2. Modern modification

3. Tattoo. Pierce. How come?

4. Hepatitis C

5. To regulate?

Cirrhosis is a chronic liver disease that damages and scars liver tissue, interfering with the liver's essential metabolic jobs. While excessive alcohol use is the leading cause of cirrhosis, hepatitis C is another cause. Image: National Library of Medicine and NIH

Epping Forest District Council

The various hepatitis viruses attack the liver, and cause jaundice, fever or even liver failure. The liver is the site of many biochemical reactions in the body; liver failure from cirrhosis kills unless a liver transplant is available.

Amidst the alphabet-soup that is hepatitis, C is a particular concern. Since the pathogen was recognized in 1988, it's been shown to cause two types of problem. Acute hepatitis syndrome includes pain in the upper right side of the body, vomiting, and fever. Far more common is chronic, or silent, hepatitis C infection, which may, decades later, cause cirrhosis of the liver or liver cancer.

Chronic liver disease is the tenth largest cause of death among U.S. adults; 40 percent to 60 percent is apparently caused by hepatitis C.

Translated: Hepatitis C is a big deal. But although surveys show that 1.8 percent of the American population of all ages -- and perhaps up to 5 percent of the working age populationó is infected with C, most of those people don't know it.

In past decades, the largest source of infection was probably blood transfusions performed before 1985, when screening of blood donors cut C's spread. But the Centers for Disease Control and Prevention (CDC) says 41,000 new infections occur annually, and transfusion is only one possible route for this blood-borne infection. Currently, CDC thinks the largest route for hepatitis C is intravenous (IV) drug use. But Robert Haley, an epidemiologist at University of Texas Southwestern Medical Center, in Dallas, argues that about 40 percent of infections aren't associated with IV drugs, or other known risk factors.

Could dirty tattoo needles or other problems with tattoo infection control be transmitting C?

Trouble signs
Perhaps. The CDC admits that the "risk of infection from intranasal cocaine use, tattooing, and body-piercing" are "unanswered questions [that] significantly impact the direction of hepatitis C prevention and control activities." That impact is unclear, however, as the CDC's hep branch didn't find time to respond to an inquiry from The Why Files.

But there are troubling indications that tattoos can transmit C.

In December, 2003, a Texas jury awarded $551,600 to a woman who had contracted hepatitis C. Her only risk factor was getting a tattoo, and the tattoo parlor, and its employee were found legally liable.

Researchers found more than a six-fold greater risk of hepatitis C infection among people with tattoos in Brazil (see "Tattooing and Transfusion-Transmitted..." in the bibliography). The study did not find increases in hepatitis B or HIV among people with tattoos.

When Haley and colleague Paul Fischer analyzed blood tests from 626 patients who visited a clinic for problems not related to hepatitis, they calculated that the odds of C infection were 6.5 times greater among people with commercial tattoos.

"Commercially acquired tattoos," Haley wrote, "accounted for more than twice as many [hepatitis C] infections (41 percent) as injection-drug use (17 percent)." C also became more common with increasing tattoo size and more tattoos (see "Commercial Tattooing as ..." in the bibliography).

This kind of "warning" is supposed to alert tattoo artists to the danger of infection. Is art more important than health?

No failure to communicate
These results have not changed the CDC position. "While it is possible for HCV [hepatitis C virus] to be transmitted from any percutaneous [through the skin] exposure to blood, exposures such as tattooing, body piercing, or acupuncture have not been shown to place people at increased risk for infection."

Haley thinks he has an explanation for the different interpretations. "If you get a hepatitis dose from IV [intravenous] drug use or a transfusion, you are infusing a large amount of virus directly into your blood stream. It goes immediately to the liver and you get sick within weeks, turn yellow with acute hepatitis syndrome.

"But if you get a dose of virus from tattooing," Haley continues, "you only get a few virus particles into your skin, and it takes much longer to work its way through the immune system to the liver, and you never develop acute hepatitis syndrome -- but the long-term risk for cirrhosis and liver cancer are the same."

Keep in mind that hepatitis C is largely a silent epidemic: "80 to 90 percent of people who get hepatitis C never get the acute syndrome," Haley adds.

CDC erred, Haley says, by investigating acute hepatitis, but not silent infections. The agency relies for information on a network that looks into every case of acute hepatitis syndrome reported to local health departments in six counties. Researchers, he says, ask patients about possible exposures, working down from IV drugs through multiple sex partners and transfusions, until they finally reach tattoos. But once a patient mentions exposure to a possible risk factor, the questions stop. And since tattoos are toward the bottom of the list, the question is seldom asked.

Who's regulating the tat-pierce biz?

There are 1 2 3 4 5 pages in this feature.
Bibliography | Credits | Feedback | Search

©2004, University of Wisconsin, Board of Regents.