Back HCV Prevention Professional Tattooing and Piercing Not Linked to Hepatitis C Risk

Professional Tattooing and Piercing Not Linked to Hepatitis C Risk


While amateur tattoos and other body modifications done in prison or other non-professional settings can carry an increased risk of acquiring hepatitis C virus (HCV), there is no evidence of increased transmission risk for tattoos or piercings done in professional studios, according to a meta-analysis described in the April 15, 2012 issue of Clinical Infectious Diseases.

It is estimated that nearly 4 million people in the U.S. are living with hepatitis C. HCV is transmitted easily via direct blood-to-blood contact, as can happen when needles for injection drug use, medical procedures, or tattooing or piercing are used on more than 1 person. Shared drug use equipment is a leading cause of hepatitis C in the U.S., but some 20% of infected individuals report no known risk factors.

Rania Tohmeand Scott Holmberg from the Centers for Disease Control and Prevention (CDC) performed a critical review of previous studies in an effort to sort out conflicting findings in the medical literature.

The authors evaluated the risk of HCV infection from tattooing and piercing following the Meta-analysis of Observational Studies in Epidemiology, or MOOSE, guidelines. They identified articles about HCV risk associated with tattoos and piercings through a literature search using PubMed and Medline, looking at articles published in all languages between 1994 and July 2011.

The literature search identified 293 published articles or abstracts about HCV infection that included information about tattooing or piercing, but most were excluded because they were review papers themselves, did not measure the risk of HCV infection via tattooing or piercing, did not control for other HCV risk factors, were editorials or author responses, or relied on self-reported HCV infection. This left 62 articles eligible for inclusion in the analysis.


  • Among studies that specified the venue, there was no definitive evidence for an increased risk of HCV infection when tattoos and piercings were received in professional parlors.
  • Among 10 case-control studies, 6 reported no increased risk of HCV infection from tattooing when they controlled for injection drug use and other risk behaviors.
  • However, the risk of HCV infection was significant overall when tattoos are done in prison or by friends -- especially among high-risk groups -- with adjusted odds ratios (ORs) ranging from 2.0 to 3.6, indicating 2- to nearly 4-fold higher risk.
  • A cross-sectional study including 5000 U.S. college students, for example, found no risk of HCV infection when tattoos were performed in a professional setting (adjusted OR 0.8), though the risk was significant for tattoos in non-professional settings (adjusted OR 3.5).

"To date, there is no definitive evidence that such infections occur when sterile equipment is used," the researchers wrote. "Of note, no outbreaks of HCV infection have been detected in the United States that originate from professional tattoo or piercing parlors. In addition, recent cohort and case-control studies including samples from the general population or blood donors in developed countries did not show an increased risk of HCV infection with body or ear piercing."

Several studies in this review found that the risk of HCV infection related to tattooing has decreased over the past 2 decades, suggesting better awareness and more careful precautions in recent years.

Needles used for tattooing and piercing, as well as ink containers, should only be used for a single person. Tools that come in contact with blood should be sterilized, for example using an autoclave. Tattoo artists and piercers should wear gloves and take other universal precautions for prevention of infectious diseases.

"Because of the increasing prevalence of tattooing and piercings, particularly among youths, awareness campaigns should highlight the danger of such procedures in unregulated and potentially unsterile environments, such as homes and prisons," the authors recommended. "In addition, tattoo and piercing parlors need to be educated about and monitored for use of proper infection control procedures to avoid isolated cases of HCV infection and other infections."

For more information on hepatitis and tattoos, visit the Hepatitis C Support Project's web site and see it's Tattoo You brochure.



RA Tohme and SD Holmberg. Transmissionof Hepatitis C Virus Infection Through Tattooing and Piercing: A Critical Review. Clinical Infectious Diseases54(8):1167-1178. April 15, 2012.