There is a decline in the global incidence, morbidity, and mortality of malaria. However, approximately 20% of hospital admissions and 10% of hospital deaths in Nigeria have been attributed to malaria. This secondary data analysis was conducted to examine the pattern severe malaria in Plateau State in the face of declining global malaria infection. Severe malaria-specific Integrated Disease Surveillance and Response (IDRS) records of Plateau State of Nigeria over a five-year period were reviewed. A total of 38,467 cases of severe malaria were reported between January 2013 and December 2017. The highest number of cases 14098 (36.65%) was reported in 2016 and the least number of cases 950 (2.47%) were reported in 2014. A total of 362 severe malaria deaths was reported within the same period with a case fatality rate (CFR) of 0.94%. The highest CFR 1.43% was recorded in 2015 while the least CFR 0.00% was recorded in 2014. The 0-28 days age group had the highest CFR (3.13%). The comparative monthly trend of severe malaria cases did not follow any consistent pattern during the 5 years under review. However, as of 2017, the trends of total cases per year and CFRs were on the decline. In conclusion, the overall number of cases and deaths of severe malaria is declining in Plateau State but the CFR among neonates remains high. Therefore, prevention and control efforts should be intensified in Plateau State, in order to achieve malaria elimination in the State.