The Risk of Viral Hepatitis From Tattoos

Tattoos are all the rage these days, with shows like LA Ink showing off tattoos and spotlighting tattoo culture. While tattoos allow you to express who you are in a permanent way, getting a tattoo carries a risk of developing an infection, especially if the tattoo artist doesn't use strict safety procedures.

Person being tattooed
Nicola Tree / Taxi / Getty Images 

Is There Really a Link?

Research from the American Association for the Study of Liver Diseases showed that out of 3,871 people studied (half with hepatitis C and half without), there was a significant association between having one or more tattoos and having hepatitis C. In short, the study found that people with hepatitis C were almost four times more likely to have tattoos. This study did not prove causality but did control for other risk factors such as intravenous drug use.

However, the setting in which a tattoo is given matters a great deal. Other studies have found no increase in the risk of hepatitis C infection when tattooing was performed in professional studios with high-quality infection control procedures in place. Conversely, tattoos given in prisons or other non-professional environments carry much greater risk for transmitting hepatitis C.

How Tattoos Can Spread Hepatitis

Getting a tattoo requires that your skin is pierced by a needle and injected with tiny amounts of ink. The bigger the tattoo, the more injections you'll need, and each injection brings the needle into contact with your blood (and only once is needed to spread disease). This isn't a problem if that needle is brand new and never came into contact with any infectious agents. But what happens if the artist already used your needle on someone else? Then you become exposed to any microbes (bacteria, viruses) in that person's blood, including hepatitis B, hepatitis C, and even HIV if he or she harbors those diseases.

How to Protect Yourself

Reusing dirty needles is an obvious safety violation, but it's not good enough to just find out if the artist uses clean needles. When you're dealing with injections and blood, you have to be aware of other potential hazards. For example:

  • Is the tattoo parlor licensed? Choose a tattoo parlor and artist that are licensed and certified according to the regulations of the state it operates in. 
  • Does the artist wash his or her hands? Though artists usually wear gloves (which you should make sure they do!), they must also wash their hands before putting gloves on and after taking them off. Make sure they only put on a fresh, new pair.
  • Is the equipment sterilized? Sterilized is different from being clean. By wiping over something with a towel, the instrument will look clean, but it could still be infectious. Sterilization involves applying chemicals or heat, killing bacteria and viruses.
  • Are work surfaces clean? Make sure the work area is cleaned and sterilized. You don't want your clean tattoo needle to be exposed to germs from the table surface or other equipment.
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  • Bini EJ, Dhalla S, Tenner T, Aytaman A, et. al. Strong Association Between Tattoos and Hepatitis C Virus Infection: A Multicenter Study of 3,871 Patients. 58th Annual Meeting of the American Association for the Study of Liver Diseases. Boston. November 2-6, 2007.
  • Centers for Disease Control and Prevention. January 21, 2008. Health and Safety of Tattoo Artists and Clients.
  • Healy, Bernadine. Flesh, Not Canvas: Self-Expression Through Body Art Has Its Drawbacks. U.S. News & World Report. February 2009.

By Charles Daniel
 Charles Daniel, MPH, CHES is an infectious disease epidemiologist, specializing in hepatitis.