Tattooing Linked to Higher Risk of Hepatitis C

Youth, prison inmates and individuals with multiple tattoos that cover large parts of their bodies are at higher risk of contracting hepatitis C and other bloodborne diseases, according to a University of British Columbia study.

The researchers reviewed and analysed 124 studies from 30 countries, including Canada, Iran, Italy, Brazil and the United States, and found the incidence of hepatitis C after tattooing is directly linked with the number of tattoos an individual receives. The findings are published in the current issue of the International Journal of Infectious Diseases.

Tattoos have become increasingly popular in recent years. In the U.S., an estimated 36 percent of people under 30 have tattoos. In Canada, approximately 8 percent of high school students have at least one tattoo and 21 percent of those who don't have one want one. During tattooing, the skin is punctured 80 to 150 times a second in order to inject color pigments.

"Since tattoo instruments come in contact with blood and bodily fluids, infections may be transmitted if instruments are used on more than one person without being sterilized or without proper hygiene techniques," says lead author Dr. Siavash Jafari, a community medicine resident in the UBC School of Population and Public Health (SPPH). "Furthermore, tattoo dyes are not kept in sterile containers and may play a carrier role in transmitting infections," says Jafari. "Clients and the general public need to be educated on the risks associated with tattooing, and tattoo artists need to discuss harms with clients."

Other risks of tattooing identified by the study include allergic reactions, HIV, hepatitis B, bacterial or fungal infections, and other risks associated with tattoo removal.

The researchers are calling for infection control guidelines for tattoo artists and clients, and enforcement of these guidelines through inspections, reporting of adverse events and record-keeping. They also recommend prevention programs that focus on youth the population who are most likely to get tattoos and prisoners who face a higher prevalence of hepatitis C to lower the spread of hepatitis infection. In Canada, 12 percent to 25 percent of hepatitis C infections among prisoners are associated with tattooed individuals, compared to 6 percent of the general population.

The chemical ingredients in tattoo dyes can include house paint, ink from computer printers, or industrial carbon. Toxic contents of some tattoo inks may be entering the kidney, lungs and lympth nodes through the circulatory system. The study also revealed a new trend among youth to get tattooed with glow-in-the-dark ink, the risks of which are not yet known.

Co-authors of the study include Jane Buxton from SPPH and the BC Centre for Disease Control; Mahyar Etminan, a scientist with the Centre for Clinical Epidemiology and Evaluation at Vancouver General Hospital and the Vancouver Coastal Health Research Institute; Dr. Ray Copes, clinical professor at SPPH and Dr. Souzan Baharlou with the Department of Urology at BC Children's Hospital.