Tattooing or body
piercing in professional parlours is not associated with an increased risk of
infection with hepatitis C virus, a literature review published in the online
edition of Clinical Infectious Diseases
shows. However, the authors did find evidence that tattooing in non-sterile
environments, such as prisons, was associated with the infection. They also
found isolated case reports of possible hepatitis C infections due to the use
of inadequately sterilised equipment in professional settings.
emphasize the need to prevent hepatitis C transmission from use of unsterile
tattooing and piercing equipment, especially in prisons,” write the authors.
“Awareness campaigns should highlight the dangers of such procedures in
unregulated and potentially unsterile environments, such as homes and prisons.”
Hepatitis C is a
blood-borne infection and affects approximately three million individuals in the
US. In 2009, approximately 16,000 new cases of the infection were diagnosed in
the country. Injecting drug use is the principal mode of hepatitis C
transmission. However, a fifth of people with incident infections deny
traditional risk factors.
Research conducted in
1994 and 2006 found that approximately 6% of patients with acute hepatitis C
reported recent tattooing. However, it also showed that two-thirds of these
individuals also reported other risk factors for hepatitis C, including
injecting drug use.
Because multiple risk
factors are often present, the importance of tattooing or piercing as a mode of
hepatitis C transmission is far from certain.
investigators from the US Centers for Disease Control and Prevention (CDC)
conducted a literature review to clarify this issue. They were partly motivated
to undertake the research because of the increasing prevalence of tattooing in
the general population, especially younger individuals.
“The review is
intended to inform recommendations to prevent or reduce the risk of hepatitis C
virus transmission,” write the authors.
A total of 62 studies
conducted between 1994 and 2011 met the criteria for inclusion.
Some 19 involved
individuals in the general population, and ten were case-controlled studies.
After taking into account other risk factors, six of these studies reported no
increased risk of tattooing and hepatitis C virus. However, two studies found
that tattooing in non-sterile environments was associated with 2-3-fold
increase in the risk of the infection.
A study conducted in a
gastroenterology clinic found a possible association between tattooing and
hepatitis C. However, 29% of individuals who originally denied injecting drug use
admitted to this behaviour when re-examined about risk factors. Moreover,
tattooing was frequently performed by friends or family member using
There was no
association between tattooing in a professional parlour and hepatitis C in a
large cross-sectional study involving 5000 US college students. However,
tattooing in a non-sterile setting was associated with a three-fold increase in
the risk of the infection.
between hepatitis C and tattooing in non-sterile environments was also
suggested in a Brazilian study. It found that individuals with tattoos were more likely to have hepatitis C, but more than half of individuals
received their tattoos in non-professional settings using non-sterile
implements. In addition, 20% of those with a tattoo reported injecting drug
use, compared to 0% of those who did not have a tattoo.
One case report
suggested possible hepatitis C transmission by tattooing in a commercial
parlour. This was due to the reuse of non-disposable needles which were not
In many countries,
individuals who have had a recent tattoo or piercing are temporarily excluded
from donating blood. A number of studies examined hepatitis C risk factors in
potential blood donors. After controlling for other risk factors – especially
injecting drug use – there was no substantial evidence that tattooing was a
major risk factor for the infection. The studies that did find an association
did not enquire about the venue of tattooing.
Several studies examined the risk of tattooing
and hepatitis C in high-risk population, such as drug users, prisoners and the
Their results were
inconsistent. However, tattooing in prison using non-sterile equipment did
appear to be a risk factor. Some 90% of tattooed prisoners received their
tattoos in non-professional settings and case reports of acute hepatitis C
infection among prisoners suggest that tattooing in prison could have been the
Research involving US
military veterans found that prevalence of hepatitis C was three times higher
in tattooed individuals. But the investigators did not enquire about the venue
between piercing and hepatitis C infection was examined in 23 studies. However,
the majority were limited because they did not enquire about piercing venue.
Although some studies did find an increased prevalence of the infection among
pierced individuals, several studies involving high-risk individuals found no
such association. Nor was an association identified in the study of 5000 US
“There is no
definitive evidence that [hepatitis C] infections occur when sterile equipment
is used,” comment the investigators. “Of note, no outbreaks of hepatitis C
infection have been detected in the United States that originate from
professional tattooing or piercing parlours.”
emphasise that tattooing in non-sterile environments was associated with an
increased hepatitis C risk.