In November 2004, a high prevalence of coral disease was observed at several sites around Navassa, an uninhabited Caribbean island between Haiti and Jamaica. At least fifteen mounding and foliaceous scleractinian species were affected with ‘white disease’ signs. Coral disease incidence was observed to be absent in quantitative surveys in 2002, but in 2004 average prevalence (i.e., % of colonies) of active disease ranged up to 15% and an additional 19% prevalence of colonies with patterns of recent mortality consistent with disease. Large and/or Montastraea spp. colonies were disproportionately affected and the anticipated loss of these large, reef-building colonies will impact coral community structure. One or more potential factors may influence the initiation and persistence of disease outbreak conditions at Navassa including recent hurricane disturbance, regional patterns of increasing disease impact in deep or remote Caribbean reefs, or vectoring of disease by the corallivorous worm, Hermodice carunculata.