The rate and extent of mortality from yellow band disease (YBD) to Montastraea annularis (species complex) on reefs off Mona Island, Puerto Rico, was evaluated over 8 yr. Isolated YBD infections were first observed in 1996. Prevalence of YBD increased dramatically in 1999, with a maximum of 52 % of all M. annularis colonies infected in 1 shallow site. YBD continued to spread among adjacent, previously uninfected corals over the next 4 yr, and disease prevalence progressively increased in deeper sites. Linear rates of disease advance and tissue mortality have been slow (5 to 15 cm yr(-1)), although colonies with single YBD lesions have become infected in multiple locations. Most (85%) colonies identified with YBD in 1999 and 2000 were still affected in 2003, and these corals have lost a mean of 60% of their living tissue. Mortality from YBD is being compounded by black band disease, white plague and other syndromes; bioeroding sponges, macroalgae, cyanobacteria and other competitors have colonized tissue-denuded skeleton, minimizing the likelihood of resheeting. The deteriorating health of M. annularis is of particular concern, as these are the dominant corals on these reefs, the largest (2 to 3 m diameter and height) and presumably oldest colonies were infected with YBD more frequently than small colonies, and no recruitment has been observed. YBD is causing extensive mortality to key reef-building taxa in a remote location where anthropogenic stressors are minimal. Additional research on causes of YBD, mechanisms of infection, and strategies to mitigate YBD is needed; otherwise, M. annularis may suffer a fate similar to that of the Atlantic acroporids.