Tattooing: Major route for Hepatitis C infection

GETTING A tattoo could be a key infection route for hepatitis C, the most common chronic viral infection affecting almost 2 per cent of the United States population. Dr. Robert Haley, chief of epidemiology, writes in the journal Medicine that tattooing has been previously overlooked as a widespread source of hepatitis C, a potentially fatal disease that attacks the liver, leading to cirrhosis and liver cancer.

The study found that people who had received a tattoo in a commercial tattoo parlour were nine times more likely to be infected with hepatitis C than people who did not have a tattoo.

Participants in the study were patients of an orthopaedic spinal clinic, a setting that provided a large volume of patients seeing a physician for reasons unrelated to blood-borne infection. Participants unaware of their hepatitis status were examined, interviewed for risk factors and tested for hepatitis C by the study's co-author Dr. Paul Fischer.

Of 626 patients studied, 113, or 18 percent, had a tattoo. Of those with a tattoo, 22 percent were infected with hepatitis C. Of the 52 patients who had acquired their tattoos in commercial tattoo parlors, 33 percent had hepatitis C. In contrast, only 3.5 percent of patients with no tattoos had hepatitis C.

Few of the tattoo-associated infections could be traced to injection-drug use, transfusions or other known routes of exposure.

The study found that people who had several tattoos, or complex or large tattoos had an increased risk of having hepatitis C and that people with white, yellow, orange or red pigments in their tattoos also were more likely to have hepatitis C than those with only black. These characteristics reflect tattoos acquired in commercial tattoo parlors.

The risk of hepatitis C infection was also higher among patients with a history of injection-drug use, hospital custodial workers, and people who drank beer heavily, but the risk was not increased for those who drank only wine or liquor.

Although hepatitis C can be transmitted by an infected blood transfusion, this route of infection was too rare to show a discernable contribution to the overall infection rate in the population at large.

Hepatitis C can be passed through tattooing by reuse of tattooing needles or dye, inadequate sterilization of tattooing needles between customers, or breaks in sterile technique such as the artist pricking the back of his or her hand to test the needle's sharpness.

Few states have hygienic regulations to ensure safe tattooing practices in commercial tattoo parlours, and even fewer monitor and enforce standards. Hepatitis C presently causes as many as 10,000 deaths each year from cirrhosis and liver cancer, and this number is expected to rise. Hepatitis C is a quiet killer.

The vast majority of people with new hepatitis C infection experience no symptoms until many years later when they develop liver cirrhosis or liver cancer. Only a small number initially develop the classic symptoms of hepatitis, including jaundice, fatigue, abdominal pain, loss of appetite and vomiting.

Doctors say people with any of the risk factors for hepatitis C should consider having a blood test, because treatments are now available to eradicate the virus in many before it causes permanent liver damage or cancer.

Tattooing has been shown to transmit other infectious diseases, including hepatitis B, syphilis, leprosy and tuberculosis. Small outbreaks of hepatitis have been identified in customers visiting certain commercial tattoo parlors on the same day.

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