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. 2025 Sep 10;17(9):e91971.
doi: 10.7759/cureus.91971. eCollection 2025 Sep.

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

Zachary Webb  1
Affiliations

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

Zachary Webb. Cureus. .

Abstract

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.

Keywords: disease surveillance; emergency medicine; imported malaria; new york; public health.

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Conflict of interest statement

Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Annual imported malaria cases in NYC and NYS, 2018–2024.
Data are presented as mean annual case counts ± standard deviation (mean ± SD). A Pearson correlation analysis demonstrated a statistically significant positive correlation between annual cases in NYC and NYS (r(5) = 0.96, p = 0.001; significance set at p < 0.05). NYS: New York State, NYC: New York City
Figure 2
Figure 2. Spatial distribution of imported malaria cases by county in New York State, 2018–2024.
Data are presented as a color-coded map by case count (N) category, distinguishing the 11 counties with the highest case counts, counties with other reported cases, counties with no reported cases, and NYC counties (shown separately). This figure is descriptive and does not include statistical testing; the study-wide significance threshold was p < 0.05. NYC: New York City
Figure 3
Figure 3. Spatial distribution of imported malaria cases by county in New York State, 2018–2024.
Data are presented as a color-coded map highlighting the 11 counties with the highest number of reported imported malaria cases, counties with other reported cases, counties with no reported cases, and NYC counties (shown separately). A chi-square test demonstrated that case distribution was not uniform across NYS counties (χ²(56, N = 401) = 1910.98, p < 0.0001; significance set at p < 0.05). NYS: New York State, NYC: New York City
Figure 4
Figure 4. Annual number of reported imported malaria cases in NYC and NYS, 2018–2024.
Line graph illustrating the total number of imported malaria cases reported annually in NYC (blue) and NYS (red). Data are presented as raw case counts (N) by year. This figure is descriptive and does not include statistical testing; comparative analyses are reported in the text. NYS: New York State, NYC: New York City
See this image and copyright information in PMC

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