Totally 7,855 malaria cases and 34,082 suspected cases with 19 deaths were reported by the annual case reporting system in 1,191 counties of 23 Provinces/Municipalities/Autonomous Regions (P/M/A) in 2010 and the annual incidence was 0.06/10000. Through the internet reporting system 7433 malaria cases were reported from 974 counties of 31 P/M/A. The number of malaria cases and the ranking of P/M/A were basically in concordance between the two systems. Among the 1,191 counties with reported malaria cases, 3 counties with an incidence of more than 10/10,000, i.e. Motuo (29.83/10,000) in Tibet, Ruili (28.01/10,000) and Yingjiang (14.25/10,000) in Yunnan. There were 31 counties in which the malaria incidence was between 1/10,000 and 10/10,000. 1,258 falciparum malaria cases accounted for 16% of the total cases, of which 92.3% (1,161) were imported cases reported in 368 counties/cities of 20 P/M/A and 7.7% (97) were indigenous cases found in 17 counties/cities of Yunnan Province, which was less than that of 2009 (230 indigenous falciparum malaria cases in the country). Only one focal outbreak with 21 malaria cases occurred in 1 village of Motuo county in Tibet in 2010. Although a considerable decrease in malaria incidence contributed to the implementation of the National Malaria Elimination Program and the project supported by the Global Fund Program, Yunnan Province was still the relatively high transmission area which ranked No. 1 in the country in terms of the number of cases while Hainan ranked down to No. 12 by malaria incidence in 2010. 2,721 malaria cases were reported from the two provinces in 2010, accounting for 34.64% of the total reported cases in the country. There were 2,643 cases with .3 deaths reported from Yunnan, the incidence was 0.74/10,000, a decrease of 22.9% than that in the last year. Among the reported cases, 513 cases were falciparum malaria with 81.0% (416/513) imported. The number of reported cases in Hainan was only 78 with an incidence of 0.09/10,000, 88.6% decrease than the last year. In central China, the case number decreased considerably in 2010, but the incidence in Anhui was still the highest in the country and the number of cases ranked No. 2. 1 864 malaria cases were reported from Anhui Province in 2010, accounting for 23.7% of the total cases in the country with an incidence of 0.28/10 000 which decreased by 76.5% than that in 2009. The number of reported cases in Henan Province was 893, decreased by 58.6% in incidence. Hubei Province reported 429 cases with an incidence of 0.075/10,000, decreased by 37.5%. 386 cases were reported from Jiangsu Province, decreased by 1.9% compared to that in 2009. Cases reported from other P/M/A occupied about 19.9% of the total. Above hundred cases were reported from Shandong and less than 100 cases were from each of Fujian, Chongqing, Shanghai, Jiangxi, Liaoning, Shaanxi, Shanxi, Heilongjiang, Gansu and Tibet in 2010. In summary the reemergence of malaria has been restrained through several years' efforts but malaria is still an important problem of public health in China especially in the southern and central parts. Yunnan still faces the spread of Plasmodium falciparum especially imported malaria in the border areas. In the central parts of the country, Anhui Province is still with the highest incidence in 2010. In addition, imported malaria cases in those provinces with a low transmission or without local transmission would become a new challenge to the National Malaria Elimination Program.