQpSNkrMFT8qftRL0ymHGPdsXMC9c4Odgs4SzvgdHyUZQXQc/mQXQ6CVry6QNdsUxLOaLTow3C8UNGsy2aodX+nHliB8asFBgCXx5xHZbODYMe+pWwKHCshs40rBv68kvXsNO17j40WNEB0uHNm3QTL+WiLWl5gv0atCU91z1TJs6eEJAxg5gGKGwUZ0TPOWe2DkeEd5F3ujykDeBaRtI+JOISNJPTN2O3bqh/yf1fKZrBGNoPsgQlvcyz7+Qjgz1ocSYWe8bO0iUilRnmuR9O+G8hmZUBI8Mo6BwxkmlhBoaOE+NNO85pwXmh48Zw572Oa4w5CR8yDIrztGGzfngGxqwM+hrTT/C60JSlQm65iK8YPdcvJkS6TJWbDtVSFNPjOC/A+v1Z/tmtMYsAG4t2qJ/r23kxXdiBMSuDNlf2TRvjQOjrjAlEppvp7NJpUjaPaQkKB0ROTrpMxYwPMz/p8hDT3DxniYE4wAzMWf7ZrTGLQHtltCyhZShjurADY6pC6+o4Lfo608860x36WnNNv+JwfnBqtH9Dy1XpRtQhM0HGmNlJN5USPPti+rADY1aGixcvNseuv7HS9Sy3jBTh3a443sxpjDH1YAfGrAya8cj9nRTRtbw05IutK07Xz2n1HziZ0wcnVHuUTB1YZ3Wy6nqzA2NWBqaRWRqK+1UA49EGPxwQ/QxXcZ4/f94ctZTUB3mwDKU9M9rg++TJk+ZoVo+z/BP2WrHO6qQqvR0as2Ls7u7y0/4T4fv37+3TI8ZOSPH52ME5cU9xDw4OmmtI84jPcvFBcUnfLA/pam9vr71jVh3rrE5q05sdGGPMxKijk7OI0wepYxlJnUauI0pLAehI4z3i4JjqHCeTc+UPykcOaJpG6pieFayzOrHeypystTHGDEAdV1dndvny5SaAOj86OFDnq1kydagivqt09W7sVCHGhXitfNWBp/meJayzOrHeyngPjDFmauKfFuCP8407s+Ofp+u/MmevkX4mC+xnYg8T6Jdh+mm84BdhQ38VFvMhcK6/5Kuf1t+5c6c56i9p6+/5nEWsszqx3v7FDowxZm7QodFpEvS/FwOdHff4n4zpXGMH2vXT+CGow6QDTTtRQWdP/vxHaeYk1lmdWG92YIwxc4TOi04zBr4I1dnR6abop/Hxl2eRvp+wx1+m8b+3cp7+XJ58Y5lm+Vtb64Z1VifWmx0YY8yc0PSyfoKpv28T+fr1a3PUtDaoU2RqWx1r7t0u9BN48o9/tl/T2Pqpvf7OFV+pxjqrFeutZewhGWPMRKSb/cROu3FPYdzJtU/Gn2LhvuJpwx+MO9YTcXLvEof7Oo+Mv0ib+ymUUe8T0jKfFayzOrHeymzwzzgjY4wxxphq8BKSMcYYY6rDDowxxhhjqmPQEtIkG3yMMcYYYxaN98AYY4wxpjq8hGSMMcaY6rADY4wxxpjqsANjjDHGmOqwA2OMMcaY6rADY4wxxpjqsANjjDHGmOqwA2OMMcaY6rADY4wxxpjqmNmB4X/p5c9mp/AnuvWnvnPwp7zj//DLeS4t7qV/jpt7+lPgZj3Rn3gnPHv2rL17RHxGyLU/oT/pTrh9+3Z79yS009Iz4N2z0N6Q69A/fZ+L26UXZKz7xOsDnef0yvtdulC/opDrO2JI2xak7YE0hpR5lUjrqZAiefXpHV1EWXWlmdIVN7aZVBclXfbZa21Ql1jPCDKJz1I9xXdzbTmFeLKfaJNdfShEPeVsIafHVH8Kep+yU4aZ4H/inQWSIBwcHLR3juDPbXf9KW3+PLfe4c996099857uc49nKTxP/7y3WR/QOe0A9OfcY1vKtbcc+tPu+lPxpJm2J8UptSeexTTWFf15/CFyLcUtvc+9+Ay77rJfZC39R0iD0KWLmI90K9SWut4vtQfKrD6qRpBnrvzYQ5RZDp5FefCO7Cie5+iKy7n0LN2kdq7rVJe8G+PWSpdMqF+0A8lA7TfGBc67ZJLKLOo9nqeg+9h2uI7tgXPVQXospcWztAyzMBcHhgpEQUKXMKlcjM/7ihvPSbvU2fB+SUimbtBtajC6loGU2kUEo+JdQRrxmnzUfuN9IK6eDc2vRrC1WM8um+qK26WXVA9QigvEj/qfVhcqk8rJkesSXe1BadUI8ov9rUAeqnOX3pFF7MsnkWlX3C47J79cmQVpdT2vFcmo1MZ5FsfHqBfO03Yr0vabyhebkxPSB+8qLaVbKm8k1w+ktj4pc9kD8+TJk+Y4ZAoL3rx5M3rw4EF7NRpdunRp9OvXr+b827dvo/PnzzdpjSvXPMvB+6Rj1g90++rVq+acacgPHz6MLly40Fz/+fNnNDa8YruI3L9/v3lXU6akGd8jn7ENFNPimdr2OjPufEYvXrxor7opxZ1EL+Lr16/t2Ulevnw5unPnTnt1xDS6UPqbm5vN8ffv36NxB9qc5+hqD9zj3ZmnvE+Bx48fj54+fdpe/WV7e3v0+vXr9iqP7O/u3bvH13Du3LkTR92P9MXtsvP9/f3RzZs3m/Mc0mnf0letdNkR42MJZJjj3bt3zXgqGG/jUtDFixezOiyBrQM2NsTuSRu7Tm2YPlptYBrmtokXQ8BQhgjh48ePo2vXrrVXo6ZD5F3Wx2i0NE6u//vvvzbGv/A+6Zj149GjR02HS3vAOBg01YF++fKlOcY11RK0I94lDeKRZhx8yadE17N1ArkOdTq64nbp5fr1603HGvcwlCBO2iFOowvyv3fv3mj8tdjeORoU+UBS+dK1/L58bty40aRRE8gaecp+BPdxIORUlGCAik4fjmqO3P2+uF12zjjCoBr3VqRjC2OF2t26gDxKTrYmCOS8ES86BF3O6KdPnxo7FD9//mzP/oJtDIE85VzKEYp7DXP2jQNFeVV2oT56EucpMjcHhoJQwOfPn7d3ylDg1HD48iEwwGj2BSSUdHaH90nHrB9s7sIY1Sbo3KR/GZ6e0ebSgUjwDu8qLmmu0+a/VaJLLwxKu7u7o62trcaWu5wAZklK+pwElQMnRm2HTpK09QwmaQ/MDkzb0Z4WtHkclRTkMsQxZIAa6uBOSpedAx+xfKTyjPbD8wgOTm4grhXqjqP//v379s5fcOyRx8HBQXtndBxPY2SXnrSyMSva7Bs/BCkzzhF6ony0rXRmjFkWZvxyoNeSs9vHXH9GTaWYJuqa1hvSAWj2BWHxBYVguJd7t7YOxXSDPjGI+GVB56VpRtpY/FIgXsmD5x3eFcQlbbeZ+dOnFwZLDVSaWc11qFpKnhd8CPH1CXT4cXDga5f2MAlDv1JXBeoXZ7tB/eoQUgehNGOTu98Vt8/OGYzjFgItKaZjy7rYMs4LYxz2kUKdcf5xDtIZDNqj7AqHLnXyRPqxT9yUvg8H2g0OZbQBnHry1MwZ5eM6zoyhI/K/evVqe+df+HCZhrk6MDQ2GmHJ04I+bx5FquEiKHVyJS+tLz1jzGqhvSm5AU57IFaVecwOLQsN9umgxyDEVzJf7RrwGCBzU//pQKf+Vn2xjrl+eJK4KbkBNsc69P/TOi8pOOql9pk6NthZdERwVLtkmXNeYMiszpB9MlPPDo2FNhMkwc7pyLiwzX12K+fgefqO4L2xt9ac3wq73+N94H3SMesHeicIdD92jJtz7o8d3OYc0rgR3uFdUYpLeqU0aGdp21tHqB/1LNllJBcX+ZX0gg1HPWC3MW6ky677dJGWS/HVh5Cu2hGUylFqD7xbKvcqQr1L7Vr06T2XBteSA8cumXTF5VlMm3JIPyqXdM17abvgXtRnjaS2EenTTZSt2npXXNkBpGl3vYuMSzYJPFPaqo/0Bn12k8afhIU4MBJmFFik1PC4HysqIRPS+H1CMXWDUUj3qZ7js9gBAvdie+RdxS0ZIXHSdITa8rQGVgtphwbYb05mubjQpZeoh5KsBXFy8s7pIi2j4iikfVB8Vuo/Su2Be6U+bRUZ0keWdCn0PCXKMUKeqexKcSG2mbSsqS5TeLdU7lqI9Y+BekWbiSGOhfF+V9vMtQXi6930GeVSejGPGKIdxvupTkg7ljlC3Gi/k7LBP+NMlwrTYiwzpdNRk8BUGRvA+qbVzNmCaXCmI90u5gNTx3HD3jIgT5YQpvn10aJgHX/c0TKKtnfODmy2pb9Of8l0msxjDDlLrGr7ndXW57oHZigMLjggWqOdFN7jfQ9SJsVO7fzAzobuRZgnbPKd5f+GWAT8DHT8FdlenS3YaItdrRL8H2BswjbDYP/Jzs5Odp/TacKPfmb5UDmVGRiYxSNk89n379/XYgOXMeZf2NjIxsJlz/7k8Nf+as2KMQjjUOV+bmy6WaWxcx4ze6fmwBhjjDHGTMupLCEZY4wxxsyCHRhjjDHGVIcdGGOMMcZUhx0YY4wxxlSHHRhjjDHGVIcdGGOMMcZUhx0YY4wxxlSHHRhjjDHGVIcdGGOMMcZUhx0YY4wxxlSHHRhjjDHGVIcdGGOMMcZUhx0YY4wxxlSHHRhjjDHGVIcdGGOMMcZUhx0YY4wxxlTHXByYK1eujDY2No7D27dv2yfzh/R//PjRXuX5/PlzUyZjjDHGrCczOzC3b98e3bx5c3R4eNiE79+/j+7du7cQJ+bhw4ejvb290aVLl9o7eTY3N0cPHjwYPXv2rL1jjDHGmHViY+x0HLbnU8GMyMHBQeM0CByHT58+jd6/f9/emR1mXS5fvtw4SUOYNL4xxhhj6mHmGRichKdPn7ZXRzx69OiE88KSTlxi0hIQjk68Vrzc7M27d+9GOzs77dXRu8z+xOWr+B6zNLdu3VrocpYxxhhjToeZHZiPHz+OPnz4cOxEpMs2OCdbW1vN0g+zIRxxegBHB6eEpSEg3u7u7uju3bvNdYQZnevXr7dXR5Dv69evm3R578mTJ+2TI27cuDHa399vr4wxxhizLszswDDTgQMhJ+Lx48cnZkOYOcFhkVOio56/ePFi9O3bt+YdZkxwanIQ5/z58+3VEaSrpasLFy40+28i3NPsjjHGGGPWh7n8CkngfORmQ3AsNENDSNESFM5MidQ5GQqOjzHGGGPWi5kcGGZRcj9XTmdDtJk2hrhMxK+WiMOvmUpo2WlS/HNqY4wxZv2YyYHBCcFR0R4Wwb4Ubbi9c+dOE0dLRtqoyxHYiEtczZSUfvqMI/L79+/2ahi/fv3q/cm1McYYY+pj5iUkZlPYyBuXiNg8q+UgHAh+Zs0sC8+0oZe9KzgvbMRVXBwf9tDkfjk0zYbc3MZfY4wxxtTPzP8PzLKY9P91mTS+McYYY+phrpt4FwkzOSw15WZncvDrJzYTG2OMMWb9qGYGRrAMxZ6arr0t7K/Z3t72L5CMMcaYNaU6B8YYY4wxppolJGOMMcYYYQfGGGOMMdVhB8YYY4wx1WEHxhhjjDHVYQfGGGOMMdVhB8YYY4wx1WEHxhhjjDHVYQfGGGOMMdVhB8YYY4wx1WEHxhhjjDHVYQfGGGOMMdVhB8YYY4wx1WEHxhhjjDHVYQfGGGOMMdVhB8YYY4wx1WEHxhhjjDHVsTQH5vbt26ONjY1/wsOHD9sYi+fZs2ejK1eutFeTQ1lJAziqDj9+/GjuAfepa4R7y6znaRH1+vbt2/buEVH/Q2UR5Q1cxzwU0ryA+1EvOXhOPNFVRvLQs/hOSlcZP3/+PFP7O00ot+oSdQKpbcf2T53jsz6dlGREmjk9R2I5SCciXafPSTOWd91J27wY2r4FcaTL+G6fbXfFjX2qguC8r+2sI2m7TWUQ+5s++4CYxiR6i/Yf7TOnM4L6CM4XqrfDJXHr1q3DnZ2d9up02N3dPbx8+XJ7NRkHBwdNHeD79++HEt3e3t7xfeA+z1OIQxrrCnJFFkA9oxzQe9Q9zxS3BPGJh85KlPTJeyU9RKJOusoofeuaeEPbUVpGrrvqtIogJ5VZsohtOeo+orjSQ0lfEZ6neiP/KP8cPFPa8VzE9zlyLdBnV9rrgvQR6w45e419WkoqL95Ve4jnObriki4hB/G6yrSuICPZHjLgWsTr9FmOafUW7R+4LukitS3SXKTeums8R6hEqXEuiyEdaAnKL+WjFKUTz0m/VEfeXaQiVw0acTSWSFdbUCeLTAnRcCKKF42OuNwjfY7pQBiJessRy5gzynhdIldG3auZVC9pHUtIbiW9pDai+NJnqT0BcUpl4r0uXROv6/k6QFuOsozwrGSPKWn7TWXblVZf3FSHKbw7pJ2tC8gr1RUykh2k8kM+epYyi95ScuUS3E/LsEi9rdQemDgFHKe0OCfEaSzQua5FnFYjlKawhk5vc//Dhw+ju3fvNtfnzp0bjRtEc/779+/jKbXHjx+P/vvvv+Y8hXdJY6HTaSuCpuevXr3aHFOQw/Xr19urfxkbwOjbt2/tVZ7nz5+PxsY82tzcbO8cMW7ToydPnrRXZd68eTN68OBBe/UvsYzSu6ZoeXdslM15F7kyXrp0qbk3ZLp3FaH90vavXbt2fA2pHnJ8+fKlkRsyyPH69evR9vZ2e3XEuOMbvX//vr0qQ3u5cOFCezVq8sE2YX9/f3Tz5s3mPIfKni47rRMXL15sbCOVL3z8+LHTHiPv3r0bjQe69mo0+vXr14klBfIp9XF9cdGh2lUO7BXbO+vQngHZIUOBbJFxjln0liPX/7FsxH31l2KReluqA/Py5csTDkMUIE4HDRgjI2BUca2dd7nHM4TE+3SkulZcBgbFIzBYMJCkoKytra1msCQex5xS4OvXr006gg54/KXQlOHevXujFy9eNPnTQEqdM5AGaa0z6BS5Ip9UFnIskUPayAXvlJ5FaA+po/Lo0aP2rB/aSK6zLJWRNkJ+PIM+BwtyZYQbN24cd0I1wQcGNkI716BPe5Y9KqQdIdfcx8HHSSmB0xidXvIY4hiBPigi6szV0dM2S2XEwcHBWle6bEOyk2xiv5zy6dOnE87Oz58/27O/lGyjKy76oBw4WCpH6uRjr9jtWUG2oLENGWEjIifnnIxhFr2l0KflPghevXo1evr0aXv1l0XqbakODB2fHAtCFBidfaw8XhsCEQwoGhAxsOgscC2FMOjEdDlPOyvAI6Xj1SClY+7LmI4wHYzpEFQPnmn2Jc7+pBCv5CGvC8gbmaA7ZBHB0ZO8ujrJPtARuhs6uOWgs2QmLSVXRs3UMfjyjMEwp99IVxmZKci1yVWHmRDqT9m18ZX2rA8JAnZJvSPIkmfEw7nN2ZjkQdxFgH3qwwbnOi0jOi11/mcBBiXpkHZf2tiMfZ8/f769mh9//vxpjrIxPij5OIyzYnHm+yyALTADSdulv8FpiB/SkzAvvalPp5+MoCd0k/v4XKTeVmoJiQarwR+lTQMdodIgdA2UCDXGLdHXsWn2BSOMnWQ6gMNZ6SRxQEte9/379xvZTzuI9y0J9DEk31hGpj/pOOSM6Gs2NxCLvjJGJ7s2+ErWl6AceaEl1NxyDB0ycszNPmkAm5bUIQEtKZFv/OC5c+dOc0zLOG17rB1kFz8eo35T0oEoLmGIUp/bFRfboh3JxhgIKVduVuws6UlyIdBnECTHnJxzMoZZ9CYYz+jTc30Xeupzrhaht5VyYLScExU2Kdp3oDS6vugwkJgfIedBlhqF0OxL3A9T+sruS8v0gxENXbPP0dUm5kVfGfs6i7NGbjZsEpBnnN2kw9YX51CbW0a7WEUmaYupo0g/F/tpPtBKcpwkbhdnVU+MJ7Tr6JjHD2Jkq2cps+gNupwXYImKpfEuFqG3lXFg+EKK+wWYwixNYw4FhbM0lYOvMBqDvqK1TJD7ckTZJe8x7n2hw5SCc8tOpFFqYLWD7CRL6olTp02y6DHORvGFh5M5bYNGb6UNwkPBoONXf1cZmY3hi1RtQ2vSOWdXdJUx1zZWGQY41RmYKaXNAzKLdsoHBLLly1E2JduhfSBH5JkieZTsrA86Ty05k4/KANg6/YDSjmUUdOBn9eOCth77Xs6l3xTagjZHA22cti7bQM45/UJXXHQWZ8G5Jq5mywB7TQfidYb2GscktVv1O3wgaXwjDvIq9Umz6A3b73JegGelDdgL1dvhkhgPBr0/0yIORSKMK9zePfqJF89Emla8HivlRBp74Sdf/EQvpstPuxSXQNwcSjNF9zkKyqH0UtK460SUOwFZR5C7nkVdAvdyP7PjnTSdki4i0muXrNHTJGVUO1KIaaudib4yknapra0qse7R9oD66Fm0L0jlltOz6JIL78Zn0nEkliPNR/EVUih3V9nWBekjBVuQbNK2HyFeqv+o4/RZahtdcWMZCKn95vJed6K8CCnIQ8+inFNm0ZvipCHqJ72OLFJv5V7WnGDWQYd3uzqGswyyWfbgQX7pYLsM+pybs8xp2chptYUaOc32e1aczEWwrnpbqT0wqwzTql0/Ae2Dd+M0rfkLsonT+cuA/JhW1RTqsuDXb+MvkvbKRJj+Zip62mWkaWGTdu7nn+ZfWOobf00fLxcvC+wUe112P7EurKveNvBi2nPTA+v9rJNP8v+NAGuIrLGnPz0zpwsD5fjrgM+S9s5iwZjZb9C1lnzWWbaM6NBxoIf8Z3nmL+zNGH/VL20v17LzW1fWTW92YIwxxhhTHV5CMsYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x1LM2BuXLlymhjY2P0+fPn9s5fuE8Ywu3bt0cPHz5sryaHcqgMpEW+3Itw/9mzZ+3VEfE98y8/fvw41qPC27dv26d/dUxAvl0g5xiftHPwLOYBamdd7wmVWQzJl/z6yk/bURqxbZF+2tZqQbZCSO0PmZSeQde7KSUZkUaq60hf+yNf3Y/6G6LPdSDqSCG270l0BPH9Pv3nwEZKcXNtIOZ3Vsi1+VI7htQG+uSVyjmmneYbSfvJdKxMy0F8WIitHS6Jy5cvN2F3d7e9c8Te3t4hxRhalFu3bh3u7Oy0V5NB3sqffEkLSE/3Dw4OmnKmfP/+PXvfHIHcSjpEbshbcF3SIXImHdID9JKTO/eJF9PlnnQaz0vwXPkMyVdttStd4sT3iBvrSrqEmqC8UbecxzpEucVzoO5RXjyPOktBdugiwvt975EncXJQ1lgG8ojlp4xdaa8DqQwiffpNSeVF/JL+cyi/XB8gPaa2x/1S+deRXJtPdZi2Y+LrusseRLS1GL/rXfWTek/XaXvQNceY1rxtrbuGcwRhUfi0YXKPUBJYCgrMNfwhRMGjaKUTz0m/JOCuZ2cd5JLqtgTyLsXlWTTSHOiQ91PD4Z6uU0NLwUhjGfryVX7E6StfJK2rylUT1DfaHOe6TvUenwF1RdZDIK0oW3Wk3OMYdZ2SlqMLypfmM/TdWkn1EunSb0rafvv0n8K70mkaT3rmmNMH94a2pVqZpM0jP+IB8Ygf4Vnpfe7rXUj1hqy78o6Qjt7lnS5bmretLXUPzPXr15tjnNp6+fLl8f1InILqmnbqmlKLMH01FvTo0qVLzfWFCxeOy/Hz58/RxYsXm6mub9++je7evdvcT9ne3h69fv26vTKRX79+jW7evNle9VNaSvn06dPoxo0b7VUedJ7Tw7hzHZ0/f745l57//PnTHFPevHkzevDgQXvVny9xx/ZynO5QSDfKhfdph11TtKsG7R47FZxjL4Deoy65L7vS1PHm5mZz7AOdkldk3OGN3r9/316VmaT9ffz48YSuVT6Vdx1BJ7l+Frr0m/Lu3bvReLBqr7r1n2Ps0Dd2lAOd8Kxkh9ggdrvuDG3zaTvOsb+/356dJLU1dBZ1jk7R7VD0Lvl12eG8bW3pm3ipHEYAVILOXIOOwBFRQ2dQ+vDhQ7bCrL1hbMSTUZTWVRFsVLacFBwfGsKjR49GT58+bUKJq1evNmUx/8JAjRyHOJOPHz8uGh4OJM6l0iFEaAc4AemgWOo0f//+3Z6dhLJeu3atverPl/YxCTgopEF7efHiRXv3COpe6lhWEWyFTlVy4VzywPlPQZaA7MdfWyf2BKXr5RFkhY0JdDzU+RnS/lQOSPVJv/Tly5f2av1Atk+ePMnqoUu/Kcg5OkJd+s/RZUd9Noa9ouN1Zkibz7Vj2Y30Sn/YNValtpbTWU63KfTHpKW+VI4QDpDaU9o3z9PWlu7A0PhfvXrVnONN5wYyvE8pRl/QuYGIdHB0RPolEUGIDFAR8sHxQXkogiPGLOGnnaC+vkuD5VkG2dEw5UzSqHPOJDLFae3qrO7du3ecDl978QsPHf/333/t1fTgGJ87d669OqIr30mhHZHO3t7eP0YcZ/9qAD0id8mG89KHQgpyBt7jHOc1N/skeUw6wyWGtD/aHM/4ktcAIOh0h3TYNSLZ8nFG/XFQoh4m0S9yTj84lwX2qvZ0lsm1Y+xGeuUetkA/m2NWW4tsbW01Y3B0uigDjiZl5BkfMZF52trSHRg6dhohQsTZiF/BQh4moWtGBKQwAgNQCQyvC82+kLc6Qsh1tqVlibMM8o0zDTTc9GtJDmHX9ChOQ3RK79+/f9xe0A1GmzO8kjHmOlsZcKQr31mgvcPXr1+bo+hrj6sEdhrtkHN9KMRpZyHHT7KXs4qO6FRzs0+z2tSQ9ifu3LnTHNNZ3Vl1vaogd/oztUUGm6iHLv2mpA5El/4XxbrqaVLSdoxe0TMBeyDk9JOztZzOcu9GGHOxs/gxSlvj40/98aJtbekODGA8ePh4ZrnpMpwSvlxRRN9aIAKU0hRydBlVnH3BM5TiUEJuHTD9cjf9DHFeQA0/B9PX0WEFnFZNm9KeNFMnA8npKpdHV76LYNGd/LJgNik6Y9iPZDmJnayCTS27DdRI+jXdpf9FYT31Q/+Hs5muOkCpT4yzIug0967IOS/Q5/SIuelwPOAvhXHDP97VPK54s2NaO5cP2p3XgvM0rq7Hzs/xe3omuE8+OXhG/BykGfNT+vE+jBvEifzMX6KOgGvJG3kiyyGkbYH3Su+mecZ8yLsrT9oJeYmh+fbVhXxjGyR+TBdiG6sByhrrxLnKL5uQLOM5ICu1A8k4Po/wjPRy8CzqOiV9znWp/XGe9hPEUfx1Q3KXbFM9dOk3Bdnl+kSlFc+7IJ1SHqkNCdLN3V9XkGWpf4PYjlM9pDpNIW60NfLhHpCGznOQbslWVA6lnSsH9+Zla+VSzhkqIWWokrpOBUbluCZwHht72vA5V9yYRgp5ReUL7qcC5pq00vilNMxfnSqogab3YxCcx04POStOqpsIz9WGhHRHkBHlyBnRkHx5L20DxI3l6GuTvJ+We9WhzKpPzi70LNqmiDrpqneXXNJ30z6j1P5ELH9Ot9yLbXDdiDoipHXt0m8EuaY67tJ/ahuCPHJtBcgjp6Nc3usM8kxl19WOUx13QTpp2shW78Zn0dbSPBRim1F8hZR52lp3LdcMhNk1qPWRU7qZHWS67MGD/HKd5KLRQGv+hXYQO8JlcVptoUZOs/3Oc+A766yLrZ3KHpjTYuzBH/+Ee1JYU9Q+GTNf+D8J+n46OG/Ij30o6eayRUP7ox2af8G2sLFlb9Lk15BxE6spw96F8Zf60v8fI+wUe112P7GurI2ttY7MmWFaL97e//qx7K9Jf+n3s2wZndaXaO1gN7PMZk/KsvM7C6yDrW3wD46MMcYYY0wtnKklJGOMMcasB3ZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMddmCMMUvh8+fPo42NjePQxdu3b4/jXblypb37l5gO6aYor2fPnrV3zBB+/PhxQrZcl+iLi970DH1G4nsPHz5s75ppibrI2UsktcOSjtHL7du326uT8GwVbMsOjDFm4dBJbm1tjXZ3d0eHh4ejy5cvFztHOth79+6N9vb2mrjfv38/McjRQd+6dat5trOz06QboWNN75lhoBdkimyR8c2bN9sn/9IVV7rlGTpHnxoo9Qy9HhwcjF6+fGlHc0awD9kW9tElz2iHHNFjCrpCLznIq/Rs2diBMcbMDB1mySGBr1+/Nsdr1641xwcPHow+fPiQ/fr78uVLc7x69WpzZJBUh0l8Br4bN2401/fv32+O+sKnDI8fP852yqYbzWRdv369OW5vbzeyLs1wQSkuupVDc+fOneb47t275vj+/ftm8Lx06dLo3Llzzb2fP382RzM52ATylpzRxatXr5rzFOlHcXVM7RAnJbUh4jBj8/Hjx5Wxr5kcGFWIzkvTUfakjTmb0ImqH0jZ399vjhqwxJ8/f9qzv3z69Kk5MsBF6G/kCF24cKE5il+/frVno+ar/unTp+2VGYocx/PnzzdH8fv37/bsL11xNUhevHixOYqckyJ9yhEykyMbkr2gE5zJHJubm43zIWdSx2hrfAxwnZt9Y1b027dv7dXpM5cZGLw9PGqExtdPut5pjFlvHj161PQB+jKTI9PXF+QGxxI5Z0docOTrnk7azI/oHPbRFTf9yudjV0uFd+/ebe+aSSnZUCpvgQPCRwL2yRG7jTx58mT04sWL9uovODWrpqe5ODCvX79ujlSQ6V59bRljzhZ0jnSI6hTpDI3JIacXJ6Zr+dHMD62asMyE7DlyLWcHp5Ll3VpYyB6YkudnjFlvNPNCAH3clEiXILpIl58i6XKFmR/pcl0XXXHjMkWEDcCl/VCmn5IN5eTNkhGzpJpJ4aglJeTPagqOZS0sxIEpNVRjzHqifXBCszBazpGDoWUgLfnknBL1HxrQdOS+OmstVWj6fJJB1uSRDCVTyTg3QHbFTTfmSud2MheD5C07QSfTbLJlPxLbQPQBwsZ5HMu+n2WfJnNxYLRhDgFSaf0ywBhzdtBPmwkp+rWDNn/ySwbi45TQb9BhahlB/Yc2eNKJsjQN2oSojb5arvYeitmRDCVTZIys5YSiIw1mXXHRKbpFxyCdqw2QhpxddC/9+sN3OpCbZlGAWc/SMhA6wEnR3jSOXHMfncp+CegEPa7Spt1/GBd0asYVp6c6HFe0ORL29vbap8YY85eDg4PjfoIg1I+MO8v2zmHTjyjeuHNu7/5Fzwikm6L3d3d32ztmCNKFAteC66iLrrhAXD1Lx4X4XtS7mY6oi9RekG+0g9QOc/YDjOsl3ZDHKtjWBv+MKzEVeM/jijQ/W/TOf2OMMcYsi4XsgTHGGGOMWSR2YIwxxhhTHTMtIRljjDHGnAaegTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMddiBMcYYY0x12IExxhhjTHXYgTHGGGNMdczNgXn27NloY2Nj9OPHj/bOYvj8+fPoypUr7VWeIXGMMcYYUy8bh2Pa85nAYSDcuHFj9OjRo/bu/CGPjx8/ji5dutTeyYNDBYssizHGGGNOh7nMwDDjAU+ePBm9evWqOV8Eb9++bRyYPucF7ty5M3r8+HF7ZYwxxph1Yi4OzJs3b0YPHjwYbW5uNtdyaASOB8tLBC01xTg4JfF5idevX4+2t7ebczkzkZguTs6tW7eaeMYYY4xZL+biwLx8+bKZ8QAcGRwawZ6Ye/fujQ4ODkasVv38+bN9csTt27cbR4RnBGZNSk7Hhw8fRlevXm3O7969O/r+/fuxw8Lx8uXLx04UsJy1v7/fXhljjDFmXZjZgcHZYKZDyzo4Mjg02sz77t27E47Ff//91xyBODglLD2JnZ2dZqYlRenF5SPifvnypTnnePPmzeZcXLhwYeGbio0xxhizfGZ2YHA2cEK0BISzAjguIi715PavbG1tHb+P85Pjz58/7dlf7t+/f7znhiPXKd++fWvPjDHGGLMuzOTAaAZFyz8Ku7u7JzbzRiciNyOi5SWF9+/ft0/+cu7cufbsL8zqsIzELBDHuHwk0n0yxhhjjKmfmRwYZllYPkphGUn7U+I5PH/+vDmCNto+ffq0vXPkcDx8+LC9+otmblIHiGUk9thwTPn161d2xscYY4wxdTOTA8OGW/0qKCLHhM28nO/t7R0vE6Uw28IMjZaQcGBevHjRPj0JaX79+rW9OkLLRtevX2+OkU+fPmXvG2OMMaZu5vYf2Q2FGRT2yTArM+nsCEtF7LmJS0xKL61G6b4xxhhj6mfmTbx94HTEmReWkHAsplna4afTzNbEZSRmZHLLRyxvsRfHGGOMMevHUmZg2NMSf100zeyLYC8Ny1Y4Miw3kVZahRjHGGOMMevH0peQjDHGGGNmZeFLSMYYY4wx88YOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqww6MMcYYY6rDDowxxhhjqsMOjDHGGGOqY2kOzJUrV0YbGxujz58/t3f+wn3CKkO5Vc5ceR8+fPjPc8KPHz/aGGeX27dvH8sDOUVSudFOSjx79mxQvGkh/bR86G+SPNXOCaS3Trx9+7apV46c7EpIprm+YBIoD20rh/LoQ7oaErc2YtslpPKOtleSo4hxkfu8iPbSla7a3iLKsEp01TH2o4QunUW5zqOvpCy5/GJ5+ojlH9pX9HK4JC5fvtyE3d3d9s4Re3t7hxRjiUX5h52dnfYsz/fv35vyHRwctHcOm3rEMpPGrVu32qsjVDfeP6sglyhf5IFcBDJL20QO3qH9CN7r0xsMiQPSZxo/lq+vrLFMuTZTO8g/tnlRkl0J4g2VTSlN2RYyT5Hsc2WNkLbSj+frQpSx5CXSvgndlupPGno3nncxRJboLuovljeS5qnrXNyaQQfqG1XHOHbE512k/VQq5xIlnZVsLdpMPM/Bs1TXQ+rSR39LnBMyEI4RVTw20GXTJXhA0Gm5ITaoVEFC9TNHIKMoj6FGmYKB5nSSMkT2tD0ZaIyvgVCdSKkdQBp33ZC8Uzstya4EHbPSGTIA5dLU++SZ2hzx9YxjF7EMGjDWFbVP1Rc5Rdmh31SWgrhRD8i/z2Zzeouk5QHK0PeeoAxxkF5HkE+UcyqvoZDGkLadk32XrcXy9NnPtGXvY6l7YK5fv94c47LKy5cvj+9Huqbi43QmQekxzcV7capqHtP458+fH40N7p8pvW/fvo3u3r3bXuWhbtTRHPHhw4cT+kauV69eba+G8+nTp9HNmzfbq9kYd4RYXnv1lz9//jTHS5cuNUe1gxxfv34djY39OO46gX29evVq9PTp0/bOX0qyK7G9vT16/fp1ezUdDx48aPLMyfrixYvNM/LpQn3GuXPnThxj37RO0D5hc3OzOd6/f7+xRdUX/ZbaLnGQq6CP/fXrV3s1Xz5+/Nie9XPhwoX2bP3Qcp/6RulJ+psU+qZpKNnaJPajukxb9i6WvomXQefdu3fNORUbe3XNwBDBAcFIEBzh8ePHx84DRxq5nvH+8+fPm2fAAEPnxbOx59m8myM6OTgYOs+tFyJ4Oup79+4dx8spKkdat7OKnE70JadPDZs2Ibmm6/Qp6J94dL4vXrxo755kEt3Co0eP2rOT/P79uz07SU73dOikv6i9AqcJ9lVyOkqyy4E86BDV2ZXo019XnkPLI+c0pXS/ZpAdfRf9oaBPo69kYOM5zmnJnvhQS/n582d79pdJ7I4BkbyjU4wTNQTa0bQfPjWAvLa2tpoxR46DPpAkU8LQMejJkyfFj71pbW0S+6EfpexMJij9ee0PXLoDw9e3GuqbN29GN27caM4FSmFwQuhiZ2fnuANl8IsGxXmqSA2Qch5yin7//v2xE0T6Os8ZK6BIxUEZakxmGHSOyA6DlHHIQZBDisFiuF2GiW6JS2eM/Oeh23mh2SXyOjg4aAaNPods1aH8yHgeX0/IY4iDcVr6W1ckP+SvgYMjfZie0b8ymM3CpHrjPjajQW3IjCptUc5YacaodpALcmOc1GZXPpBw2qJ80V8fer/knC7L1jRzTdqcx0mJWVi6A8MARAVoiHh8165da5+chIFMDZt4gvd0n5Dz7heNGpi8yi7kfZojmLqW/uWMqCPS4Kbp7i7kpA6JOy2l2bNcx8l0NnpWuRjwuf7y5UtzXSvMZpY6v0mgI40zAKdNaRaob3aoZhigWHoFBkc+GAQfjHFJKZLrY+OS0ixowCRAV39O2bAp2pHsbJ1htlJLavqAFv/9919z7PpAwuZ4f97OCExiP+pH1b/TfzITv7+/31zPwtIdGKDwCJfGWPqy4ws2Nm48RWA6m/d1fxleOF8mOUcFY8tNpUb4spnXXg2zXGSM6tS7nNF1XCqk3jib1JmPBb58gfPcQNcFHSnv865kyEfKaS2zqd/QlLeOy+hPagOZxH6OAXER+09oIyX5nzXnZVYW6bzAJPaz0I+CsROwFMaN73hH9djzb3Ylj78Imut0B/PYQTmx45l3FZejno071+Y9XZN+TEfpEm8WlG7cRa28dS+WS+i9WfOvGWQi3QG6lJxoB1wLtYscaVzSLMWdlrSsQJ7kDTzXeQ7iqo2vo+5T+4rkZFcitZ1pydmc6CqriGXmOLT8NZDKWH2h2mdqa8hiiCyVzjyIttVnL7Hs60qso/Qn+aRtnevYH0Z4p/RsWtL8YRL7Ia7qojY0q/3DfFriAGLnLuXoOmcUxOceIQpO7xKUpt6N56B0c0ZBmkonhpLilVYMMV2Ulz5P45xVSrqEVG6R2OihK25kUt0K3kuNMG1vkbR8EPObh4GuEql9RXKyK8lAMi3JZ6j+yI+4OXJlRVdp/Jj+upH2WepvRbSnKFvpp9S/pemIoXoT0bYIsT2Qh95DbzGeQtreaieVR9q3RPmmMuWe5Kc4aYj6FLPaWnwnkrM10lTcUhualA3+GSdojDHGGFMNp7IHxhhjjDFmFuzAGGOMMaY67MAYY4wxpjrswBhjjDGmOuzAGGOMMaY67MAYY4wxpjrswBhjjDGmOuzAGGOMMaY67MAYY4wxpjrswBhjjDGmOuzAGGOMMaY67MAYY4wxpjrswBhjjDGmOuzAGGOMMaY67MAYY4wxpjrswBhjjDGmOuzAGGOMMaY67MAYY4wxpjrswBhjjDGmOuzAGGOMMaY6lubAPHz4cHT79u326ogfP36MNjY2ToSUK1eu/BOH8Pbt2zbGSZ49e9bk1ceQtMz8QCdR5ug+gt70DJ13EdP5/Plze3c2cu0z5pM+K0FbIv66oPooRJB9fIYOu4hxF6m32Nb6+oLYv/SVvxa6dBah7l16SPVLmIfecjoTPOvSQzpm9Om3JmK7JUzbR6YyWqStca18+nQR6ze3MfdwSezs7BzeunWrvTo8PDg4OCT7vb299s7h4e7ubnPv+/fv7Z3Dw8uXLzf3I7yTxgO9T15dkKbyVTnStMz8QC9R99KTkD4FcUs6RHd6hs7moTulE8sY2wjEfLsgXqxLzcg2RLThVPa6jjKLLEtvadviWdp/iPhMaVHnmunSWUTttKu+6JJ48ySnM0FZeVbSF6Rl7otfC9Shqx1P0kdGGaXvTUtOb+Qfy8Dzkv3Hdpm20VmYTyoDSA0Jw8g1vKHxUmFxTehSbIk0LbNY0sECnQ3phNTweV+g6yHvdkH+tLPY7lLIo68zVxzKuI70dYYl21um3tL+grz79CbSd9eBVGe6RmYcZYM5kEWXTUxDTmfqD7g/qQ7S8WJdmLaPTEnTmZac3lJ4Vhp7uR+fkdY8xtxT2QPDlNZYsKM7d+60d/5y//790YcPH/6ZPutjrFystL0ajqbXrl692hzN8jh37lxzRN/Xrl1rzqfh06dP7dnkMJV56dKl0c2bN9s7ZfqmbV+9ejV6+vRpe2f92N/fH407qfYqz8WLF9uzfpalN/qavv6E58SbpR2uIjmdUc8XL160V2V+/vw5unHjRns1O106Gw9mo2/fvrVXk0Ga68qsfeTXr1+b4+bmZnOchqG2RhmvX7/eXp0E+4p9A33pr1+/2qvpORUH5vfv380x1/CksD9//jTHHFo/i07Ho0eP2rPhIMStra3G+VlnI1g1nj9/Php74I3MNbDQJrQ+WloflxHyvnj58mV7Nh1PnjwZ1Jk/fvy4szOnTK9fv26v1gvthUDWJVkRp9TJLlNvdLLoSrx586Y9K0N7oz2OvxBn6uhXiZLO7t69O7iv+/jxY+OUyy5n3W9S0hnloVyTQt9B/UqDZs1M20dGiHfv3r3GOZyFvj5Se1twlEt6zDmnOMizUsWvkOiQpDgp5eDgYGanA6Eya4ORzmqcZhg4n3Q6dI4RBn90QUAvJX3w9cj7agsMOtPCprgHDx60V2XoLDDOkpPMYEEnsy6DXwr1Qi/YHJ2qZi0j+hAoyWBZeqOjRVfKZwjv379v6ocOhwwMNTBEZ32gM+RMOtLftBudh9raJOCs0o6mcX5WmVn7SKG4jJeL1Bs2Rz6Mx12z1IvgVByY8+fPN0d5lhHNvGgmBrQ8RKBzIgwdLOiQ1JmVhIuC0sZi5g+GiTHRGcr51BEvX3Tpg/hqCwTaUM6RxfCkd0La1rjGce2budOAxiBXYnt7u/MLZV3A5hgMv3z50t45Avlio12yXKbe5JAQ9HWeyysFPTKLtE6UdDYE5Cc5Iz+chdyy37xsbRLoy3Fg1s3u5tFHpixLb2z/oNxpOpAbeydZbi5xKg6MjOrdu3ftnb8VZMoXB6XU4dA5DfE+RezMctNYZjnkDFPQFqaFASdnCBid9E5I82RtmLLIePniIa1oaEOcF4yVdKgD6VBHyHUI6wj17HNecixSbxH2gMzSvkw/89ZZH7x3VpwXsYg2vEy9kXZcMmIsvnDhQns1A+OCL4WxF3hiBzO7osleO5F1TRgLrbkHY8X9s/tacTmmkAd5dRHzJS+u0zzM/JC+ol4jyD62jS59RN0Rh+t5kLbP9HoolG1eZTpt0rpI3tJjzjZLnIbeZNvKNyUtP3H7+o5Vp09nQrLJ9aGQPu+T5SR02VZfm+K92nWUY159ZKo3pbsIvaW6QHclvcZ2qTLNg/mkMoBco5Wwc0EKKDVo0iNeqvBUqDnSfLsMxswOOonyVohGJX0Sov6IQxsQavwKJYOflNg+u9plfJ7LOxrqOoBtxPqrzqpnGiTD09CbIF/lE207pzfFI/T1G7VQ0llEslA/C3064/k8yOlMpP191FlaHoVY5lpZZB+5SL1FW4vPot5ELP+8yrTBP+MEVwqm3tkLM3SfizHGGGPOFivpwBhjjDHGdFHFz6iNMcYYYyJ2YIwxxhhTHXZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMddmCMMcYYUx12YIwxxhhTHXZgjDHGGFMZo9H/AakZqOUWBhEPAAAAAElFTkSuQmCC\"\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec3\"\u003e\n \u003ch2\u003eSeroprevalence of HBV markers\u003c/h2\u003e\n \u003cp\u003eThe overall anti-HBc prevalence was 1.35%, (1,159 out of 85,811; CI95%: 1.27\u0026ndash;1.42%) ranging among the different departments from 0.70 to 3.86% (Fig. 1). Due to the limited number of samples from the Alto Paraguay and Boquer\u0026oacute;n departments, these were excluded from further analyses. A significant progressive increase in anti-HBc seroprevalence was observed, correlating strongly with donor age. This rate ranged from 0 27% in the \u0026lt;\u0026thinsp;20 age group to 3.10% in the over- 50 age group, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 (Fig. 2). Furthermore, the prevalence was significantly lower in women than in men (1.06% vs 1.53%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003eThe national prevalence of HBsAg was 0.086% (74 out of 85,811; CI95%: 0.067\u0026ndash;0.108%), distributed unevenly across the country\u0026apos;s different departments, from 0.0 to 0.38% positivity (Table 2) and did not strictly follow the anti-HBc rates in the different departments. Particularly, the seroprevalence of HBsAg in the 35\u0026ndash;40 age group (0.16%) was significantly higher than the national average (p\u0026thinsp;=\u0026thinsp;0.001). Conversely, donors under the age of 25 exhibited notably lower rates (p\u0026thinsp;=\u0026thinsp;0.001) (Fig. 2). Similarly, seroprevalence was substantially lower in women compared to men (0.048% vs 0.110%, p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eSeroprevalence of anti-HBc, HBsAg and anti-HCV by departments (n\u0026thinsp;=\u0026thinsp;85,811). Department data was available on 17,165 blood donors. * Due to the limited number of samples from the Alto Paraguay and Boquer\u0026oacute;n departments, they were excluded from the analyses. n/a: Department not available.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDepartment\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePopulation\u003c/p\u003e\n \u003cp\u003e(n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDonors\u003c/p\u003e\n \u003cp\u003e(n)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eF/M\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAnti-HBc (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHBsAg\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAnti-HCV\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAsunci\u0026oacute;n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e541,133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6,795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlto Paraguay*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20,130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlto Paran\u0026aacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e894,046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11,615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmambay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e210,033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoquer\u0026oacute;n*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83,209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaaguaz\u0026uacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e505,168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCaazap\u0026aacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e163,284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCanindey\u0026uacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e223,732\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCentral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,205,465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31,796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.1\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcepci\u0026oacute;n\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e241,371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCordillera\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e313,784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGuair\u0026aacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e210,200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eItap\u0026uacute;a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e526,384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5,271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35.6\u0026thinsp;\u0026plusmn;\u0026thinsp;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMisiones\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130,111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,261\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026Ntilde;eembuc\u0026uacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89,813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParaguar\u0026iacute;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e234,687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36.5\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePresidente Hayes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e144,359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1,130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSan Pedro\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e415,794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en/a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,991\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e7,152,703\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e85,811\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.63\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e35.3\u0026thinsp;\u0026plusmn;\u0026thinsp;10.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.086\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.267\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eAmong the 1,248 individuals who tested positive for at least one HBV serological marker (anti-HBc, HBsAg, or HBV-DNA), seven distinct patterns were identified (Table 3). The most common pattern indicated past infections, characterized by reactive anti-HBc only. Less frequently, ongoing infections (all markers reactive) and occult infections (reactive anti-HBc with detectable HBV-DNA) were observed. Interestingly, eight cases presented with detectable HBV-DNA in the absence of HBsAg, while five exhibited both HBsAg and HBV-DNA, suggesting recent infections. Lastly, it is worth noting that isolated HBsAg reactivity-potentially consistent with false positives in the absence of confirmatory testing-was observed in 76 samples. (Table 3).\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eHepatitis B Virus serological marker patterns. Among the 1,248 individuals who tested positive for at least one HBV serological marker (anti-HBc, HBsAg, or HBV-DNA), seven distinct patterns were identified. OBI: Occult hepatitis B infection, NR: No Reactive.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePattern\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAnti-HBc\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHBsAg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHBV-DNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePast infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOngoing infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOBI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eRecent infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndetectable HBV-DNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFalse positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eReactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTAL REACTIVES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,159\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e150\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e104\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,248\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eThe impact of the national vaccine schedule\u0026apos;s implementation on HBV marker seroprevalence was also assessed. The study cohort comprised 7,412 individuals (8.6%) born after the vaccine rollout and 78,399 (91.4%) born before its implementation. Anti-HBc seroprevalence was notably lower in the post-implementation birth group compared to the pre-implementation group (0.27% vs 1.45%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Furthermore, no HBsAg-positive donors were identified in the post-implementation group, in contrast to the 74 positive donors (0.094%) observed among those born prior to vaccine introduction (p\u0026thinsp;=\u0026thinsp;0.008).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eAnti-HCV seroprevalence\u003c/h3\u003e\n\u003cp\u003eThe nationwide prevalence of anti-HCV was 0.267% (229 out of 85,811; CI95%: 0.205\u0026ndash;0.304%). Seroprevalence varied across departments, ranging from 0.09% in Amambay to 0.46% in Concepci\u0026oacute;n (Table\u0026nbsp;2). Importantly, no significant differences in anti-HCV seroprevalence were observed across age groups or sex. Among the 229 individuals who tested reactive for anti-HCV, only one was confirmed positive for HCV-RNA. Furthermore, four cases consistent with the viral window period were identified, characterized solely by the presence of HCV-RNA.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSeropositivity rates in blood donors are key indicators of blood safety and the effectiveness of donor selection and screening protocols. Highly sensitive diagnostic tests have revolutionized blood safety, minimizing the risk of parenterally transmitted infections like HBV and HCV \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. However, maintaining and improving this security requires continuous monitoring and adaptation to territorial variations.\u003c/p\u003e\u003cp\u003eTo our knowledge, this study represents the most comprehensive assessment of HBV and HCV prevalence among Paraguayan blood donors to date, offering crucial insights into the current epidemiological landscape. However, notable disparities across age groups, sex and geographic regions highlight the need for targeted interventions and region-specific awareness campaigns to effectively address the disease burden.\u003c/p\u003e\u003cp\u003eThe limited availability of detailed epidemiological data from population-based studies on HBV and HCV in Paraguay has hindered public health planning. Previous reports indicate that HBsAg prevalence ranges from 0.4% among women of reproductive age to 4.5% in clinically suspected hepatitis cases,\u003csup\u003e9,10\u003c/sup\u003e underscore the critical need for more representative and robust data. Furthermore, a recent investigation involving 278 blood donors, primarily from the Central Department and Asunci\u0026oacute;n, reported HBV and HCV marker rates consistent with our findings.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e In response to this critical gap, our national-scale cohort study provides a significantly more comprehensive understanding of HBV and HCV seroprevalence. Additionally, the absence of HBV infection markers among donors vaccinated through Paraguay's childhood immunization programs, launched in 2003, offers evidence of their effectiveness.\u003c/p\u003e\u003cp\u003eAnother finding of our study is that 76 out of 150 HBsAg-reactive samples showed no reactivity for anti-HBc or HBV DNA. In low-prevalence cohorts, such as blood donors, this result is consistent with false reactivity. This issue has been documented in other studies and represents a challenge that cannot be ignored.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Similarly, HBV DNA was detected in 24 of the 1,090 donors (2.2%) who were anti-HBc reactive but HBsAg negative, indicating occult HBV infection.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e While reported OBI rates in blood donors vary widely \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e -largely influenced by the overall prevalence of the infection in the population- several studies have reported findings similar to those presented here.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAdditionally, the decreasing prevalence of anti-HBc across age groups, from older to younger individuals, indicates a decline in HBV circulation over time. This trend has been widely documented in regions where preventive public health measures have been effectively implemented to control the infection.\u003csup\u003e\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe anti-HCV seroprevalence rates observed in our study are substantially lower than those reported in neighboring countries.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Notably, only two other studies -one conducted in indigenous communities in the eastern Paraguayan Chaco in 1998 and another among individuals attending the Institute of Health Sciences Research in 2009- reported significantly higher anti-HCV prevalence (14.9% and 6.6%, respectively). \u003csup\u003e10,22\u003c/sup\u003e Interestingly, in contrast to several studies where older individuals usually have significantly higher seroprevalence rates than younger individuals,\u003csup\u003e23,24\u003c/sup\u003e this cohort showed no age-related differences in anti-HCV rates. Furthermore, unlike what was observed for HBV, no differences in anti-HCV seroprevalence were found between men and women. This contrasts with findings from other regions, where men, who are more likely to engage in high-risk behaviors such as intravenous drug use, exhibit higher rates.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e These results suggest that the impact of risk behavior and exposure factors varies across different contexts.\u003c/p\u003e\u003cp\u003eHCV-RNA was detected solely in one of the 229 anti-HCV reactive samples (0.44%). While it is well-established that 20% to 50% of HCV infections resolve spontaneously, which may partially explain these results,\u003csup\u003e27\u003c/sup\u003e the high sensitivity of screening assays can sometimes come at the expense of specificity, particularly in the case of anti-HCV tests, which have been widely scrutinized.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e The issue is especially pronounced in populations with low infection rates, such as blood banks, where a low signal-to-cutoff ratio (S/Co) further exacerbates the challenge.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eNucleic acid testing was partially implemented in 2022; subsequently, all donations within the public system have been screened since 2024, significantly reducing the risk of transfusion-transmitted infectious diseases and enhancing the safety of the blood supply. Importantly, the analyzed cohort identified eight potential cases of HBV infection during the eclipse period and four cases of HCV infection in the window period. While these findings require confirmation, they strongly support the routine implementation of NAT assays.\u003c/p\u003e\u003cp\u003eIn conclusion, HBV and HCV seroprevalence among Paraguayan blood donors remains low. However, achieving the WHO\u0026rsquo;s goal of eliminating viral hepatitis by 2030 requires extensive large-scale studies and targeted research on high-risk groups. As the WHO emphasizes, robust strategic data is essential for guiding effective public health interventions. In this context, the strength of this study lies in the fact that it was based on a nationwide representative cohort of over 85,000 donors, encompassing data from all departments across the country. Identifying \u0026ldquo;epidemiological hotspots\u0026rdquo; enables the efficient allocation of resources and enhances health policy development. Furthermore, understanding HBV and HCV infections across regions and age groups is keystone for refining public health strategies, optimizing prevention efforts, and addressing disparities in disease burden.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003ePopulation\u003c/h2\u003e\u003cp\u003eA prospective, cross-sectional study was carried out from 1 June 2024 to 31 July 2025, on the serological markers of HBV, and HCV. Serum samples from 85,811 blood donors who attended blood banks across the country's 17 departments and the capital district of Asunci\u0026oacute;n were analyzed. Donors completed a routine questionnaire to identify potential risks that could affect the safety and quality of donated blood and underwent a physical examination conducted by trained physicians. These assessments included measuring blood pressure, body temperature, pulse and respiratory rate.\u003c/p\u003e\u003cp\u003eEligible participants were donors aged between 18 and 65 years, and weighed at least 50 kilograms, and appeared to be in good general health. People under 18 years of age can only donate blood with the consent of their parents, while those over 65 were exceptionally allowed to donate if they were repeat donors. Data collected included only age, sex, and donation location to ensure anonymity. After obtaining consent, each donor completed the form and had a blood sample drawn in a plain (non-anticoagulated) tube for serological testing. The cohort was categorized into the following age groups: individuals under 20 years, 5-year intervals for those aged 20 to 50, and individuals over 50.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eSerological assays\u003c/h2\u003e\u003cp\u003eHepatitis B virus core antibody (anti-HBc), HBV surface antigen (HBsAg), and hepatitis C antibody (anti-HCV) testing was performed on the ARCHITECT i2000 fully automated chemiluminescent microparticle immunoassay platform (Abbott Diagnostics, Abbott Park, IL), according to the manufacturer's instructions.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eNucleic Acid Amplification Test (NAT) Assays\u003c/h3\u003e\n\u003cp\u003eSamples were tested for HBV and HCV nucleic acids on a fully automated Roche Cobas 6800 system using a multiplex polymerase chain reaction kit (Cobas MPX test), following the manufacturer's instructions.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData were compiled and analyzed using IBM SPSS Statistics version 23.0 for iOS (IBM Corp., Armonk, NY, USA). Categorical variables were expressed as frequencies and percentages. Comparisons between qualitative variables were performed using the Chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. A p-value below 0.05 was considered statistically significant. Prevalence estimates were reported with their corresponding 95% confidence intervals (CI) to assess statistical precision.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDMF, MME, PB, and FAD are members of the National Research Council (CONICET). The authors would like to thank Maria Ferreyra and Victoria Ceñal Filotti for their technical assistance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDMF, NM and FAD conceptualization and design, data collection, reviewing and editing;\u0026nbsp;LCN, NPN, DF, MME, APM designed the study protocol and carried out the clinical assessment; PB, APM, DMF and FAD made the analysis and interpretation of the database. DMF and FAD drafted the manuscript; PB, APM, ACM and NM critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. DMF, NM and FAD are guarantors of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einterests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn behalf of all authors, the corresponding author states that there is no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical aspects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the School of Pharmacy and Biochemistry, University of Buenos Aires (EX-2022-01463207- -UBA-DME#SSA_FFYB). During the study period, informed consent was obtained from all donors. The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHsu, Y. C., Huang, D. Q. \u0026amp; Nguyen, M. H. Global burden of hepatitis B virus: current status, missed opportunities and a call for action. \u003cem\u003eNat. Rev. Gastroenterol. Hepatol.\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e (8), 524\u0026ndash;537. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41575-023-00760-9\u003c/span\u003e\u003cspan address=\"10.1038/s41575-023-00760-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchr\u0026ouml;eder, S. E. et al. 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Rep.\u003c/em\u003e \u003cb\u003e11\u003c/b\u003e (1), 8689. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-021-88138-2\u003c/span\u003e\u003cspan address=\"10.1038/s41598-021-88138-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2021).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hepatitis B virus, hepatitis C virus, Seroprevalence, Blood donors, Public Health, Paraguay","lastPublishedDoi":"10.21203/rs.3.rs-8071757/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8071757/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe true burden of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) in Paraguay remains poorly defined, hindering effective public health planning toward the WHO's 2030 elimination goal. This cross-sectional study aimed to establish a comprehensive, nationally representative epidemiological baseline among blood donors.\u003c/p\u003e\u003cp\u003eWe prospectively analyzed 85,811 blood donor samples. Screening involved chemiluminescent immunoassays for anti-HBc, HBsAg, and anti-HCV, followed by confirmatory Nucleic Acid Amplification Testing (NAT) for HBV-DNA and HCV-RNA.\u003c/p\u003e\u003cp\u003eOverall seroprevalence was low: 1.35% for anti-HBc, 0.086% for HBsAg, and 0.267% for anti-HCV. However, significant regional variations were noted, with anti-HBc prevalence ranging from 0.70% to 3.86% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Anti-HBc also increased with age (0.27% in \u0026lt;\u0026thinsp;20 years to 3.10% in \u0026gt;\u0026thinsp;50 years). Critically, no HBV markers were detected in donors born after the national 2003 vaccination program. Only 1 of 229 anti-HCV reactive samples was HCV-RNA positive.\u003c/p\u003e\u003cp\u003eWhile low overall seroprevalence confirms blood safety standards, pronounced regional disparities require targeted public health interventions focused on specific epidemiological hotspots. The absence of HBV markers in the post-vaccination cohort provides strong evidence of the national immunization program's success, offering an invaluable baseline for future elimination strategies.\u003c/p\u003e","manuscriptTitle":"Nationwide Seroprevalence Study of Hepatitis B and Hepatitis C Viruses Among Blood Donors in Paraguay","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 10:05:19","doi":"10.21203/rs.3.rs-8071757/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-12T07:00:19+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-11T12:53:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297079132225187000896238593168171937205","date":"2025-12-09T08:35:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302099520089441277845824195818527815215","date":"2025-12-08T07:19:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-07T17:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"315880906216584894121366745089526980231","date":"2025-12-05T06:39:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-05T00:20:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"217964716302775637559231576105199909255","date":"2025-12-03T15:55:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24144035038914904111941424600809939725","date":"2025-11-20T05:07:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121964846160307916262453369237889520747","date":"2025-11-13T20:10:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-13T04:49:47+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-13T03:50:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-11T07:24:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-11T07:21:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-11-10T01:32:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0245f097-1cb7-49d7-bd0d-0299172eb1a3","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":58493520,"name":"Health sciences/Diseases"},{"id":58493521,"name":"Health sciences/Gastroenterology"},{"id":58493522,"name":"Biological sciences/Immunology"},{"id":58493523,"name":"Health sciences/Medical research"},{"id":58493524,"name":"Biological sciences/Microbiology"}],"tags":[],"updatedAt":"2026-05-04T15:59:31+00:00","versionOfRecord":{"articleIdentity":"rs-8071757","link":"https://doi.org/10.1038/s41598-026-48872-x","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-04-27 15:56:51","publishedOnDateReadable":"April 27th, 2026"},"versionCreatedAt":"2025-11-24 10:05:19","video":"","vorDoi":"10.1038/s41598-026-48872-x","vorDoiUrl":"https://doi.org/10.1038/s41598-026-48872-x","workflowStages":[]},"version":"v1","identity":"rs-8071757","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8071757","identity":"rs-8071757","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}