An evaluation of malaria transmission and epidemiology in the Amazonian city of Belém over the last 70 years shows that (1) Anopheles darlingi, reported to be eradicated in 1968, reappeared in the mid 1990s, with a marked increase in abundance between 1997 to 1999 in two of three districts sampled; (2) An. darlingi and An. aquasalis are each implicated in current malaria transmission in different districts of the city; (3) mosquito species diversity (in Anopheles subgenus Nyssorhynchus) has increased from two in the 1930s to six in the 1940s to 10 in the 1990s; (4) there is no overall correlation between malaria case incidence and human population size from 1940 to 1996 in Belém; (5) however, the total number of malaria cases has increased significantly since the late 1970s and over the short term from 1993 to 1999; and (6) interestingly, the short term increases are due solely to cases of Plasmodium vivax infection; cases of P. falciparum malaria are declining (significantly for Pará state only). The reappearance of An. darlingi may be a result of the continued expansion of Belém into the surrounding forest in the 1990s. In the absence of preventative measures, we predict an increase in local outbreaks of malaria in the DAENT and DAICO districts where the population sizes of An. darlingi are increasing.