Researchers at Children’s Hospital of Philadelphia (CHOP), working with colleagues across the country, found that more than one in four pediatric patients treated for malaria in the United States had their initial diagnosis delayed, increasing the risk of more severe infections.
The survey results were published in a magazine Pediatricshighlights the continued need for malaria prevention before international travel and faster diagnosis of imported cases to improve patient outcomes.
Malaria is a life-threatening disease that infects more than 250 million people and kills more than 600,000 people each year, the majority of them children under the age of five. Although malaria is no longer endemic in the United States, approximately 2,000 cases of imported malaria are diagnosed in the United States each year, 10-20% of which occur in children. The number of infections in the United States has increased over the past several decades, primarily due to increased travel and immigration to countries where malaria is endemic.
The disease course of these pediatric malaria patients in the United States was relatively unknown. Because many physicians in the United States have never encountered pediatric patients with malaria, there was a desire to better understand the risk factors for developing malaria and outcomes for these patients.
Children are not small adults. They are not traveling for work, but frequently travel abroad to visit relatives and friends, and they contract malaria while traveling. ”
Sesh A. Sundararaman, MD, PhD, study co-lead author and principal investigator, Department of Infectious Diseases, Children’s Hospital of Philadelphia
This retrospective study analyzed pediatric patients treated for malaria at nine hospitals across the United States from 2016 to 2023 to better understand patient demographics, clinical outcomes, and risk factors for severe malaria. A total of 171 patients were identified, 73% of whom had traveled to West Africa to visit friends or relatives.
The most common symptom reported was fever, affecting 90% of patients, and two-thirds of patients reported at least one abdominal symptom. There were no deaths in this population, but almost one-third of the patients were diagnosed with severe malaria.
The study also found that 26% of patients had delayed malaria diagnosis, and this rate was similar across all hospitals studied.
“It is important to note that symptoms alone do not determine who has malaria,” said Audrey R. Odomjohn, MD, lead study author and chief of CHOP’s Division of Infectious Diseases. “Children who come to the hospital with suspected malaria typically have a fever, but they can also have a wide range of symptoms. They can have a cough, tummy troubles, headaches, and almost anything else. That’s why we need fast and accurate testing to confirm these cases.”
Delays in diagnosis can be caused by a variety of factors, including not asking about recent travel or U.S. pediatricians not being familiar with the disease. In either case, the longer the period, the more likely the patient is to develop more severe disease.
“Severe illnesses result in longer hospital stays,” Sundararaman said. “Children with severe malaria are more likely to require blood transfusions and often receive antibiotics in addition to malaria treatment. And these long hospital stays can result in significant costs for both patients and hospitals.”
The researchers emphasized that healthcare providers should discuss planned international travel with patients and should always check for possible malaria infection in patients with fever who have recently traveled to malaria-endemic areas around the world.
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Children’s Hospital of Philadelphia
Reference magazines:
Sundararaman, S.A. others (2026). Childhood malaria in nine U.S. hospitals: 2016–2023. Pediatrics. DOI: 10.1542/peds.2025-073556. https://publications.aap.org/pediatrics/article-abstract/doi/10.1542/peds.2025-073556/207437/Malaria-in-Children-at-9-US-Hospitals-2016-2023.
