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Objective. To describe the epidemiological status of malaria in the Brazilian Amazon region between 2003 and 2012. Methods. The present retrospective ecological study employed data from the Brazilian Epidemiological Surveillance and Malaria Communication System (SIVEPMalária/SVS/MS), Hospital Admissions System (SIH/DATASUS/MS), and Mortality Information System (SIM). For each year, the percentage of Plasmodium falciparum cases, the number of admissions, and deaths and lethality due to malaria were determined. The distribution of P. falciparum cases in each state was also described. Data from 2012 were compared to data from 2005, when the Amazon region recorded a peak number of cases, and with data from 2011. Results. In 2012, 241 806 malaria cases were recorded in the region, a reduction of 60.1% vs. 2005 and of 9.1% vs. 2011. Between 2003 and 2005, there was an increase of 48.3% in the number of cases, with 606069 recorded cases in 2005. Since 2006, a declining trend in number of cases has been observed, especially for P. falciparum, with 155169 cases notified in 2005 vs. 35 385 in 2012 (reduction of 77.2%). Between 2005 and 2012, the number of malaria hospital admissions (74,6%) and deaths (54,4%) was also reduced. Conclusions. Despite a decline in the number of malaria cases, the possible emergence of drug-resistant parasites and the lower frequency of P. falciparum indicate the need to adopt new surveillance strategies, more sensitive tools, and integrated vector management to achive a bold, but not impossible, goal: the elimination of P. falciparum. [ABSTRACT FROM AUTHOR]