Records of reported die-offs of the American White Pelican (Pelicanus erythrorhynchos) held by the U.S. Geological Survey National Wildlife Health Center from 1978 through 2003 indicate that type C botulism (caused by Clostridium botulinum) was the major cause of mortality. In 1996, over 15,000 birds, including 8,500 American White Pelicans, were estimated to have died from type C botulism at the Salton Sea in California. This was the largest documented die-off of any pelican species and was estimated to represent 15-20% of the western metapopulation. This event was also notable in that it was the first time that fish, specifically Tilapia (Oreochromis mossambicus), were implicated as the source of type C botulinum toxin for birds. Type C botulism has recurred in both North American species of pelicans at the Salton Sea every year since, although the magnitude of mortality is much lower. West Nile virus caused mortality in both adult and immature American White Pelicans, but may have a more significant impact on nestlings. Emaciation and mortality is common in pelican nesting colonies. Further clarification of the cause of nestling mortality and the ability to differentiate background mortality from mortality due to infectious disease agents such as West Nile virus and Newcastle disease virus would be important in determining the impact of disease in pelicans. Although definitive conclusions cannot be drawn, the number of die-offs and the estimated losses of American White Pelicans appears to have increased along with declines in number in western U.S.