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Background  Although autochthonous malaria cases are no longer reported in Anhui Province, China, imported malaria has become a major health concern. The proportion of reported malaria cases caused by  Plasmodium ovale  spp. increased to levels higher than expected during 2012 to 2019, and showed two peaks, 19.69% in 2015 and 19.35% in 2018.    Methods  A case-based retrospective study was performed using data collected from the China Information System for Disease Control and Prevention (CISDCP) and Information System for Parasitic Disease Control and Prevention (ISPDCP) from 2012 to 2019 to assess the trends and differences between  Plasmodium ovale curtisi  ( P. o. curtisi ) and  Plasmodium ovale wallikeri  ( P. o. wallikeri ) .  Epidemiological characteristics were analyzed using descriptive statistics.    Results   Plasmodium o. curtisi  and  P. o. wallikeri  were found to simultaneously circulate in 14 African countries. Among 128 patients infected with  P. ovale  spp., the proportion of co-infection cases was 10.16%. Six cases of co-infection with  P. ovale  spp. and  P. falciparum  were noted ,  each presenting with two clinical attacks (the first attack was due to  P. falciparum  and the second was due to  P. ovale  spp.) at different intervals. Accurate identification of the infecting species was achieved among only 20.00% of cases of  P. ovale  spp. infection. At the reporting units, 32.17% and 6.96% of cases of  P. ovale  spp. infection were misdiagnosed as  P. vivax  and  P. falciparum  infections, respectively.    Conclusion  The present results indicate that the potential of  P. ovale  spp. to co-infect with other  Plasmodium  species has been previously underestimated, as is the incidence of  P. ovale  spp. in countries where malaria is endemic.  P. o. curtisi  may have a long latency period of > 3 years and potentially cause residual foci, thus posing challenges to the elimination of malaria in  P. ovale  spp.-endemic areas. Considering the low rate of species identification, more sensitive point-of-care detection methods need to be developed for  P. ovale  spp. and introduced in non-endemic areas.

Epidemiological profile of Plasmodium ovale spp. imported from Africa to Anhui Province, China, 2012–2019