Over the past 80 years, tilapia have been translocated globally for aquaculture; active production is recorded in >124 countries. Of 7 million tonnes of tilapia produced in aquaculture, 79% is from 79 countries outside the natural range of tilapia. Capture fisheries account for a further 723,627 tonnes of tilapia, and >47% of this is landed from established invasive populations outside Africa. Tilapias host a rich fauna of parasites, many of which have been translocated with their hosts. This review summarises >2500 host–parasite records from 73+ countries and >820 recorded tilapia translocations (provided in the supplementary materials). This work focuses on the notable pathogens that threaten the health of cultured populations of tilapia, providing a description of their pathology and includes species that also have substantial impacts on wild tilapia populations, where relevant. For each major parasite taxonomic group, we highlight which parasites have been translocated or have been acquired from the new environments into which tilapia have been introduced, together with remarks on standard treatment approaches and research on them and their management and control. Regarding the theme ‘Tilapia health: quo vadis?’, Africa has enormous potential for aquaculture growth, but substantial knowledge gaps about tilapia parasites in many African states remain, which creates associated production and biosecurity risks. For each parasitic group, therefore, the risks of parasite translocation to new regions as tilapia aquaculture industries expand are highlighted.