The Daily Mail and the Sun are
alarming their readers today with articles alleging that “fish foot spa
pedicures could spread HIV and hepatitis C” and that there is a "fish foot spa virus bombshell". The story has been picked up other media outlets, including Fox News, the Times of India and the Daily Telegraph. However, the stories mostly twist and distort
the source they are based on: a set of recommendations from the Health
Protection Agency (HPA) on the management of fish pedicures and fish spas.
Indeed, the HPA titled its press release: “Fish pedicures unlikely to cause
no known cases of HIV infection due to the use of fish spas, or indeed from any
other water-borne route.
number of salons and beauty therapists offer ‘fish pedicures’ in the UK. They
involve immersing the feet in a tank of water containing Garra rufa fish
(a small toothless species of freshwater carp) that nibble off dead and
thickened skin. The use of Garra rufa fish is long established in
Turkey, India and the Far East where it has a history as a treatment for a
variety of skin conditions and, more recently, as a cosmetic treatment for the
removal of dead and hardened skin from the feet.
While there is little evidence in scientific literature of
the potential public health risk to users, some are concerned about the presence
of bacteria in the fish tank water. Moreover, while the fish are only meant to
nibble dead skin, some clients may occasionally bleed into the water, raising anxieties
about the transmission of blood-borne viruses.
There are restrictions on the practice in Germany and 18
states of the USA. Four Canadian provinces have banned the procedure on the
grounds that fish used as ‘instruments’ for pedicures cannot be disinfected or
sterilised between clients.
The HPA’s report examines the available evidence and
scientific plausibility for the transmission of blood-borne viruses from person
to person, via the water in the fish tank. Hepatitis B and C survive outside
the body for longer than HIV and the only suspected blood-borne virus
transmission cases via water relate to hepatitis B.
An infected client would
need to bleed from an open cut, abrasion or wound into the water, and then
another client would need to also have an open cut, abrasion or wound for the
infected blood to enter his or her bloodstream. Importantly, the concentration
of virus would be substantially reduced by the diluting effect of the water.
If virus contaminated a fish’s mouth, it would be unlikely
to remain on the mouth and thus to effect a transmission to the next client. Moreover, a
fish cannot itself be infected with the human
immunodeficiency virus (and there is no 'fish equivalent' of HIV).
Overall, the HPA describes the risk of blood-borne virus
infection as “extremely low”, although it cannot be completely excluded.
It does make a number of hygiene recommendations for operators
of fish spas (e.g. refreshing the water supply). To reduce the risk of
infections being passed on or picked up, clients who have broken skin, athlete’s
foot, a verruca, psoriasis or eczema affecting the feet or lower legs should
not have fish pedicures.
Similarly, the HPA advises that people with HIV (and hepatitis B
or C) should not have fish pedicures. However, it is not clear what scientific evidence
this recommendation is based on or whether it is a proportional response to
this theoretical transmission risk.
Lisa Power of the Terrence Higgins Trust
dismissed the media’s concern about the issue: "The reality is, in this
country, too many people are contracting HIV because they aren't using condoms,
not because they're going for fish pedicures."