PURPOSE: A previous report identified Vilas County, Wisconsin, as an area highly endemic for blastomycosis based on a case series 1979-90. This study was done to compare the epidemiologic features of persons with this disease over the following six years. METHODS: Compilation of data from the 47 mandatory physician/laboratory case reports of blastomycosis, disease onset 1991-96, received at the Vilas County Health Department; case mapping by site visit; and statistical comparison to the previous series. RESULTS: The estimated mean annual incidence rate for Vilas County during 1991-96, 40/100,000, remains unchanged from 1984-90. Cases were again disproportionately represented in the southeast corner of the county, and 36/46 lived within 1/4 mile of water. There was a trend toward a higher proportion of female cases in this study (27/47) compared to the prior report (28/73; P = 0.06); the mean age, 47 years, did not differ. Among 32 patients whose activities were recorded, a minority engaged in hunting (4), fishing (4) and gardening (12) prior to disease onset; but 19/32 recalled excavation prior to exposure compared to 17/60 in 1979-90 (P < 0.01). Among cases with a pulmonary presentation, winter onset cases (3/40) were significantly fewer than in 1979-90 (19/55). However, over the entire 18 years there was no disproportionately represented season. CONCLUSIONS: In highly endemic Vilas County, the mean annual incidence of human blastomycosis appears stable over the past 13 years. A combined case series of 18 years reveals no predilection by gender or season of onset.