Investigators from the New York City Department of Health and Mental Hygiene (DOHMH) discovered that the newborns contracted the herpes simplex virus (HSV), following an out-of-hospital Jewish ritual circumcision that involved a mohel (circumciser), who performed orogenital suction – removing blood from the wound with the mouth.
After metzitzah b'peh
was performed said the report, 10 of the 11 newborns were hospitalized and two of the babies died. In six of the 11 cases health-care providers and investigators said, parent testimonies confirmed that the newborns had undergone the ritual circumcision. For the remaining five cases, genital infection possibly introduced by orogenital suction, was implicated.
The report followed a 2004
investigation by DOHMH into the deaths of twin boys who had contracted herpes simplex virus type 1 following circumcision with metzitzah b’peh
. HSV-1, the virus responsible for causing cold sores is transmitted orally. The twins developed disseminated HSV-1 infection following the ritual circumcision said DOHMH.
The babies born by cesarean section to a mother with no history of oral and genital herpes, were circumcised eight days after birth by a mohel that practiced metzitzah b'peh
. Just over a week later said the Centers for Disease Control, the twins received medical care for lesions "On their abdomen, buttocks, and perineum, including the genitals," and both tested positive for HSV-1.
Prior to the twins' case, a 2003 case was also linked to the same mohel, who tested positive for antibody to HSV-1 (blood), 97 days after the twins' circumcision was performed. DOMNH uncovered another eight similar cases through Dec. 2011 in New York City, which brought the total number of cases to eleven.
According to Cantor Philip L. Sherman, Mohel of White Plains, NY, he said on his website
that he never performs metzitzah b'peh
and never will. Sherman writes that the Talmud describes metzitzah as a method to prevent illness by drawing blood away from the wound to remove impurities.
But "Performing metzitzah using one’s mouth is primarily a Chasidic custom," he says and although "many in the Chasidic community insist that direct oral contact (i.e. b’peh) is the only acceptable way to perform metzitzah, [...] the word metzitzah is described as a squeezing, and not suction.
Sherman insists that Metzitzah can be performed but orogenital suction should be eliminated.
NY City Health Commissioner Dr. Thomas Farley agrees, telling the Jewish Times
There is no safe way to perform oral suction on any open wound in a newborn.
Several hospitals, adds the Times
, "Including those serving the Haredi community, have agreed to distribute a brochure that describes the risk of contracting the herpes virus from the practice."
The CDC says the ritual and the risk of HSV infections in newborns, can have dire consequences for babies and result in death or permanent disability. But they acknowledge that the procedure can be difficult to curb because it is a traditional religious practice. As a result the Center says, "Rabbinical authorities in some ultra-Orthodox Jewish communities maintain that direct orogenital suction is an integral part of ritual circumcision."
The CDC is urging physicians to counsel parents about the risks surrounding metzitzah b'peh
, and the threat of infection from direct orogenital suction. The Center advises doctors to be on alert, "Because approximately 20% of neonatal herpes patients do not have skin lesions." Physicians it said, should therefore consider herpes infection when evaluating any newborn infant presenting with a fever following Jewish ritual circumcision.
But the CDC is also taking things one step further by asking local health departments to alert the mohel who performs the metzitzah b'peh
ritual, and offer him the opportunity to voluntarily cease putting infants at risk. If that fails says the Center, "To protect infants' health," departments may even "need to take legal measures to ensure mohelim associated with cases of neonatal herpes cease the practice of direct orogenital suction."