Charity warning over raw sewage discharge levels

Sewage discharges from an overflow on to the beach at Godrevy in Cornwall

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• Most beaches meet new standards
• Sewage alerts scheme to continue
• Anger over new Thames sewer plan

Thousands more pipes could discharge raw sewage into the sea, rivers and lakes than was previously thought, the Marine Conservation Society has said.

The conservation charity said the usually published figure of 22,000 discharge pipes in England and Wales should actually be about 31,000.

That is because other categories of pipes have the same function, it said.

The Environment Agency said over £8bn has been invested to upgrade the sewage system over the past 20 years.

The MCS also called for overflow pipes to be mapped and managed more closely.

The charity said that overflow pipes which prevent sewage backing up into drains and houses in times of heavy rain are necessary in an emergency. But water companies needed to invest in the sewer network to ensure untreated waste water was only released in urgent cases.

The MCS also called for overflow pipes to be mapped and managed more closely.

Referring to the 22,000 discharge pipes, the charity said the figure only referred to pipes known as combined sewer overflows and emergency overflows.

'Public information'

The organisation said it had discovered that four other categories of outflows - for example at pumping stations or waterworks - perform the same function, bringing the total figure to an estimated 31,000.

MCS pollution programme manager Dr Robert Keirle said the society "accepts that combined sewer overflows and emergency overflows are an essential part of a well-managed and maintained sewerage network, if sited, used and monitored appropriately.

"However, MCS insists that they should not be used for routine discharge of excess sewage, as an alternative to increasing the capacity of sewers to cope with a growing population."

Dr Keirle also said more needed to be done to map and monitor the outflows, so the public had more information about where they are, if they are monitored and when and for how long sewage is flowing into the sea.

"Mapping costs relatively little yet it could make the difference between an enjoyable trip to the beach or one that ends up in A&E with ear, nose and throat infections or stomach upsets," he added.

Research from the society also suggested there are outlets around the UK coastline which are discharging sewage more than the permitted 10 times a year, including one in Kent which let out waste for more than 1,000 hours during the bathing season in 2010.

A spokesman for the Environment Agency said in addition to the £8bn spent by water companies to upgrade sewer systems and reduce water pollution over the past 20 years, over 98% of beaches had met standards for bathing water quality this year.

He said that the agency had also helped to secure a further £4bn investment by water companies in environmental improvements by 2015.

He added: "The Environment Agency publishes detailed online profiles of every designated bathing water in England and Wales.

"The location of all types of outfall is included in these profiles, along with information on the work being done to improve bathing water quality."

Beach litter levels are too high

Litter is swamping our oceans and is washing up on beaches. It kills wildlife, looks disgusting, is a hazard to our health and costs millions to clear up.

There are two pieces of litter for every footstep you take on a beach. Marine wildlife gets entangled in litter and accidentally ingests it. Turtles mistake plastic bags for jellyfish and the bags can block their stomachs, often leading to death from starvation.

Seabirds mistake floating plastic litter for food, and over 90% of fulmars found dead around the North Sea have plastic in their stomachs. Plastic litter on beaches has increased 135% since 1994. Plastic never biodegrades. It just breaks down into small pieces but does not disappear.

Microplastic particles are now found inside filter feeding animals and amongst sand grains on our beaches. Litter comes from many sources - the public, fishing activities, sewage pipes and shipping, but it is all preventable.

• Most beaches meet new standards 08 NOVEMBER 2011, SCIENCE & ENVIRONMENT
• Sewage alerts scheme to continue 03 OCTOBER 2011, CORNWALL
• Anger over new Thames sewer plan 04 NOVEMBER 2011, LONDON

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• Marine Conservation Society

“Trendy fish pedicures; the risk of catching a virus are 'very low'

Tuesday October 18 2011

The risk of catching a virus are 'very low'

“Trendy fish pedicures could spread HIV and hepatitis C,” The Sun has today reported. Its front-page story said that officials have raised an “alert” over the treatment, popular in beauty spas, where tiny fish are used to nibble away areas of hard foot skin.

While The Sun has been carping on about warnings and alerts, the newspaper seems to have overestimated the scale of the risk, which health experts have described as being “extremely low”. Rather than being an alert, the news is based on a report by the Health Protection Agency that has set out good practice for so-called ‘fish spas’ that offer the service.

While the report did acknowledge that the risk of infections could not be completely ruled out, it is important to view this in context and not be reeled in by fishy headlines.

What exactly is a fish pedicure?

A fish pedicure is a beauty treatment that uses dozens of tiny fish to nibble away dead and hardened skin from the feet. During a session a person immerses their feet in a tank of warm water and lets the minute, toothless Garra rufa fish nibble away for around 15 to 30 minutes. The fish are said only to eat dead skin, although there are some anecdotal reports that they can break the skin if they nibble too deep.

Fish pedicures have long been used as beauty treatments in Turkey and the Far East, but have only recently been introduced to this country. In the few years since the first UK ‘fish spa’ opened the treatment’s popularity has rocketed due to celebrity endorsements and high-profile press coverage. The HPA says that, as of spring 2011, it is aware of 279 in operation (although there are likely to be many more).

A small number of spas may also be using other species of fish to perform pedicures, such as Chin chin fish. However, the HPA says that these should not be used as they develop teeth when they get older, and may therefore present a greater risk to public health.

What did the report examine?

The report examined a number of issues relating to fish pedicures, including:

• potential ways infections might occur
• the risk of catching blood-borne viruses, including HIV and hepatitis
• the risk of bacterial infections
• the risk of catching parasites, such as fluke worms
• the risk of transmitting conditions, such as athlete’s foot and verrucas
• procedures that might reduce any health risks

The report is based on consultations with experts and professional bodies within the fields of public health, aquaculture, health and safety, and animal welfare.

What did the report find?

The report considered three main ways that a person might catch an infection:

• from a fish or a fish tank
• from tank water
• from another person via surfaces, such as floors

Within these areas they considered the different types of infections that might occur.

Blood-borne viruses

Viruses such as HIV and hepatitis are carried in the blood and, in theory, could be transmitted through tank water if someone with a cut or abrasion were to use a tank containing traces of blood from an infected person with cuts.

However, there is only anecdotal evidence that Garra rufa fish can draw blood, and the HPA says that any blood-borne viruses they come into contact with are unlikely to stay on the surface of their mouths and lead to infection. Any blood entering the tank is likely to be diluted by the volume of water used.

While transmission through this method cannot be completely ruled out, the HPA says the risk of catching a blood-borne virus in this way is extremely low. Further to this, the HPA is recommending that the fish spas check clients for cuts and abrasions both before and after their session.

Parasites

Fish-borne parasites, such as tapeworms and flukes that can be caught by humans if they eat undercooked fish. However, the HPA says that there is no evidence that these can be caught from a fish pedicure as this would require ingestion of the fish or the water.

Bacterial infections

The report looked at a number of specific harmful bacteria, including those that cause salmonella and legionnaires’ disease. Generally, these were deemed to be of low risk as they would not be ingested or would need broken skin to cause infection.

However, certain bacteria were identified as posing a greater risk of infection. For example, Staphylococcus aureus might infect people’s skin if they had eczema or psoriasis. Also, a type of bacteria called Mycobacterium marinum, which is associated with fish tanks and non-chlorinated swimming pools, could cause boils if transferred into broken skin.

Fungal infections such as verrucas and athlete’s foot

Fungi are known to survive on inanimate surfaces for prolonged periods and could, therefore, be passed on by infected clients walking around barefoot. However, the HPA points out that this route of transmission is not unique to fish spas.

So are fish pedicures safe?

The Health Protection Agency says that “on the basis of the evidence identified and the consensus view of experts, the risk of infection as a result of a fish pedicure is likely to be very low”. The agency does outline some groups who are not recommended to have fish pedicures due to increased risk of infection, such as people with diabetes or compromised immune systems.

The HPA also specifically addresses the possibility of transmitting blood-borne viruses such as HIV and hepatitis. The agency says that, in theory, transmission could occur if infected blood from one person got into an open wound on another person using the same tank, although, once again, the risk is “extremely low”. In part, the risk would be minimised due to factors such as the diluting action of the water and the fact that infected blood would be unlikely to stay on the fishes’ mouths.

However, the agency does say that the risk of infections cannot be completely excluded and, in order to reduce this risk even further, they have drawn up a list of recommendations for fish spas.

What recommendations does the HPA make?

The HPA has made extensive recommendations on how fish spas can further reduce the risk of infections. Below are some of the major ones.

Groups not recommended to have a fish pedicure

The agency also says fish pedicures are not recommended for people that may increase the risk of infection or pose an infection risk to other clients. This includes people who:

• have had their legs waxed or shaved in the previous 24 hours (they may have tiny cuts that increase infection risk)
• have any open cuts, wounds, abrasions or broken skin on the feet or lower legs
• have an infection on the feet (including athlete’s foot or a verruca)
• have psoriasis, eczema or dermatitis affecting the feet or lower legs
• are diabetic (which leads to increased risk of infection)
• have a blood-borne virus such as hepatitis B, hepatitis C or HIV
• have an immune deficiency due to illness or medication
• have bleeding disorders or take anticoagulant medication (for example, heparin or warfarin)

Safety procedures for fish spas

The HPA recommends that:

• Clients should be provided with medical information on any potential risk, including specific guidance on conditions that raise infection risk.
• Clients should have their feet examined both before and after treatment to make sure they are free from cuts and infections. Staff should log that these checks have been performed.
• Feet should be thoroughly washed and rinsed before a pedicure to minimise the number of micro-organisms transferred into the tank.
• If there is evidence that bleeding has occurred during a session the tank should be drained and cleaned thoroughly. The HPA has drawn up thorough guidelines on how to disinfect tanks in a fish-friendly way. After 48 hours in a holding tank the fish can be reused.
• Clients should be told to seek advice from their GP if they experience any adverse effects.

Links to the headlines

Fish foot spa virus bombshell. The Sun, October 18 2011

Health risk from fish pedicures. The Daily Telegraph, October 18 2011

Links to the science

Fish pedicures unlikely to cause infection. HPA 2011

“Trendy fish pedicures could spread HIV and hepatitis

“Trendy fish pedicures could spread HIV and hepatitis C,” The Sun has today reported. Its front-page story said that officials have raised an “alert” over the treatment, popular in beauty spas, where tiny fish are used to nibble away areas of hard foot skin.

While The Sun has been carping on about warnings and alerts, the newspaper seems to have overestimated the scale of the risk, which health experts have described as being “extremely low”. Rather than being an alert, the news is based on a report by the Health Protection Agency that has set out good practice for so-called ‘fish spas’ that offer the service.

While the report did acknowledge that the risk of infections could not be completely ruled out, it is important to view this in context and not be reeled in by fishy headlines.

What exactly is a fish pedicure?

A fish pedicure is a beauty treatment that uses dozens of tiny fish to nibble away dead and hardened skin from the feet. During a session a person immerses their feet in a tank of warm water and lets the minute, toothless Garra rufa fish nibble away for around 15 to 30 minutes. The fish are said only to eat dead skin, although there are some anecdotal reports that they can break the skin if they nibble too deep.

Fish pedicures have long been used as beauty treatments in Turkey and the Far East, but have only recently been introduced to this country. In the few years since the first UK ‘fish spa’ opened the treatment’s popularity has rocketed due to celebrity endorsements and high-profile press coverage. The HPA says that, as of spring 2011, it is aware of 279 in operation (although there are likely to be many more).

A small number of spas may also be using other species of fish to perform pedicures, such as Chin chin fish. However, the HPA says that these should not be used as they develop teeth when they get older, and may therefore present a greater risk to public health.

What did the report examine?

The report examined a number of issues relating to fish pedicures, including:

• potential ways infections might occur
• the risk of catching blood-borne viruses, including HIV and hepatitis
• the risk of bacterial infections
• the risk of catching parasites, such as fluke worms
• the risk of transmitting conditions, such as athlete’s foot and verrucas
• procedures that might reduce any health risks

The report is based on consultations with experts and professional bodies within the fields of public health, aquaculture, health and safety, and animal welfare.

What did the report find?

The report considered three main ways that a person might catch an infection:

• from a fish or a fish tank
• from tank water
• from another person via surfaces, such as floors

Within these areas they considered the different types of infections that might occur.

Blood-borne viruses

Viruses such as HIV and hepatitis are carried in the blood and, in theory, could be transmitted through tank water if someone with a cut or abrasion were to use a tank containing traces of blood from an infected person with cuts.

However, there is only anecdotal evidence that Garra rufa fish can draw blood, and the HPA says that any blood-borne viruses they come into contact with are unlikely to stay on the surface of their mouths and lead to infection. Any blood entering the tank is likely to be diluted by the volume of water used.

While transmission through this method cannot be completely ruled out, the HPA says the risk of catching a blood-borne virus in this way is extremely low. Further to this, the HPA is recommending that the fish spas check clients for cuts and abrasions both before and after their session.

Parasites

Fish-borne parasites, such as tapeworms and flukes that can be caught by humans if they eat undercooked fish. However, the HPA says that there is no evidence that these can be caught from a fish pedicure as this would require ingestion of the fish or the water.

Bacterial infections

The report looked at a number of specific harmful bacteria, including those that cause salmonella and legionnaires’ disease. Generally, these were deemed to be of low risk as they would not be ingested or would need broken skin to cause infection.

However, certain bacteria were identified as posing a greater risk of infection. For example, Staphylococcus aureus might infect people’s skin if they had eczema or psoriasis. Also, a type of bacteria called Mycobacterium marinum, which is associated with fish tanks and non-chlorinated swimming pools, could cause boils if transferred into broken skin.

Fungal infections such as verrucas and athlete’s foot

Fungi are known to survive on inanimate surfaces for prolonged periods and could, therefore, be passed on by infected clients walking around barefoot. However, the HPA points out that this route of transmission is not unique to fish spas.

So are fish pedicures safe?

The Health Protection Agency says that “on the basis of the evidence identified and the consensus view of experts, the risk of infection as a result of a fish pedicure is likely to be very low”. The agency does outline some groups who are not recommended to have fish pedicures due to increased risk of infection, such as people with diabetes or compromised immune systems.

The HPA also specifically addresses the possibility of transmitting blood-borne viruses such as HIV and hepatitis. The agency says that, in theory, transmission could occur if infected blood from one person got into an open wound on another person using the same tank, although, once again, the risk is “extremely low”. In part, the risk would be minimised due to factors such as the diluting action of the water and the fact that infected blood would be unlikely to stay on the fishes’ mouths.

However, the agency does say that the risk of infections cannot be completely excluded and, in order to reduce this risk even further, they have drawn up a list of recommendations for fish spas.

What recommendations does the HPA make?

The HPA has made extensive recommendations on how fish spas can further reduce the risk of infections. Below are some of the major ones.

Groups not recommended to have a fish pedicure

The agency also says fish pedicures are not recommended for people that may increase the risk of infection or pose an infection risk to other clients. This includes people who:

• have had their legs waxed or shaved in the previous 24 hours (they may have tiny cuts that increase infection risk)
• have any open cuts, wounds, abrasions or broken skin on the feet or lower legs
• have an infection on the feet (including athlete’s foot or a verruca)
• have psoriasis, eczema or dermatitis affecting the feet or lower legs
• are diabetic (which leads to increased risk of infection)
• have a blood-borne virus such as hepatitis B, hepatitis C or HIV
• have an immune deficiency due to illness or medication
• have bleeding disorders or take anticoagulant medication (for example, heparin or warfarin)

Safety procedures for fish spas

The HPA recommends that:

• Clients should be provided with medical information on any potential risk, including specific guidance on conditions that raise infection risk.
• Clients should have their feet examined both before and after treatment to make sure they are free from cuts and infections. Staff should log that these checks have been performed.
• Feet should be thoroughly washed and rinsed before a pedicure to minimise the number of micro-organisms transferred into the tank.
• If there is evidence that bleeding has occurred during a session the tank should be drained and cleaned thoroughly. The HPA has drawn up thorough guidelines on how to disinfect tanks in a fish-friendly way. After 48 hours in a holding tank the fish can be reused.
• Clients should be told to seek advice from their GP if they experience any adverse effects.

Links to the headlines

Fish foot spa virus bombshell. The Sun, October 18 2011

Health risk from fish pedicures. The Daily Telegraph, October 18 2011

Links to the science

Fish pedicures unlikely to cause infection. HPA 2011

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