As reported by the Republican-American, September 23, 2004.

Tattoos ... and the Risk of Hepatitis

By T. Colleen Morgan

Everywhere you go, you see them. Tattoos of all shapes, sizes and colors peek out from under cuffs, tank tops, miniskirts and socks, no longer reserved for the fringe population.

The increase in tattoo demand by the mainstream has caused a proliferation of studios. But because tattooing carries health risks, including possible exposure to HIV and hepatitis, Waterbury's health department is drafting the city's first safety regulations for tattoo parlors.

Currently, there are no city regulations for tattoo parlors, a situation the city wants to redress. Additionally, the state does not require licenses for tattoo parlors, although state licenses are required for hairdressers and barbers. Although the state requires tattoo parlors to operate under a doctor's supervision, the doctor does not need to be physically present. Instead, new tattoo parlors hire a physician to inspect the facility before it opens. Thereafter, the doctor acts as a consultant to to the tattoo artists. The doctor is not responsible for periodic inspections.

"There is good money in this business," John Whitman of Murder Ink studio in Waterbury said this week. "Anyone who picks up a tattoo gun thinks they can start tattooing, even if they have no doctor [supervisor], no certification, no nothing.... Waterbury has a big problem."

The Waterbury Health Department wants to regulate businesses that perform tattoos and body piercing, as well as hairdressing and massages, because it believes that any business involving the potential for "interchange" of bodily fluids should be regulated and inspected.

In addition to worries over possible health risks to clients, the city's health department is also concerned with how these shops dispose of their waste, particularly used needles.

"From our point of view, the Department of Public Health should be involved any time people come in to a business and possibly have exposure to blood and bodily fluids, for the worker and the customer," Dr. Joseph DeMayo, acting health director, said this week. "We are not making a judgment on these types of business, but it is an environment where needles are used, so there is a possibility of someone being exposed and there is a risk of infection. We have to make sure it is done in the proper way to minimize any kind of risk."

The city's health department is studying regulations from other towns, including Naugatuck, and will draft an ordinance to bring to city officials in a few months.

Jim Rokos, director of the Torrington Area Health District, said the agency has not yet adopted regulations on tattoo parlors, but that the health risks do cause a concern.

"We have seen a big increase in hepatitis B and C in the last five years, and it has no age, seasonal or ethnic boundaries," Rokos said. "If we ever wanted to show a link between hepatitis and tattoos, it would have to be a scientific study, but it could be done. It is a concern."

The problem has been finding the resources to conduct inspections.

"I think we should discontinue inspections and licensing of hair salons and inspect tattoo parlors. I think they pose a greater risk to the public health."

Any procedure that involves piercing the skin runs a risk that certain infectious viruses will spread, said Dr. George Wu, an expert on hepatitis at the UConn Medical Center in Farmington.

Hepatitis, an inflammation of the liver, is a blood-borne virus with several forms. Initially, doctors believed it spread only through blood products.

Experts now know that hepatitis B can be transmitted through needles, body piercing, tattooing, dialysis, sexual contact, and even childbirth.

Tattoo parlors typically use disposable, pre-packaged needles. Nevertheless, Wu called tattooing "a risky behavior" even when tattoo parlors take precautions to guard against it.

"If the ink is used only once and it is sterile and the needle is sterile and the proper technique is used, the risk is low.... It's a small percentage of tattoos (that transmit hepatitis), and it's usually kids who do it on their own. They tattoo themselves or each other, like being blood brothers. I think, in this country, most of the tattoo places are pretty careful."

Most newborns today are vaccinated against hepatitis B in a series of three shots over six months. The federal government recommends that certain adults in high-risk groups, like health care workers, also get vaccinated. No virus yet exists for hepatitis C, which is more severe. The damage it does to the liver is usually chronic and can lead to cirrhosis and cancer.

"Hepatitis C is a greater concern than hepatitis B," Wu said, noting that the C strain is also more common. "Someone acutely affected with hepatitis B can get it and it resolves on its own without any treatment in 80 to 85 percent of cases, which means only 15 to 20 percent of the cases will go on to be a chronic disease or even need treatment. In contrast, about 80 to 85 percent of patients with hepatitis C acutely will go on to have the chronic disease, and there is no vaccine for it so we can't be protected."

A typical symptom of hepatitis is fatigue. Yellow and itchy skin, light stools and dark urine, and loss of taste in food, typically associated with the disease, only occur in about 10 percent of the cases, said Dr. Michael Simms of St. Mary's Hospital, who specializes in infectious diseases.

"Fatigue is one of the symptoms, but everybody's fatigued so you usually don't hear about that," Simms said. "If you have fatigue and something else unusual, like you're tired and you can't stay awake when driving, or you have itchiness of the skin or a change in the way food tastes. A lot of people who have hepatitis have nonspecific symptoms and they are different for everyone."

Primary care physicians who see a tattoo on a patient during a routine examination will usually question its origin, Simms said. If they do not see one, they may ask if the patient has a tattoo. It's one of many things doctors look for, he said, especially if a patient has symptoms consistent with a blood-borne virus.

"The medical community is very concerned about people with chronic hepatitis infections," Wu said, noting that there are "many documented cases" of people who died from a different ailment but were found on autopsy to have advanced stage liver disease from viral hepatitis.

Anyone interested in getting a tattoo should be aware of the risks. Visit a few tattoo studios, look around and ask questions about the safety procedures, tattoo artists urge.

Reputable tattoo parlors are aware of the risks and urge clients to ask questions.

"A lot of people think there are shortcuts, but if you make mistakes they are permanent mistakes," Whitman, of Murder Ink, said. "When you mess up a tattoo, you better know how to fix it. You can fix a tattoo, but you can't fix hepatitis."