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Doctor fish, beauty centres and public health: three keywords for a possible marriage to respect fish welfare and human health

Paolo Pastorino1*, Erika A. Burioli1, Roberta Pennazio2, Maria C. Bona1, Maria P. Briata2, Marzia Righetti1, Laura Serracca1 and Marino Prearo1
  • 1 Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Italy
  • 2 ASL 2 Savonese, Italy

Doctor fish (Garra rufa) are freshwater Cyprinid fish that naturally inhabit river basins in central Eurasia (Patimar et al., 2010). They are widely used in aesthetic practices, such as ichthyotherapy and fish pedicure (Sayili et al., 2007). This last practice consist of the immersion of the feet in a tank with fish that nibbles off dead skin. The use of Garra rufa is long established in Turkey, India and it is also becoming popular in some European countries, where the number of aesthetic centers that adopt this practise is increasing. Whereas fish pedicure involve the use of living fish, the conventional methods of sterilisation and disinfection of water and equipment are not applicable. This has led to concerns about the potential transmission of infection to human and, in addition, on the welfare of fish. For this reason, the practice has been banned in some countries. In Europe, the issue has been addressed in Germany where spa centres offer the service for psoriasis (Höller et al., 2013). No information is available from other EU member states such as Italy, where there aren't specific measures for the correct management of this peculiar sector. The lack of specific legislations do not permit to evaluate the possible risks for public health. Despite there is little evidence in scientific literature (Prearo et al., 2012; Verner-Jeffreys et al., 2012; Ruane et al., 2013; Sugimoto et al., 2013; Veraldi et al., 2014) of the potential public health risk to consumers that exert fish pedicure, the possible contamination of the users required an adeguate risk assessment. Legal and hygienic requirements must be observed, if one considers the use of fish for cosmetic or therapeutic treatment. The aims of this work are to develop guide lines that: 1) provide informations on public health risks from fish pedicures activities based on our survey about the health status of G. rufa came from different spa; 2) supply practical biosecurity measures to mitigate the public health risks; 3) give advice on the use, welfare and care of fish and on maintenance of the tanks. During summer 2015, fish (36) and tanks biofilm take from swabs (60) were collected from North Italian beauty centres. The fish was analyzed for the presence of diseases, instead, the swabs are analysed for mesophilic bacteria, Escherichia coli β-glucuronidase, Listeria monocytogenes, Salmonella spp., Vibrio parahaemolyticus, V. cholerae, Norovirus and viral hepatitis A. Microbiological, parasitological and mycobacteria analysis are negative for each samples. The count of mesophilic bacteria show a range from 330 to 6500 CFU/cmq, whereas the E. coli ß-glucuronidase show a value < 10 CFU/cm2. The biomolecular analysis from swabs are negative. The biosecurity measures that should be applied to this specific activity regard: a) the genetic identity of fish: it is hard to distinguish the original Garra rufa fish from its family members basing only on morphological characteristics, because there are more than a hundred different Garra species which can not be used for treatments since they develop teeth; b) the healthy status of fish: there is evidence that handling, poor water quality and overcrowding can lead to stress and compromise the immune system (Ramsay et al., 2009). Apparently healthy fish can harbor pathogens without signs of disease, but outbreaks in fish can occur when they are subjected to poor environmental conditions. For this reason it is necessary a periodic healthy control of fish to reduce the risk to the potential transmission of infections; c) the safety of tanks: tanks and other equipment including filters should be cleaned and maintained according to supplier or manufacturer’s advice. The maintenance of water quality is important to reduce the risk of infection to clients, and for fish welfare. A filter is essential to the correct water conditions for fish and hygienic environment for the customers. Leftovers from fish food, droppings, hard skin and other waste need to be filtered. It is recommended that a well structured sampling programme be undertaken in order to control chemical and microbiological water parameters; d) the effectiveness of cleaning and disinfection treatments on tanks: chemical water treatments used in conventional spa can not be used. In general, chemicals are toxic to fish at microbiologically effective concentrations, so they are not applicable in this case. A thorough cleaning and disinfection of the tanks (without fish) should be applied periodically in order to prevent the appearance of tanks biofilm; e) welfare of fish: examples of behaviour that are commonly used as an indicator of welfare are feed intake, swimming activity and ventilation rate (Huntingford et al., 2006). These indicators should be observed everyday. The fish require: 1) a stable environment with good water quality at the optimum temperature (25-28°C) in order to remain health and 2) a correct feed intake obtained through a fish pellet feed, sufficient to be eaten in few minutes. Uneaten food may indicate early signs of disease with loss of appetite. The water should be well oxygenated, using air-pumps and air-stones. The filtration system should maintain good water quality, free from pollution by metabolic waste products. The frequency of the water tests will depend on the stability of the system and stocking density, and may need to be done more than once a week. Specialist advice should be follow on the equipment and conditions required to maintain suitable conditions for fish health; f) staff training: personnel should receive an appropriate training in the basic care and welfare of fish, additionally specialist in fish diseases should be contact to receive advice on the safe and legal disposal of sick or dead fish. On the basis of ours studies, the risk of infection as a result of a fish pedicure is likely to be very low, but cannot be completely excluded. Certain groups of clients such as those who are immunocompromised are likely to be at increased risk of infection and fish pedicures are not recommended. These guidelines should improve the management of fish and equipment of beauty centers and should permit to target the official controls for the correct risk management.

References

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Huntingford F.A., Adams C., Braithwaite V.A., Kadri S., Pottinger T.G., Sandoe P., Turnbull J.F. (2006). Current issues in fish welfare. J. Fish. Biol., 68: 332–372.
Patimar R., Chalanchi M.G., Chamanara V. & Naderi L. (2010). Some life history aspects of Garra rufa (Heckel, 1843) in the Kangir River, Western Iran: (Osteichthyes: Cyprinidae). Zoology in the Middle East, 51(1): 57-66.
Prearo M., Righetti M., Arsieni P., Di Donfrancesco B., Saragaglia C., De Vita V., Amato G. & Pavoletti E. (2012). Risultati del monitoraggio sanitario condotto su Garra rufa (Heckel, 1843) in Italia. Ittiopatologia, 9: 151-158.
Ramsay J.M., Watral V., Schreck C.B. & Kent M.L. (2009) Husbandry stress exacerbates mycobacterial infection in adult zebrafish, Danio rerio (Hamilton). Journal of Fish Diseases,32 (11): 931–41.

Ruane N.M., Collins E.M., Geary M., Swords D., Hickey C. & Geoghegan F. (2013). Isolation of Streptococcus agalactiae and an aquatic birnavirus from doctor fish Garra rufa L. Irish veterinary journal, 66: 16.
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Veraldi S., Nazzaro G. & Çuka E. (2014). Staphylococcus aureus infection of the feet following fish pedicure. Infection, 42(5): 925-926.
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Keywords: Doctor fish, Public Health, Risk Assessment & Risk Management, fish welfare, beauty centers

Conference: AquaEpi I - 2016, Oslo, Norway, 20 Sep - 22 Sep, 2016.

Presentation Type: Poster

Topic: Aquatic Animal Epidemiology

Citation: Pastorino P, Burioli EA, Pennazio R, Bona MC, Briata MP, Righetti M, Serracca L and Prearo M (2016). Doctor fish, beauty centres and public health: three keywords for a possible marriage to respect fish welfare and human health. Front. Vet. Sci. Conference Abstract: AquaEpi I - 2016. doi: 10.3389/conf.FVETS.2016.02.00021

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Received: 30 May 2016; Published Online: 14 Sep 2016.

* Correspondence: Dr. Paolo Pastorino, Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle d'Aosta, Turin, Piedmont, 10154, Italy, paolo.pastorino@izsto.it