Epidemic and Non-Epidemic Hot Spots of Malaria Transmission Occur in Indigenous <i>Comarcas</i> of Panama LainhartWilliam DutariLarissa C. RoviraJose R. SucupiraIzis M. C. M. PóvoaMarinete E. ConnJan R. LoaizaJose 2016 <div><p>From 2002–2005, Panama experienced a malaria epidemic that has been associated with El Niño Southern Oscillation weather patterns, decreased funding for malaria control, and landscape modification. Case numbers quickly decreased afterward, and Panama is now in the pre-elimination stage of malaria eradication. To achieve this new goal, the characterization of epidemiological risk factors, foci of transmission, and important anopheline vectors is needed. Of the 24,681 reported cases in these analyses (2000–2014), ~62% occurred in epidemic years and ~44% in indigenous <i>comarcas</i> (5.9% of Panama’s population). Sub-analyses comparing overall numbers of cases in epidemic and non-epidemic years identified females, <i>comarcas</i> and some 5-year age categories as those disproportionately affected by malaria during epidemic years. Annual parasites indices (APIs; number of cases per 1,000 persons) for <i>Plasmodium vivax</i> were higher in <i>comarcas</i> compared to provinces for all study years, though <i>P</i>. <i>falciparum</i> APIs were only higher in <i>comarcas</i> during epidemic years. Interestingly, two <i>comarcas</i> report increasing numbers of cases annually, despite national annual decreases. Inclusion of these <i>comarcas</i> within identified foci of malaria transmission confirmed their roles in continued transmission. Comparison of species distribution models for two important anophelines with <i>Plasmodium</i> case distribution suggest <i>An</i>. <i>albimanus</i> is the primary malaria vector in Panama, confirmed by identification of nine <i>P</i>. <i>vivax</i>-infected specimen pools. Future malaria eradication strategies in Panama should focus on indigenous <i>comarcas</i> and include both active surveillance for cases and comprehensive anopheline vector surveys.</p></div>