Imported Malaria in New York: Geographic Patterns and Implications for Emergency Physicians

Although malaria is no longer endemic in the United States, imported cases continue to pose a diagnostic challenge for emergency physicians. This study examined county- and city-level trends in imported malaria across New York State (NYS) and New York City (NYC) from 2018 to 2024. Surveillance data revealed that NYC accounted for the majority of reported cases (79.1%). Within NYS, 11 of 57 counties (Albany, Dutchess, Erie, Monroe, Nassau, Oneida, Onondaga, Orange, Suffolk, Sullivan, and Westchester) contributed 88.3% of all state cases outside NYC. A marked decline in cases occurred in 2020, coinciding with COVID-19-related travel restrictions, followed by a rebound in 2021. These findings underscore the importance of incorporating both recent travel history and awareness of local county-level malaria cases into the evaluation of febrile patients in New York emergency departments, while also highlighting the need for targeted malaria prevention strategies in the state's identified hotspots.