Parasitic nematodes of the genus Anisakis are among the most important biological hazards associated with seafood. A survey of Anisakis spp. in European hake (Merluccius merluccius) was undertaken as this species is a staple of the Portuguese diet. Moreover, a literature review of cases of anisakiosis reported from Portugal, a country with one of the highest levels of fish consumption in the world, was also carried out. Seventy-five European hake caught in the Atlantic Ocean off the northern coast of Portugal were analyzed to determine the infection levels and site distribution of Anisakis spp. Isolated nematode larvae were identified to species level by molecular analysis. Two sets of samples were collected. Firstly, a total of 46 Anisakis spp. L3 larvae were collected with a prevalence of 76.7% (95% CI 61.5–91.8%) and intensity (mean ± SD, range) of 2.0 ± 1.2 (1–5). Most larvae were found on the liver (45.7%) and on the gonads (32.6%), but none in the muscle. The molecular analysis showed the presence of both A. simplex s.s. (70%) and A. pegreffii (30%). For the second sample, analyzed using the UV-Press method, a total of 473 Anisakis spp. were found, with a prevalence of 95.6% (95% CI 89.5–100.0%), intensity (mean ± SD, range) of 11.3 ± 9.7 (1–41), density of 0.05 ± 0.04 (0–0.16) worms/muscle weight in g, and density of 0.54 ± 0.50 (0–2.53) worms/viscera weight in g. Surprisingly, only three very recent cases of human anisakiosis in Portugal have been reported in the literature. Data from this study contribute towards an updating of the existing epidemiological picture in an area characterized by very high seafood consumption and changing eating habits.