title: Is acupuncture a risk factor for hepatitis? Systematic review of epidemiological studies.
abstract: OBJECTIVE
  Acupuncture has been repeatedly associated with infectious hepatitis. The aim of the present systematic review was therefore to critically evaluate such data from epidemiological investigations.
  
  
  METHODS
  Four independent literature searches were carried out to identify all epidemiological evidence linking acupuncture with hepatitis. All studies were validated by the authors and data extracted according to predefined criteria.
  
  
  RESULTS
  Fifteen investigations fulfilled our inclusion criteria. Most studies originated from Asia. One study included markers to hepatitis A virus, three to hepatitis B virus, and 13 to hepatitis C virus. Five investigations reported associations between acupuncture and seropositivity to hepatitis C virus. In those studies, acupuncture increased the risk only modestly.
  
  
  CONCLUSIONS
  A modest association between hepatitis C and acupuncture has been reported in some countries. This emphasizes the importance of exclusively using disposable acupuncture needles.
authors.affiliation: Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK. Edzard.Ernst@pms.ac.uk
authors.forename: E
authors.initials: E
authors.lastname: Ernst
authors.forename: K J
authors.initials: KJ
authors.lastname: Sherman
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects* / Q000295:instrumentation; D016021:Epidemiologic Studies; D006505:Hepatitis / Q000453:epidemiology*; D006801:Humans; D009339:Needles; D012307:Risk Factors; D013242:Sterilization