There has been significant concern in recent times about the safety of molluscan shellfish for human consumption. Despite extensive efforts to assure a safe supply of molluscan shellfish, the number of cases of disease and death are still great enough to cause concern among the public. The number of cases of illness and death associated with the ingestion of shellfish falls in the lower end of the range of other similar microbial pathogen-related foodborne disease. Disease and deaths due to viruses and naturally occurring bacteria are now of greatest concern because they are the most often cited causative agents. The greatest risk of disease or death due to shellfish consumption is among the population with underlying health conditions who choose to consume raw shellfish. Control strategies to limit shellfish-borne disease should focus upon disease and death caused by viruses and naturally occurring bacteria among at-risk populations.