The regulation of shellfish and their growing waters is based on total and fecal coliform standards. Application of these standards has reduced the incidence of shellfish-borne bacterial illnesses in humans, but outbreaks of viral diseases, such as hepatitis A, Norwalk illness, and viral gastroenteritis, prevail. Hepatitis A virus contributed to 1,395 cases of shellfish-associated illness since 1961. An additional 6,049 cases of shellfish-associated gastroenteritis were reported over the past 50 years, 75% of which (4,609 cases) occurred since 1980. The alarming rate of disease outbreaks during the past 5 years may further increase as better reporting practices are initiated by health professionals and state and federal agencies. Actions necessary to reduce the incidence of shellfish-associated viral illness include development of methods for detecting viral pathogens in shellfish and harvest waters, correlation of levels of viral pathogens with potential viral and bacterial indicators, and acceleration of field monitoring and enforcement efforts.