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[Deboche]

Disease would have to come with ways to manage it. All those medieval children were malnourished and dirty.  If you keep your dwarves fed, well rested and clean and keep cats around to eat vermin, they should be nice and healthy. I wouldn't mind having diseases in these terms.

And you have to admit it'd be pretty cool to jail your goblins in a dirty room and watch them die from various illnesses. Also children.

[Urist Tilaturist]

Diseases are unpredictable and one can't battle them in the same sort of way as a Clown or other monster. It's not really that it's not worth bothering, it's jut not something most people want to have to worry about. We have forms of disease from dust and rain and clouds and such. I'm sure most folks only toy with those things before going back to more stable threats they can manage without just bunkering down. I know I barely touch evil biomes.

Am I the only one who enjoys an evil biome for the challenge?

Disease mechanics already exist in the game in the form of syndromes, and one could say they already exist in evil biomes. All that would need to happen is a small change allowing syndromes to be randomly present among the population and spread by miasma and rotten food. Children would be much more vulnerable to these. Bunkering down could make things worse, since refuse might accumulate inside and spread the rot.

Ventilation would be another good addition, forcing players to leave some holes in the fort to allow in air and let out furnace smoke, which should choke dwarves if not allowed to escape (choking and suffocating mechanics already exist, just needs implementing). Clever designs and grilles could stop syndromes and most monsters from coming in, but it would make complete isolation that bit harder, which I think would be good; players should have to interact with the world outside sometimes.

[Badger Storm]

I steer clear of them mainly because apparently I think DF is a livestock ranching simulator, and not only are animals a liability, but almost all evil creatures you can't tame.

On topic, certain classes of dwarves, not just children, should be more vulnerable to disease.  The old (100+), those under stress, those who are already sick or injured, etc.  I also wouldn't mind seeing zoonoses (diseases you can get from animals), making disease resistance a boon for farmers and rangers.  Though you might want to keep married women out of those industries...

[Urist Tilaturist]

Dwarves over 100 years old show no signs of physical deterioration and can still hack through 10 goblins if they need to, so disease vulnerability would be unusual. If ageing was properly added and dwarves became weaker with age, it would make sense.

[Deboche]

Ventilation would be another good addition, forcing players to leave some holes in the fort to allow in air and let out furnace smoke

Yes, and it would be cool if we could build these 3/4 height walls as chutes to the outside that only a very small animal could crawl through.

I also wouldn't mind seeing zoonoses (diseases you can get from animals), making disease resistance a boon for farmers and rangers.

I agree that outside animals should have rabies and tetanus or equivalent and occasionally a foreign animal could introduce disease into your livestock.

Also, there should be some way to keep track of whether your animals have sanitary conditions. If you allow them to pasture outside(if they're outdoors animals) with plenty of room they should be fine. When confined in overcrowded indoors rooms with bad quality food(not the stuff they're used to) and dwarves don't keep them clean, they should get diseased.

Essentially imitating what happens to animals in our industrial food systems.