An increase in cases of Paralytic Shellfish Poisoning (PSP) was noted beginning in May, 2011 in Alaska. Eight probable and five confirmed PSP cases were identified in Metlakatla, and five probable and two confirmed cases of PSP were identified in Ketchikan, and one case of PSP in Ketchikan. All case patients experienced paresthesias. Four were hospitalized; no one died. Fifteen had consumed cockles; four had consumed blue mussels; one had consumed butter clams and cockles; and one had consumed an unidentified clam. The cockles collected from a case patient in Metlakatla and the mussels collected from a case patient in Ketchikan tested positive for high levels of saxitoxins. Mussels collected from implicated beaches in Metlakatla also tested positive for saxitoxin. Alaskan shellfish can have high levels of PSP saxitoxins at any time of year. Cooking and freezing do not destroy the toxin.