Community-onset methicillin resistant Staphylococcus aureus (CO-MRSA) became a prominent cause of infection in North America in 2003, with a peak in the epidemic noted by multiple groups in the USA between 2005 and 2007. We reviewed rates of MRSA in two hospitals in Vancouver, Canada, to observe changes in epidemiology from 2003 to 2011. Episodes of emergency department (ED) MRSA bacteraemia and wounds were extracted from the laboratory database, with rates calculated per 10,000 ED visits. All cases were assumed to be community onset, as they were diagnosed in the ED. A peak in ED MRSA bacteraemias occurred in 2005, at 7·8/10,000 ED visits. By 2011, rates of ED bacteraemia declined significantly to 3·3/10,000 ED visits (P<or=0·03). MRSA wound rates peaked at 82·2 cases/10,000 ED visits in 2007 with a subsequent significant decline to 34·3 cases in 2011 (P=0·04). We have demonstrated a significant decline in CO-MRSA within our population, consistent with reports from the USA, suggesting a substantial change in the epidemiology of CO-MRSA in certain North American cities.