Coastal marine ecosystems are subjected to environmental changes related to human activities and climate change. Harmful algal blooms (HAB) are considered a major threat to marine coastal areas due to the wide range of impacts they have on the ecology of coastal marine ecosystems. There are several shellfish-mediated intoxications involved in human poisoning worldwide caused by HAB. Shellfish poisonings are classified with respect to their bioactivity or to the symptoms caused in humans: paralytic shellfish toxins (PST), diarrheic toxins (DST), neurotoxic toxins (NST), amnesic toxins (AST), azaspiracid toxins (AZA), yessotoxins (YTX) and so on. This chapter focuses mainly on Dinophysis species as the major producers of okadaic acid (OA) and its analogs. It presents the maximum levels of paralytic shellfish toxins recorded in shellfish from North America. The chapter also presents the maximum levels of domoic acid in shellfish from North America. HAB can also impact the reproduction and recruitment of shellfish.