Between 1990 and 2010, 18 outbreaks of respiratory disease occurred in Rwanda's wild human-habituated mountain gorillas (Gorilla beringei beringei). An outbreak was defined as clinically observable respiratory illness involving at least one third of all the gorillas in a family group (> 30% morbidity) over the course of at least 7 days. Outbreaks lasted 2 wk to 4 mo and affected up to five different gorilla family groups, either concurrently or sequentially. An outbreak was considered over if no further clinical illness was observed in the same or another group for at least 1 mo. Clinical signs varied from nasal discharge, sneezing, and mild intermittent coughing (mild), to spasmodic coughing, lethargy, and partial anorexia (moderate), to dyspnea, tachypnea, respiratory distress, weakness, complete anorexia, and occasionally death (severe). Nearly every mountain gorilla group habituated for tourism or research in Rwanda experienced at least one outbreak, and they may be increasing in frequency. In the first 15 yr of the review period 1990-2005, there were nine outbreaks involving 16 gorilla groups; in the last 5 yr of the review period, 2006-2010, there were nine outbreaks involving 11 groups. Although most gorillas recovered without treatment, 41 veterinary procedures were required to medically manage 35 severely ill individuals. Given the rise of mountain gorilla ecotourism in Rwanda, the possibility that respiratory disease results from contact with infected humans is of great concern, and both the etiology and epidemiology of this problem are active areas of research. The observed clinical signs, response to antimicrobial therapy among the sickest individuals, and postmortem findings are most consistent with viral upper respiratory tract infections complicated in some cases by secondary bacterial infections. The current gorilla visitation rules have been designed to minimize the risk of disease transmission between humans and wild human-habituated great apes.