April 9, 2001 -- Beth Blackmarr, 38, is an insurance executive in Cleveland, Ohio. In a business suit, briefcase in hand, she is all button-down, no-nonsense professional. But under the suit she carries five permanent reminders of her life as a teenager in LaGrange, Ky. -- five tattoos.-->
Blackmarr tells WebMD that she got the tattoos at a commercial tattoo parlor when she was in her teens. She says she now wishes she could get the tattoos removed, but "I've never been overly concerned about health problems because of the tattoos." That, however, may change.
A new study by a former CDC researcher suggests that getting a tattoo can significantly increase the risk of hepatitis C, a viral infection of the liver for which there is no cure and which often leads to fatal liver disease.
Hepatitis C is considered a major public health risk because it is a silent disease, which lies dormant for decades before it flares up. The CDC estimates that 4 million Americans are infected with hepatitis C and about 10,000 people die from the disease each year.
Although there is no cure, the disease is treated with a combination of an antiviral drug called ribavarin and immune therapy with interferon. The treatment is very long -- 48 weeks -- and is difficult to tolerate because of unpleasant side effects including headaches, constant nausea, fatigue, and depression. -->
Hepatitis C is spread by blood-to-blood contamination, says lead study author Robert Haley, MD, chief of epidemiology at the University of Texas Southwestern Medical Center (UTSW) in Dallas. Injection drug abusers have an increased risk for hepatitis C because they often share needles. Healthcare workers, especially nurses, are also considered high risk for hepatitis C because of "accidental needle sticks," he says. And because the nation's blood supply was not tested for hepatitis C until about 10 years ago, blood transfusions before 1991 are also considered a risk factor for transmission of hepatitis C.
"But when all the known risk factors are considered, the majority of hepatitis C cases are still not accounted for," says Haley, who worked for more than 10 years at the CDC before joining the faculty at UTSW. "That's because tattoos were left out of the equation. When we consider tattoos as a risk factor we can explain the difference."
"People who had do-it-yourself tattoos have a three times greater risk for hepatitis C than people without tattoos, and people tattooed in jail have an even higher risk. But the greatest risk comes from commercial tattoo parlors," he says. "People who get tattoos at commercial tattoo parlors have a nine times greater risk."
He bases his risk calculations on a study of over 600 people who were patients at a spine clinic in the early 1990s. The patients agreed to be evaluated for blood-borne infections, says Haley. The evaluation included detailed information about lifestyle risk factors as well as blood tests.
Haley found that 113 patients had at least one tattoo and 22% of those patients tested positive for hepatitis C. "Only 3.5% of the patients with no tattoos had hepatitis C," he says.
The news about tattoos is welcomed but not surprising, says Thelma King Thiel, who runs the Hepatitis Foundation International, an educational-advocacy group based in Cedar Grove, N.J. Thiel's group sponsors Hepatitis Awareness Month in May.
"We say that anything that invades the body by piercing the skin is a risk factor," says Thiel. She says that as soon as she saw Haley's paper "I shot a copy right off to the CDC." Thiel and Haley would like the CDC to officially designate tattooing as a risk factor for hepatitis C.
The CDC, which does list tattooing as a risk factor for hepatitis B, has stopped short of linking tattoos to hepatitis C. It states simply that more research is needed.
Brooke Seckel, MD, director of cosmetic surgery at Boston's Lahey Clinic and an assistant professor of surgery at Harvard Medical School, is an ardent opponent of tattoos. Seckel says the medical community was recently dealt a major setback when Massachusetts, which had banned tattooing, passed a law allowing tattoo parlors in the state. "Here we are supposed to be the bastion of medical science and we have just legalized this dangerous practice," says Seckel.
"Who is overseeing the process? We don't know if this equipment is properly sterilized. We don't know if the needles are disposed after a single use, says Seckel. "We don't allow nonmedical personnel to draw blood; why do we allow these people to pierce the skin?"
Macedonia, Ohio, tattoo artist Jerry Davis, 40, takes exception to Seckel's charges. Davis tells WebMD, "Dentists don't operate in hospitals. They learn all the necessary procedures for sterilization and disposal of hazardous materials. If they can learn it, who is to say that we can't learn it, too?"
Davis, who has operated a studio in the basement of an old schoolhouse for the last 15 years, says that he is interested in improving the image of tattoo artists and in improving health standards.
In his studio, where the walls are covered with thousands and thousands of tattoo designs, he points out that he has initiated some safety measures not required by Ohio law. For example, he insists that all his artists cover the tattoo machine -- he objects to the term tattoo gun -- in plastic to protect against blood splatter.
He says the entire tattoo machine cannot be placed in a sterilizer because it would be ruined. He does, however, sterilize the tubes that hold the pigment and the bar that holds the needles. He uses disposable needles "that are removed and disposed of in the presence of the customer."
Davis says he and the five artists he employs have all been tested for hepatitis B and have current vaccinations. They have not, however, been tested for hepatitis C, but he plans to change that. "I didn't know about this but now that I do, I will be tested. I would like to live to a ripe old age and to see my kids graduate from college, so I want to stay healthy," says Davis.
Husband and wife Hugh O'Donnell and Jenny Grospitch, both 30, say they are very happy with their 5-year-old tattoos. The Lakewood, Ohio couple says they did ask their tattoo artist about safety practices.
"We picked this place because it had a good reputation for safe practices and because the artist could do original designs," says Grospitch. She says she doesn't plan to get any more tattoos, but O'Donnell says he plans to get at least one more.
Asked about hepatitis C, both Grospitch and O'Donnell said they had never heard about it. However, Grospitch, O'Donnell, and Blackmarr all tell WebMD that they will now be tested for hepatitis C.
As O'Donnell puts it, "Of course, I'll get tested. It would be stupid not to. But I'm still going to get another tattoo."
If you have a tattoo and want to find out whether you've been exposed to hepatitis C, you can ask your doctor about getting your blood tested.