Who Should Avoid Sushi? A Guide to Raw Fish Risks

December 11, 2025 •

4 min read

According to the CDC, pregnant women, older adults, and those with weakened immune systems face a heightened risk of serious foodborne illness from raw seafood. While sushi is a delicious delicacy enjoyed by many, certain individuals need to be cautious about consuming raw fish due to potential health risks.

Quick Summary

This guide details the specific populations who should not eat sushi, including pregnant women, children, and immunocompromised individuals, and explains the risks involved, such as bacterial infections, parasites, and mercury contamination. It also provides safe alternatives for those who need to avoid raw fish.

Key Points

Vulnerable Groups: Pregnant women, immunocompromised individuals, children, and the elderly are at a higher risk of severe illness from raw fish due to weaker immune systems.
Primary Risks: The main dangers of raw fish are bacterial infections (Listeria, Salmonella), parasites (tapeworms, roundworms), and mercury contamination.
Handling Matters: Even in high-end restaurants, improper handling or storage can lead to contamination, and home freezers are not cold enough to kill all parasites.
Choose Cooked or Vegetarian: Safer alternatives include sushi rolls with fully cooked seafood, vegetarian options, or dishes where all ingredients are heated thoroughly.
Consider Cross-Contamination: When eating out, it is important to ensure cooked options are not prepared alongside raw ingredients to avoid cross-contamination.
Know Your Fish: Certain large predatory fish, like some tuna and mackerel, are higher in mercury and should be avoided by at-risk individuals, regardless of whether they are cooked or raw.
Seek Medical Advice: If you have an underlying health condition that compromises your immune system, consult a doctor or dietitian for personalized dietary recommendations.

Understanding the Risks of Raw Seafood

While sushi served in reputable restaurants is often prepared to high safety standards, it is still inherently riskier than eating cooked food. The main dangers associated with consuming raw fish include parasites, bacteria, and toxins. High-quality commercial freezers can kill many parasites, but they cannot eliminate all bacteria, such as Listeria, which can survive at refrigeration temperatures.

Raw Fish and Vulnerable Populations

Certain groups of people are far more susceptible to the severe consequences of foodborne illness, making raw fish a food item to be completely avoided or consumed with extreme caution.

Pregnant Women: The developing fetus is particularly vulnerable to toxins and bacteria. For example, Listeria infection can lead to miscarriage, stillbirth, or preterm delivery. High mercury levels in certain fish can also negatively affect a baby's neurological development.
Immunocompromised Individuals: People with weakened immune systems due to conditions like HIV, cancer, or organ transplants, as well as those on immunosuppressant medication, have a higher risk of developing serious, potentially life-threatening infections from foodborne pathogens.
Young Children and Older Adults: Both ends of the age spectrum are more susceptible to severe illness from foodborne bacteria and parasites due to less developed or weakened immune systems.
Individuals with Liver Disease: People with liver issues are at an increased risk of infection from specific bacteria like Vibrio vulnificus, which can be present in raw shellfish and can cause severe illness.

Common Pathogens and Contaminants

Eating improperly handled or stored raw fish can lead to several types of infections or toxic reactions. Here is a breakdown of what can go wrong:

Parasites: The most well-known are roundworms (Anisakis) and tapeworms (Diphyllobothrium). Symptoms can include abdominal pain, nausea, and vomiting. Proper freezing is necessary to kill these parasites, but it is not a guarantee that all fish has been treated properly.
Bacteria: Pathogens like Salmonella, Listeria monocytogenes, and Vibrio can contaminate raw fish and cause severe food poisoning. Listeria is especially concerning because it can grow even in refrigerated conditions.
Heavy Metals: High-mercury fish like tuna, mackerel, and swordfish can be particularly harmful to pregnant women and young children. The heavy metal accumulates in the fish and can cause neurological damage.
Marine Toxins: Some fish carry natural toxins from algae that are not destroyed by cooking. For example, Ciguatera poisoning from reef fish can cause severe gastrointestinal and neurological symptoms.

Safer Alternatives and When to Enjoy

For those who love sushi but belong to a high-risk group, there are still ways to enjoy Japanese cuisine safely. Cooked sushi rolls, or those made with vegetarian ingredients, are a great alternative. Options include:

California rolls (made with imitation crab meat, which is cooked)
Ebi (shrimp) or unagi (eel) rolls, which use cooked seafood
Vegetarian maki with cucumber, avocado, or shiitake mushrooms
Dishes like tempura, cooked teriyaki, or ramen with fully cooked protein

When ordering, always inform the restaurant staff of your dietary restrictions to ensure no cross-contamination occurs between raw and cooked items. If eating at home, be sure to use only high-quality, properly handled seafood and cook it thoroughly to an internal temperature of 145°F.

Raw Fish vs. Cooked Fish: A Comparison


Aspect	Raw Fish (as in traditional sushi)	Cooked Fish
Risk of Bacteria	Higher risk of bacterial contamination like Listeria or Salmonella.	Significantly lower risk, as proper cooking kills most bacteria.
Risk of Parasites	Higher risk, especially if not frozen properly to commercial standards.	No risk, as thorough cooking eliminates all parasites.
Cross-Contamination	High risk, as raw fish can easily contaminate other ingredients.	Lower risk, provided raw and cooked ingredients are handled separately.
Mercury Levels	Same risk as cooked fish, but high-mercury varieties should be avoided by vulnerable groups.	Same risk as raw fish, but cooking does not remove mercury.
Food Handling	Requires strict, professional handling and storage protocols.	Less stringent handling requirements than raw fish, but still important.
Safety for At-Risk Groups	Generally not recommended for pregnant, immunocompromised, or elderly individuals.	Generally safe for most people, including pregnant women, if fully cooked.

Conclusion: Make Informed Choices

For most healthy adults, eating sushi from a reputable establishment poses a low risk, especially if prepared following strict food safety guidelines. However, for vulnerable populations such as pregnant women, young children, older adults, and those with compromised immune systems, the risks of foodborne illness from raw fish are significant and potentially dangerous. The best course of action for these individuals is to either avoid raw sushi entirely or opt for safe, fully cooked, or vegetarian alternatives. Being aware of the potential health risks and making informed choices about food consumption is key to protecting your health and well-being.

Frequently Asked Questions

Pregnant women should not eat raw sushi due to a heightened risk of contracting foodborne illnesses like Listeriosis, which can cause miscarriage, stillbirth, or severe illness in the newborn. Additionally, some fish contain high levels of mercury, which can harm the baby's developing nervous system.

Young children should avoid sushi with raw fish because their immune systems are not yet fully developed, making them more susceptible to severe illness from bacteria and parasites.

No, individuals with weakened immune systems (due to illness, medication, or age) should avoid raw fish sushi. They are at a significantly higher risk of serious infection from pathogens that may be present.

Raw fish can contain parasitic worms like Anisakis and tapeworms. These parasites can cause gastrointestinal issues if ingested alive. While freezing at commercial temperatures can kill many, not all sushi fish undergo this process, and not all parasites are eliminated.

Yes, high-risk individuals can choose fully cooked sushi rolls, such as those with cooked shrimp (ebi) or eel (unagi). Vegetarian options with avocado, cucumber, or cooked mushrooms are also safe choices.

Scombroid poisoning is an allergy-like reaction caused by eating spoiled fish that contains high levels of histamine. Symptoms can include flushing, headache, and palpitations and occur even if the fish is cooked, but it is not a true allergy.

Imitation crab meat, or surimi, is generally considered safe because it is made from cooked and pasteurized fish. It is a suitable alternative for those who need to avoid raw seafood.

People with a known fish or seafood allergy should avoid sushi containing those specific allergens. This includes potential cross-contamination. Unlike food poisoning, allergic reactions are caused by a protein in the food and can be life-threatening.