P. ovale is considered as one of the minor parasites of the five human malaria species along with P. malariae because of low prevalence rates in most endemic areas and its relatively mild and chronic nature. Acute illnesses in nonimmunes can produce typical pyroxysms with chills, rigor and high fever. Infections resolve over a period of a couple of weeks and partial immunity is relatively quickly acquired. The parasite, like P. vivax, has a true relapse mechanism with liver stage hypnozoites that can produce blood infections through relapse up to five years after primary infection. Blood stage infections are chronic with low level parasitemia that are most frequently subpatent by microscopy and, thus, generally show low prevalence in endemic areas.

P. ovale is distributed most frequently throughout Sub-Saharan West Africa as well as in East Africa. P. ovale infections are also found in the Philippines, New Guinea, Southeast Asia (Myanmar, Thailand, Cambodia, Laos and Vietnam) and in the Indian subcontinent.

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