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Korean J Gastroenterol 2023; 82(3): 127-136  https://doi.org/10.4166/kjg.2023.060
Risk of Hepatitis C Virus Transmission through Acupuncture: A Systematic Review and Meta-Analysis
Myung Han Hyun1,2, Ji Hoon Kim3, Jeong Won Jang4, Jeong Eun Song5, Do Seon Song6, Hye Won Lee7, Young Youn Cho8, Gi-Ae Kim9, Eileen L. Yoon10, Dong Hyun Sinn11, Soon Sun Kim12, Sun Young Yim13, Hyun Yang14 , Jihyun An15
Integrative Cancer Center, CHA Ilsan Medical Center, Goyang1; Department of Oncology and Hematology, CHA Ilsan Medical Center, CHA University, Goyang2; Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul3; Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul4; Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu5; Department of Internal Medicine, The Catholic University of Korea, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon6; Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul7; Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul8; Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul9; Department of Internal Medicine, Hanyang University Seoul Hospital, Hanyang University School of Medicine, Seoul10; Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul11; Department of Gastroenterology, Ajou University Hospital, Ajou University School of Medicine, Suwon12; Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul13; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul14; Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri15, Korea
Correspondence to: Jihyun An, Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri 11923, Korea. Tel: +82-31-560-2234, Fax: +82-31-560-2539, E-mail: starlit1@naver.com, ORCID: https://orcid.org/0000-0002-0110-0965

Hyun Yang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea. Tel: +82-2-2030-2530, Fax: +82-2-2030-2521, E-mail: oneggu@naver.com, ORCID: https://orcid.org/0000-0001-6588-9806

Financial support: This study was supported by grants from the Basic Science Research Program through the National Research Foundation of Korea (RS-2022-00166674).
Received: May 17, 2023; Revised: May 27, 2023; Accepted: May 27, 2023; Published online: September 25, 2023.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background/Aims: Chronic hepatitis C is a major risk factor for liver cirrhosis, hepatocellular carcinoma, and hepatic failure. Although traditional practices, including acupuncture, tend to increase the risk of HCV infection, the association remains controversial. Therefore, the current meta-analytical study was undertaken to evaluate the risks of acupuncture and hepatitis C transmission.
Methods: Two researchers independently screened studies from the databases encompassing the period from inception to May 12, 2022. Baseline demographics, HCV transmission OR, and 95% CIs were extracted, pooled, and analyzed using random-effect models. Subgroup analyses utilizing study design and ethnicity were performed. Heterogeneity and publication bias were analyzed using the Higgins I2 test and funnel plots, respectively.
Results: In all, 28 studies with 194,826 participants (178,583 controls [91.7%] vs. 16,243 acupuncture users [8.3%]) were included in the final analysis. The pooled analysis showed that acupuncture users had a significantly higher HCV transmission rate than controls with heterogeneity (OR, 1.84 [1.46–2.32]; p<0.001; I2 =80%). In the subgroup analysis, both cross-sectional case-control (n=14; OR, 1.96 [1.47–2.61]; p<0.001; I2 =88%) and cross-sectional studies (n=12; OR, 1.85 [1.32–2.61]; p<0.001; I2 =0%) showed significantly higher HCV infection rates in the acupuncture group than in the control group. Both Asian and non-Asian acupuncture users showed a higher HCV transmission risk than the controls (all Ps<0.001). No significant publication bias was observed.
Conclusions: Our findings indicate that acupuncture increases the risk of HCV transmission. Due to HCV's contagiousness, unsafe medical and social practices (including acupuncture) should be performed with caution.
Keywords: Acupuncture; Hepatitis C virus; Transmission; Meta-analysis

HCV infection is a global health problem that can elicit liver cirrhosis, hepatocellular carcinoma (HCC), and hepatic failure.1 The World Health Organization reported that in 2019, approximately 290,000 people died from hepatitis C worldwide, mostly from cirrhosis and HCC.2 HCV is primarily a blood-borne virus that is transmitted through unsafe therapeutic injections, injection drug use, blood transfusion, accidental needle stick injury, and sexual contact.3 Despite recent improvements in direct-acting antiviral agents for chronic hepatitis C, the prevention of HCV transmission via unsafe invasive medical practices, including acupuncture, remains inadequate.4

Acupuncture was first performed over 2,500 years ago in China and consists of the therapeutic insertion and manipulation of thin needles at more than 2,000 acupuncture points connected by yin and yang pathways.5 Over the centuries, acupuncture has extended to other continents as a novel treatment strategy for chronic diseases, including musculoskeletal pain and hypertension.6 In recent decades, medical oriental doctors, physiotherapists, and chiropractors worldwide are applying acupuncture needling approaches to treat musculoskeletal pain and other health problems.7

Although acupuncture is more widely applied than before, unsafe acupuncture practices in the community have increased the risk of HCV transmission.8,9 However, previous meta-analyses showed insufficient data and controversial results.10-13 Therefore, this study comprehensively analyzes and performs an updated meta-analysis to assess the association between acupuncture and the risk of HCV transmission.


1. Search strategy and eligibility criteria

We conducted a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement (Supplementary Table 1). From January 2000 to May 2022, two authors (MHH and YH) independently identified eligible articles from databases such as PUBMED, EMBASE, and the Cochrane Library, using the structured keywords “acupuncture,” “sham,” “piercing,” “tattoo,” “hepatitis C virus,” “HCV,” “chronic hepatitis C,” and “CHC.” For electronic scrutiny, all the study references and relevant review articles were manually searched. Disagreements were resolved through discussion and consensus referrals to a third investigator (JA). All the analyzed studies were published in English. Detailed search terms and strategies are listed in Supplementary Table 2.

The full text of potentially relevant publications of clinical studies was analyzed based on the following inclusion criteria: (1) non-randomized studies that compared the clinical effects of acupuncture and HCV transmission as either primary or secondary outcomes; (2) extractable RR or OR and their corresponding CI, or provided with enough data to compute these parameters; (3) participant age >18 years; and (4) study sample size >100. If the cases included in a study were published in different phases of duplication, the most recent publications or the largest cohort was selected. Studies excluded were non-human studies (animal or cell studies), non-peer-reviewed articles (meeting abstracts, case reports, editorials, clinical trial protocols, correspondence letters, or editorials), and studies that did not meet the inclusion criteria.

2. Data extraction and quality assessment

Data extracted included author names, publication year, country, ethnicity, enrollment period, study design, study population, sample size, HCV infection rate, adjusted OR or RR, and 95% CI. Two independent reviewers (MHH and YH) reviewed the selected studies. The study designs were categorized as a cross-sectional case-control study, a cross-sectional cohort study, and a cross-sectional study. Ethnicity was classified as either Asian or non-Asian. The risk of bias was assessed by adapting the quality assessment scale from the modified Newcastle–Ottawa Scale according to three categories: selection (range, 0–5 stars), comparability (range, 0–2 stars), and outcome assessment (range, 0–3 stars).14 More stars indicate a lower risk of bias. Each item was scored as ‘‘yes (star),’’ ‘‘no,’’ or ‘‘unclear,” and an agreement between the three authors (MHH, YH, and JA) was required.

3. Statistical analysis

A random-effects model was used to calculate the pooled OR and 95% CI for the association between acupuncture and HCV transmission risk due to the predicted high heterogeneity. The analysis of heterogeneity was assessed using the Higgins I2 statistic, in which 50% or more was considered significant heterogeneity.15 Funnel plots and Egger’s test for HCV transmission risk were used to assess publication bias.16 A subgroup analysis was performed to investigate the source of heterogeneity according to the study design and ethnicity. Statistical significance was set at p<0.05. Statistical analysis was conducted using Review Manager 5.3 (The Cochrane Collaboration).


1. Article selection

Fig. 1 shows the detailed steps of the study selection. Overall, we identified 1,465 potentially relevant studies through database searches and additional records by manual search. After excluding articles subsequent to primary screening, 373 studies were retrieved for full-text review. Of these, 345 articles were excluded as they did not meet the inclusion criteria: 38 conference abstracts only, 245 with other transmission routes, 24 insufficient HCV data, 5 genetic studies, 6 case series, 12 review papers, and '15' no extractable data. Finally, 28 studies with 194,826 participants were included in the systematic review and meta-analysis.17-44

Figure 1. Study flow chart.

2. Study characteristics and quality assessment

Among the 194,826 participants included in the 28 studies, 178,583 (91.7%) were control participants and 16,243 (8.3%) had undergone acupuncture. Most studies were cross-sectional case-control studies (n=14 [50.0%]),17,18,21-24,26,28,29,32,35,38-40 cross-sectional studies (n=12 [42.9%]),19,20,25,27,31,33-34,36,37,41,43-44 and cross-sectional cohort studies (n=2 [7.1%]).30,42 Categorizing by ethnicity, 16 (57.1%) studies included Asian populations, whereas 12 studies included non-Asian populations. Most studies analyzed hospital samples (n=13 [46.4%]) and the general population (n=9 [32.2%]). The majority of the studies collected acupuncture data from questionnaires, except for 3 studies procured from medical records.26,33,44 The baseline demographics of the included studies are presented in Table 1. The quality assessment results (Supplementary Table 3) adopted the Newcastle–Ottawa scale, which showed that most of the included studies scored more than three stars in the selection and outcome assessment sections. However, the comparability section showed diverse results between studies (0–2 stars).

3. Association between acupuncture and HCV transmission

In the overall analysis, acupuncture users showed a higher HCV transmission rate (17.4% [2,941/16,843]) than control participants (4.6% [8,233/178,583]). The pooled analysis showed statistical significance for the HCV transmission rate in acupuncture users with high-grade heterogeneity (OR, 1.84; 95% CI, 1.46–2.32; p<0.001; I2=80%; Fig. 2). Three studies showed a lower rate of HCV infection in control than in acupuncture subjects.18,33,43 However, there were no consistent findings between the studies. Among the studies analyzed, four studies reported 0 HCV infection in acupuncture patients due to the small study population.27,33,37,43

Figure 2. Pooled analysis of odds ratio for the association between acupuncture and HCV infection. Each dot represents the OR with a 95% CI. The box size represents the weight of the study in the meta-analysis. Weights were obtained using the random-forest model. M-H, Mantel-Haenszel.

4. Subgroup analysis and publication bias

Fig. 3 shows the pooled analyses of ORs for the association between acupuncture and HCV transmission, according to the study design. Both cross-sectional case-control studies (OR, 1.96; 95% CI, 1.47–2.61; p<0.001; I2=88%) and cross-sectional studies (OR, 1.85; 95% CI, 1.32–2.61; p<0.001; I2=0%) showed significantly higher HCV transmission rates in acupuncture users than in controls. However, cross-sectional cohort studies did not show statistical significance between the two groups (OR, 1.08; 95% CI, 0.73–1.60; p=0.760; I2=0%). As presented in Fig. 4, both Asian and non-Asian populations showed significantly higher HCV transmission rates in acupuncture users than in controls (Asians: OR, 1.98; 95% CI, 1.43–2.76; p<0.001; I2=84%; non-Asians: OR, 1.60; 95% CI, 1.28–1.99; p<0.001; I2=29%). No significant asymmetry was detected in the funnel plots for the association between acupuncture and HCV infection (Egger’s p>0.05; Fig. 5).

Figure 3. Pooled analysis of odds ratio for the association between acupuncture and HCV infection according to study design. Each dot represents the OR with a 95% CI. The box size represents the weight of the study in the meta-analysis. Weights were obtained using the random-forest model. M-H, Mantel-Haenszel.

Figure 4. Pooled analysis of odds ratio for the association between acupuncture and HCV infection according to ethnicity. Each dot represents the OR with a 95% CI. The box size represents the weight of the study in the meta-analysis. Weights were obtained using the random-forest model. M-H, Mantel-Haenszel.

Figure 5. Funnel plot for the association between acupuncture and HCV infection. SE, standard error.

This study reports an updated systematic review and meta-analysis of the effects of acupuncture on HCV transmission. By analyzing 28 studies (194,826 participants), we found that acupuncture users showed significantly higher HCV transmission rates than controls (17.4% vs. 4.6%; OR, 1.84; 95% CI, 1.46–2.32, p<0.001). The risk of acupuncture and HCV infection was consistent with the study design (cross-sectional case-control and cross-sectional studies) and ethnicity (Asian and non-Asian populations).

Acupuncture remains popular worldwide and appears to be a relatively safe treatment for the management of lifestyle risk factors, especially for musculoskeletal diseases.45 The major indications for acupuncture include biological effects on local inflammatory responses, pain control, arthritis, and other joint diseases, as well as a broad range of minor diseases (headaches) that do not respond to conventional treatments.46,47 However, there is a need for safer acupuncture practices using disposable needles and close monitoring of acupuncturists worldwide.41 As the prevalence of blood transfusion is less than 1% in the general population, parenteral viral exposure (such as during acupuncture) should be a public health priority to prevent HCV transmission.48

A previous meta-analysis regarding percutaneous needle injections, including tattoos, piercings, and acupuncture, showed conflicting results from our study.10-13 Jafari et al.10 showed that tattoos were associated with a higher risk of HCV infection (83 studies, 132, 145 participants; pooled OR, 2.24; 95% CI, 2.01–2.50; p<0.001). In this study, non-injection drug users showed the strongest association between tattooing and HCV infection (OR, 5.74; 95% CI, 1.981–6.66).10 However, Tohme and Holmberg12 reported no definitive evidence for an increased risk of HCV infection if tattoos and piercings were performed by professional parlors (adjusted OR, 0.8; 95% CI, 0.4–1.7), but a significant risk for tattoos performed in nonprofessional settings (adjusted OR, 3.5; 95% CI, 1.4–8.8). Van Remoortel et al.13 pooled and analyzed 21 studies and showed that percutaneous needle treatments (including tattooing, acupuncture, and piercing) increased the HCV infection in blood recipients (tattoo: OR, 5.28; 95% CI, 4.33–6.44; p<0.001; acupuncture: OR, 1.56; 95% CI, 1.17– 2.08; p=0.03; piercing: OR, 3.25; 95% CI, 1.68–6.30; p=0.005). The report by Lim et al.11 analyzed 86 studies investigating tattoos and transfusion-transmitted diseases (HBV, HCV, and HIV) and found that the tattooed group showed a higher risk of HCV infection than the non-tattooed group (OR, 2.89; 95% CI, 2.48–3.37). Although previous meta-analyses have assessed tattooing, piercing, and HCV infection risk, the current study is the first and largest study to focus on acupuncture and HCV infection risk.

This study has several limitations. First, the included studies contained observational data from a cross-sectional design. Second, a substantial degree of heterogeneity may be present; therefore, caution should be taken when interpreting the results. Third, insufficient information on other confounding factors for HCV infection between the acupuncture and control groups may serve as potential limitations. Fourth, since a majority of the studies collected acupuncture data by using questionnaires (25/28; 89.3%) without reporting time intervals between acupuncture and HCV infection, the direct correlation between acupuncture and HCV infection is hard to establish. Lastly, meta-analysis of studies is controversial because uncontrolled confounders may affect pooled estimates. It could be argued that pooling analyses might be inappropriate due to possible heterogeneity which can affect the outcomes of interest.

In conclusion, the evidence from this meta-analysis shows that acupuncture potentially increases the HCV transmission rate. Unsafe medical procedures and social practices, including acupuncture, should be performed with caution. Further large-scale, high-quality studies are warranted in the future.


Supplementary material is available at the Korean Journal of Gastroenterology website (https://www.kjg.or.kr/).

Financial support

This study was supported by grants from the Basic Science Research Program through the National Research Foundation of Korea (RS-2022-00166674).

Conflict of interest


  1. Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 2016;388:1081-1088.
    Pubmed KoreaMed CrossRef
  2. WHO. Hepatitis C world health organization key facts. [Internet]. WHO [cited 2023 Feb 28]. Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c.
  3. Nelson PK, Mathers BM, Cowie B, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet 2011;378:571-583.
    Pubmed KoreaMed CrossRef
  4. El-Ghitany EM, Abdel Wahab MM, Abd El-Wahab EW, Hassouna S, Farghaly AG. A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013): do they differ in Egypt? Liver Int 2015;35:489-501.
    Pubmed CrossRef
  5. Saks M. Professions and the public interest: medical power, altruism and alternative medicine. London: Routledge, 1994.
  6. National Center for Complementary and Integrative Health. Acupuncture: What you need to know. [Internet]. NIH; 2016 [cited 2022 Nov 15]. Available from: https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know.
  7. Brady S, McEvoy J, Dommerholt J, Doody C. Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists. J Man Manip Ther 2014;22:134-140.
    Pubmed KoreaMed CrossRef
  8. Mitrovic N, Delic D, Markovic-Denic L, et al. Seroprevalence and risk factors for hepatitis C virus infection among blood donors in Serbia: A multicentre study. Dig Liver Dis 2015;47:572-576.
    Pubmed CrossRef
  9. Rezaei N, Amini-Kafiabad S, Maghsudlu M, Abolghasemi H. Risk factor analysis of hepatitis C virus seropositivity in Iranian blood donors: a case-control study. Transfusion 2016;56:1891-1898.
    Pubmed CrossRef
  10. Jafari S, Copes R, Baharlou S, Etminan M, Buxton J. Tattooing and the risk of transmission of hepatitis C: a systematic review and meta-analysis. Int J Infect Dis 2010;14:e928-e940.
    Pubmed CrossRef
  11. Lim SH, Lee S, Lee YB, et al. Increased prevalence of transfusion-transmitted diseases among people with tattoos: A systematic review and meta-analysis. PLoS One 2022;17:e0262990.
    Pubmed KoreaMed CrossRef
  12. Tohme RA, Holmberg SD. Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Clin Infect Dis 2012;54:1167-1178.
    Pubmed KoreaMed CrossRef
  13. Van Remoortel H, Moorkens D, Avau B, Compernolle V, Vandekerckhove P, De Buck E. Is there a risk of transfusion-transmissible infections after percutaneous needle treatments in blood donors? A systematic review and meta-analysis. Vox Sang 2019;114:297-309.
    Pubmed CrossRef
  14. Modesti PA, Reboldi G, Cappuccio FP, et al. Panethnic differences in blood pressure in Europe: A systematic review and meta-analysis. PLoS One 2016;11:e0147601.
    Pubmed KoreaMed CrossRef
  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560.
    Pubmed KoreaMed CrossRef
  16. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-634.
    Pubmed KoreaMed CrossRef
  17. Salama BM. Risk factors associated with HCV infection among adults in Damietta Governorate, Egypt. Ann Clin Anal Med 2020;11:519-522.
  18. Mohd Suan MA, Said SM, Lim PY, Azman AZF, Abu Hassan MR. Risk factors for hepatitis C infection among adult patients in Kedah state, Malaysia: A case-control study. PLoS One 2019;14:e0224459.
    Pubmed KoreaMed CrossRef
  19. Wasitthankasem R, Vichaiwattana P, Siripon N, et al. Birth-cohort HCV screening target in Thailand to expand and optimize the national HCV screening for public health policy. PLoS One 2018;13:e0202991.
    Pubmed KoreaMed CrossRef
  20. Mac Donald-Ottevanger MS, Vreden S, van der Helm JJ, et al. Prevalence, determinants and genetic diversity of hepatitis C virus in the multi-ethnic population living in Suriname. Virology 2016;499:114-120.
    Pubmed CrossRef
  21. Sohn HS, Kim JR, Ryu SY, et al. Risk factors for hepatitis C virus (HCV) infection in areas with a high prevalence of HCV in the Republic of Korea in 2013. Gut Liver 2016;10:126-132.
    Pubmed KoreaMed CrossRef
  22. Huang P, Zhu LG, Zhai XJ, et al. Hepatitis C virus infection and risk factors in the general population: a large community-based study in eastern China, 2011-2012. Epidemiol Infect 2015;143:2827-2836.
    Pubmed KoreaMed CrossRef
  23. Huang Y, Guo N, Yu Q, et al. Risk factors for hepatitis B and C infection among blood donors in five Chinese blood centers. Transfusion 2015;55:388-394.
    Pubmed CrossRef
  24. Carney K, Dhalla S, Aytaman A, Tenner CT, Francois F. Association of tattooing and hepatitis C virus infection: a multicenter case-control study. Hepatology 2013;57:2117-2123.
    Pubmed CrossRef
  25. Kin KC, Lin B, Ha NB, et al. High proportion of hepatitis C virus in community Asian American patients with non-liver-related complaints. J Clin Gastroenterol 2013;47:367-371.
    Pubmed CrossRef
  26. Seong MH, Kil H, Kim YS, et al. Clinical and epidemiological features of hepatitis C virus infection in South Korea: a prospective, multicenter cohort study. J Med Virol 2013;85:1724-1733.
    Pubmed CrossRef
  27. Ahmed F, Irving WL, Anwar M, Myles P, Neal KR. Prevalence and risk factors for hepatitis C virus infection in Kech District, Balochistan, Pakistan: most infections remain unexplained. A cross-sectional study. Epidemiol Infect 2012;140:716-723.
    Pubmed CrossRef
  28. Kim JY, Cho J, Hwang SH, et al. Behavioral and healthcare-associated risk factors for chronic hepatitis C virus infection in Korea. J Korean Med Sci 2012;27:1371-1377.
    Pubmed KoreaMed CrossRef
  29. He Y, Zhang J, Zhong L, et al. Prevalence of and risk factors for hepatitis C virus infection among blood donors in Chengdu, China. J Med Virol 2011;83:616-621.
    Pubmed CrossRef
  30. Vickery K, Tawk HM, Bisset L, Selby W, Cossart YE. Hepatitis C virus infection rates and risk factors in an Australian hospital endoscopy cohort. Aust N Z J Public Health 2009;33:442-448.
    Pubmed CrossRef
  31. Nguyen VT, McLaws ML, Dore GJ. Prevalence and risk factors for hepatitis C infection in rural north Vietnam. Hepatol Int 2007;1:387-393.
    Pubmed KoreaMed CrossRef
  32. Karmochkine M, Carrat F, Dos Santos O, Cacoub P, Raguin G. A case-control study of risk factors for hepatitis C infection in patients with unexplained routes of infection. J Viral Hepat 2006;13:775-782.
    Pubmed CrossRef
  33. Méndez-Sánchez N, Motola-Kuba D, Zamora-Valdés D, et al. Risk factors and prevalence of hepatitis virus B and C serum markers among nurses at a tertiary-care hospital in Mexico City, Mexico: a descriptive study. Ann Hepatol 2006;5:276-280.
    Pubmed CrossRef
  34. Dominitz JA, Boyko EJ, Koepsell TD, et al. Elevated prevalence of hepatitis C infection in users of United States veterans medical centers. Hepatology 2005;41:88-96.
    Pubmed CrossRef
  35. Hand WL, Vasquez Y. Risk factors for hepatitis C on the Texas-Mexico border. Am J Gastroenterol 2005;100:2180-2185.
    Pubmed CrossRef
  36. Yildirim B, Tahan V, Ozaras R, et al. Hepatitis C virus risk factors in the Turkish community. Dig Dis Sci 2005;50:2352-2355.
    Pubmed CrossRef
  37. Lee PL, Wang JH, Tung HD, Lee CM, Lu SN. A higher than expected recovery rate from hepatitis C infection amongst adolescents: a community study in a hepatitis C-endemic township in Taiwan. Trans R Soc Trop Med Hyg 2004;98:367-372.
    Pubmed CrossRef
  38. Brandão AB, Fuchs SC. Risk factors for hepatitis C virus infection among blood donors in southern Brazil: a case-control study. BMC Gastroenterol 2002;2:18.
    Pubmed KoreaMed CrossRef
  39. Brillman JC, Crandall CS, Florence CS, Jacobs JL. Prevalence and risk factors associated with hepatitis C in ED patients. Am J Emerg Med 2002;20:476-480.
    Pubmed CrossRef
  40. Kim YS, Ahn YO, Lee HS. Risk factors for hepatitis C virus infection among Koreans according to the hepatitis C virus genotype. J Korean Med Sci 2002;17:187-192.
    Pubmed KoreaMed CrossRef
  41. Shin HR, Kim JY, Kim JI, et al. Hepatitis B and C virus prevalence in a rural area of South Korea: the role of acupuncture. Br J Cancer 2002;87:314-318.
    Pubmed KoreaMed CrossRef
  42. Domínguez A, Bruguera M, Vidal J, Plans P, Salleras L. Community-based seroepidemiological survey of HCV infection in Catalonia, Spain. J Med Virol 2001;65:688-693.
    Pubmed CrossRef
  43. Haley RW, Fischer RP. Commercial tattooing as a potentially important source of hepatitis C infection. Clinical epidemiology of 626 consecutive patients unaware of their hepatitis C serologic status. Medicine (Baltimore) 2001;80:134-151.
    Pubmed CrossRef
  44. Müller Z, Deák J, Horányi M, et al. The detection of hepatitis C virus in South Hungary. J Clin Virol 2001;20:81-83.
    Pubmed CrossRef
  45. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012;172:1444-1453.
    Pubmed KoreaMed CrossRef
  46. Langevin HM, Schnyer R, MacPherson H, et al. Manual and electrical needle stimulation in acupuncture research: pitfalls and challenges of heterogeneity. J Altern Complement Med 2015;21:113-128.
    Pubmed KoreaMed CrossRef
  47. Luo J, Xu H, Liu B. Real world research: a complementary method to establish the effectiveness of acupuncture. BMC Complement Altern Med 2015;15:153.
    Pubmed KoreaMed CrossRef
  48. Raffaele A, Valenti M, Iovenitti M, et al. High prevalence of HCV infection among the general population in a rural area of central Italy. Eur J Epidemiol 2001;17:41-46.
    Pubmed CrossRef

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