Malaria Complications in China: How Imports Impact Treatment

China has successfully eradicated malaria, but the threat of reintroduction via imported cases remains active. We examined data on imported malaria from 2014 to 2021 to understand what makes some cases severe and others prone to relapse. Patients first diagnosed with non-malarial illnesses were about four times more likely to develop severe malaria than those initially diagnosed correctly. Interestingly, the relapse risk of Plasmodium vivax and Plasmodium ovale varied depending on where patients lived in Africa. Those in western and southern Africa were less likely to relapse compared to those in Central Africa. Another fascinating find was that using primaquine effectively protected against relapse. Improving prompt diagnosis and treatment could lessen disease severity, and includg primaquine in treatment plans might help prevent relapses.