title: People with multiple tattoos and/or piercings are not at increased risk for HBV or HCV in The Netherlands.
abstract: BACKGROUND
  Although published results are inconsistent, it has been suggested that tattooing and piercing are risk factors for HBV and HCV infections. To examine whether tattooing and piercing do indeed increase the risk of infection, we conducted a study among people with multiple tattoos and/or piercings in The Netherlands who acquired their tattoos and piercings in The Netherlands and/or abroad.
  
  
  METHODS
  Tattoo artists, piercers, and people with multiple tattoos and/or piercings were recruited at tattoo conventions, shops (N = 182), and a biannual survey at our STI-outpatient clinic (N = 252) in Amsterdam. Participants were interviewed and tested for anti-HBc and anti-HCV. Determinants of HBV and HCV infections were analysed using logistic regression analysis.
  
  
  RESULTS
  The median number of tattoos and piercings was 5 (IQR 2-10) and 2 (IQR 2-4), respectively. Almost 40% acquired their tattoo of piercing abroad. In total, 18/434 (4.2%, 95%CI: 2.64%-6.46%) participants were anti-HBc positive and 1 was anti-HCV positive (0.2%, 95%CI: 0.01%-1.29%). Being anti-HBc positive was independently associated with older age (OR 1.68, 95%CI: 1.03-2.75 per 10 years older) and being born in an HBV-endemic country (OR 7.39, 95%CI: 2.77-19.7). Tattoo- and/or piercing-related variables, like having a tattoo or piercing in an HBV endemic country, surface percentage tattooed, number of tattoos and piercings etc., were not associated with either HBV or HCV.
  
  
  CONCLUSIONS
  We found no evidence for an increased HBV/HCV seroprevalence among persons with multiple tattoos and/or piercings, which might be due to the introduction of hygiene guidelines for tattoo and piercing shops in combination with the low observed prevalence of HBV/HCV in the general population. Tattoos and/or piercings, therefore, should not be considered risk factors for HBV/HCV in the Dutch population. These findings imply the importance of implementation of hygiene guidelines in other countries.
authors.affiliation: Cluster Infectious Diseases, Department of Research, Public Health Service, Amsterdam, The Netherlands. aurbanus@ggd.amsterdam.nl
authors.forename: Anouk T
authors.initials: AT
authors.lastname: Urbanus
authors.forename: Anneke
authors.initials: A
authors.lastname: van den Hoek
authors.forename: Albert
authors.initials: A
authors.lastname: Boonstra
authors.forename: Robin
authors.initials: R
authors.lastname: van Houdt
authors.forename: Lotte J
authors.initials: LJ
authors.lastname: de Bruijn
authors.forename: Titia
authors.initials: T
authors.lastname: Heijman
authors.forename: Roel A
authors.initials: RA
authors.lastname: Coutinho
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
mesh_terms: D000328:Adult; D046288:Body Piercing / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D013653:Tattooing / Q000009:adverse effects* / Q000706:statistics & numerical data; D055815:Young Adult