- Getting a tattoo could be a key infection route for hepatitis
C, the most common chronic viral infection affecting almost 2 percent of
the United States population, according to a study by a UT Southwestern
Medical Center at Dallas researcher.
- Dr. Robert Haley, chief of epidemiology, writes in the
March issue of the journal Medicine that tattooing has previously been
overlooked as a widespread source of hepatitis C, a potentially fatal disease
that attacks the liver, leading to cirrhosis and liver cancer. It affects
2 percent of the U.S. population.
- The study found that people who had received a tattoo
in a commercial tattoo parlor 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.
- "Prior studies were unable to account for a substantial
proportion of infections, perhaps 40 percent or more, by the accepted risk
factors like injection-drug use and transfusions," Haley said. "That
suggested that important risk factors were yet to be identified. Tattooing
appears to be one of those. It has proven to be an important route of infection
in other countries, but its role in the United States has received too
little study until now."
- Patients in the study were asked questions about the
number of tattoos they had, the surface area covered by tattoos, the colors
in the tattoos and where they had received the tattoos.
- Study participants also were asked about other possible
hepatitis C risk factors, including injection-drug use, prior blood transfusions,
sexual promiscuity, acupuncture, electrolysis, occupation, ethnic factors,
obesity and others.
- 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 discernible
contribution to the overall infection rate in the population at large.
- "Most importantly, we found that commercially acquired
tattoos accounted for more than twice as many hepatitis C infections as
injection-drug use," Haley said. "This means that it may have
been the largest single contributor to the nationwide epidemic of this
form of hepatitis."
- 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 parlors, and even fewer monitor and enforce
- Patients for the study were interviewed and tested in
1991 and 1992.
- "The results of the study were not published then
because other epidemiological studies at the time were expected to address
the issue, but they did not," said Fischer. "This was the last
study done before widespread hepatitis C testing began, when a largely
unbiased study could still be done."
- Hepatitis C presently causes as many as 10,000 deaths
each year from cirrhosis and liver cancer, and this number is expected
to rise. Nearly 4 million Americans are chronically infected with hepatitis
C, and about 36,000 more become infected each year.
- 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
- 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.
- Fine-art tattooing has become a common practice, particularly
among teenagers and young adults. Sociological studies of tattoo recipients,
however, have shown that few recipients compare tattoo parlors or watch
a tattooing procedure before getting one, and few consider tattooing a
future health risk.
- Haley is the study's lead author. Fischer is an internal
medicine specialist, formerly at the Dallas Spine Group and presently at
Presbyterian Hospital of Dallas. - By Mindy Baxter
- Contact Mindy Baxter email@example.com
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