| Gaia: | <p><strong>Background: </strong>The northwestern border of Thailand is an area of low seasonal malaria transmission. Until recent successful malaria elimination activities, malaria was a major cause of disease and death. Historically the incidences of symptomatic <em>Plasmodium falciparum</em> and <em>Plasmodium vivax</em> malaria were approximately similar.</p>
<p><strong>Methods: </strong>All malaria cases managed in the Shoklo Malaria Research Unit along the Thailand-Myanmar border between 2000 and 2016 were reviewed.</p>
<p><strong>Results: </strong>There were 80 841 consultations for symptomatic <em>P. vivax</em> and 94 467 for symptomatic <em>P. falciparum</em> malaria. Overall, 4844 (5.1%) patients with <em>P. falciparum</em> malaria were admitted to field hospitals, of whom 66 died, compared with 278 (0.34%) with <em>P. vivax</em> malaria, of whom 4 died (3 had diagnoses of sepsis, so the contribution of malaria to their fatal outcomes is uncertain). Applying the 2015 World Health Organization severe malaria criteria, 68 of 80 841 <em>P. vivax</em> admissions (0.08%) and 1482 of 94 467 <em>P. falciparum</em> admissions (1.6%) were classified as severe. Overall, patients with <em>P. falciparum</em> malaria were 15 (95% confidence interval, 13.2–16.8) times more likely than those with <em>P. vivax</em> malaria to require hospital admission, 19 (14.6–23.8) times more likely to develop severe malaria, and ≥14 (5.1–38.7) times more likely to die.</p>
<p><strong>Conclusions: </strong>In this area, both <em>P. falciparum</em> and <em>P. vivax</em> infections were important causes of hospitalization, but life-threatening <em>P. vivax</em> illness was rare.</p>
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