Tropical shorelines, acclaimed as serene destinations and supporting local seascape user livelihoods, also harbour dangerous marine organisms, causing injury, envenomation and poisoning, that frequently challenge existing species and curative interventions. Documentation of indigenous knowledge on harmful marine biota is critical to develop cost-effective integrated management interventions. Dedicated cross-section interviews among indigenous seascape users in Mtwapa at the north and Gazi at the south coast of Kenya, elicited data on demographics and injury, envenomation and poisoning, as well as financial burden. Responses from 100 respondents, dominated by adult, Mijikenda males, participating in fishery (boat, foot) and beach services (trade, beach boys), were analysed. Over 24 dangerous marine fauna; causing injury (shark, urchin), envenomation (stingray, lionfish & stonefish) and poisoning (puffers), were documented. Over 39 biohazard incidents per year, mostly by urchin, stingray, stonefish and lionfish with an estimated yearly intervention cost of 151$, and corresponding burden of 18% of earnings, occurred. Biohazard events differed significantly (P < 0.01) between incident and livelihood. Injury prevalence (74 yr−1), cost (275$.yr−1) and burden (15%), were significantly (P < 0.001) higher than envenomation, while poisoning was rare. Foot fisher injury (66%) and envenomation (15%) burden, were significantly higher than other livelihoods, attributed to unprotected intertidal wading, inexperience and low incomes, leading to increased expenditure. Delivery of universal healthcare targets to coastal communities, should incorporate biohazard management, to reduce health burden.