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Imported malaria continues to be an increasing medical challenge in the US. A significant proportion of imported malaria occurs in foreign born immigrants visiting their native countries and do not take prophylaxis for malaria mostly due to a misconception of being immune to malaria. The purpose of this study is to review epidemiology, clinical presentation, rate of prophylaxis and delineate the rate of severe malaria in a community hospital with largely immigrant population. Retrospective chart review of forty patients diagnosed with malaria from 1997 to 2007 at a 673 bed teaching hospital in Newark, NJ, USA. Of the 40 cases included, 90% were born in a malaria endemic area (MEA).The Majority (85%) acquired malaria while visiting the African subcontinent. Overall prophylaxis rate was only 12%. Plasmodium falciparum was the most common malaria species diagnosed. Severe malaria was diagnosed in 25% of the cases, all in foreign born subjects visiting native countries where malaria is endemic. Malaria continues to be a challenge in a population of immigrants visiting their country of origin. Low use of prophylaxis is of major concern in immigrant population especially in light of high rates of severe malaria. Primary care physicians play an important role in pre-travel advice to prevent the complications of malaria.