Since its discovery about 50 years ago, Vibrio parahaemolyticus has been implicated as a major cause of foodborne illness around the globe. V. parahaemolyticus is a natural inhabitant of marine waters. Human infections are most commonly associated with the consumption of raw, undercooked or contaminated shellfish. A few individual V. parahaemolyticus virulence factors, including the thermostable direct hemolysin (TDH) and TDH-related hemolysin (TRH), have been investigated in depth, yet a comprehensive understanding of this organism's ability to cause disease remains unclear. Since 1996, serotype O3:K6 strains have been associated with an increased incidence of gastroenteritis in India and in Southeast Asia, and with large-scale foodborne outbreaks in the United States (US). In light of the emerging status of pathogenic V. parahaemolyticus, the US Food and Drug Administration conducted a microbial risk assessment to characterize the risk of contracting V. parahaemolyticus infections from consuming raw oysters. This review summarizes epidemiological findings, discusses recognized and putative V. parahaemolyticus virulence factors and pathogenicity mechanisms, and describes strategies for preventing V. parahaemolyticus infections.