Circumcision Ritual Under Fire Due to Risk of Herpes Infection

NEW YORK -- A controversial Jewish circumcision ritual is under fire after allegedly causing the deaths of two infants and exposing potentially thousands more to the risk of herpes infections.

New York City health officials are pushing a proposed regulation that would require parents to sign a consent waiver before they take part in a circumcision ritual called "metzitzah b'peh," typically practiced by ultra-Orthodox Jews. The ritual potentially poses a fatal risk to newborns, according to the New York City Department of Health and Mental Hygiene.

The legislation was proposed at a Board of Health meeting last month by Dr. Jay K. Varma, deputy commissioner for disease control for New York City's health department, after 11 infants contracted neonatal herpes between November 2000 and December 2011, after the circumcision ritual. Two of the infants died.

Jews regularly practice circumcision as part of their religion, but mostly ultra-Orthodox Jews practice metzitzah b'peh, during which the mohel, or person performing the procedure, orally sucks the blood from the infant's newly circumcised penis.

The numbers reported came to light as the city's health department launched an investigation after the infant deaths were reported in New York, the most recent in September in Brooklyn.

The health department reported last month that an estimated 20,493 infants in New York City were exposed to direct oral suction. Baby boys who were reportedly circumcised "with confirmed or probable orogenital suction" between April 2006 and December 2011 had an estimated risk of contracting neonatal herpes (HSV-1) infection of 24.4 per 100,000 cases, making the risk 3.4 times greater than those infants who did not have direct oral suction, according to the health department findings.

In a statement advising New York parents to refrain from direct oral-genital suction during circumcision, New York City Health Commissioner Dr. Thomas Farley said, "There is no safe way to perform oral suction on any open wound in a newborn.

"Parents considering ritual circumcision need to know that circumcision should only be performed under sterile conditions, like any other procedures that create open cuts, whether by mohelim or medical professionals."

Reports of infant herpes infections and deaths are not new.

In November of 2004, the Department of Health reported that twin male infants contracted neonatal herpes after the ritual circumcision, one of whom died.

Spokesman Jerry Schmetter of the Brooklyn Defense Attorney's office said a criminal investigation regarding a rabbi who was linked to infant herpes cases, was "still ongoing."

In the case of the Brooklyn infant's death in September, the parents of the baby refused to tell authorities who performed the ritual.

The United Jewish Organizations of Williamsburg in Brooklyn could not be reached for comment.

Jeffrey Mazlin, a certified mohel and physician in New York who regularly practices circumcision procedures, said "only the more orthodox, the more traditional mohels" perform the metzitzah b'peh.

"[Orthodox Jews] look at it in terms of religion being more important than the individual, whereas someone who is more liberal will make sure that the individual's rights are taken care of," he said.

But the ritual is not just an upholding of a Jewish tradition, but also a firm reminder of their beliefs.

"Because blood is the life-giving element, they believe that it's supposed to be part of the whole procedure," Mazlin said.

The little blood that is drawn from the newly circumcised penis is usually left alone or wiped away under regular procedures, he said.

"There are no known medical benefits to sucking [the blood]." he said.

View the original article here

Ritual in Some Jewish Circumcisions Raises Risk of Herpes Infection: Report

THURSDAY, June 7 (HealthDay News) -- The practice of "oral-genital suction" performed during some Orthodox Jewish circumcision ceremonies could leave the infant with a potentially fatal herpes virus infection, health officials warn.

New York City and federal health authorities issued a public advisory Thursday cautioning against the sucking practice because it has been linked to 11 infants becoming infected with the herpes simplex virus type 1 since 2000. Ten of the infected newborns were hospitalized, two developed brain damage and two died, the health officials said.

A newborn can become infected when the adult performing the circumcision places his mouth on the circumcision wound to siphon blood away from the cut. The ritual is only embraced by a handful of sects within the Orthodox Jewish community, according to New York City Health Commissioner Dr. Thomas Farley.

"There is no safe way to perform oral suction on any open wound in a newborn," Farley said in a news release. "Parents considering ritual Jewish circumcision need to know that circumcision should only be performed under sterile conditions, like any other procedures that create open cuts, whether by mohelim [the circumciser] or medical professionals."

A report on the infections also appears in the June 8 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Almost 80 percent of adults carry the herpes simplex virus type 1, which is usually spread orally through common activities and is different from the sexually transmitted type 2 version of the virus. The common cold sore is a typical sign of infection with the herpes simplex virus type 1, but most people don't know they are infected because they have no history of symptoms, officials said.

In six of the 11 circumcision cases, health care providers confirmed that the suction ritual had taken place, although there was evidence of a connection in the other five cases. The ritual more than tripled the risk of infection among newborns getting circumcised, the CDC report stated.

New York's deputy health commissioner, Dr. Jay Varma, said: "The [New York City Department of Health and Mental Hygiene] has been concerned about this problem for some time. And so we are taking the approach right now to try and educate parents and the community about the dangers of this very specific procedure.

"The infections we're talking about are not the ones people normally associate with sexual type interaction," he added. "Many actually acquire herpes type 1 when they are children, because it can be gotten through very casual contact. This causes what people commonly call cold sores in the mouth.

"We're not implying in any way that these mohel [circumcisers] have done anything untoward in a sexual context," Varma said. "The point is that regardless if you're a mohel or someone else, having direct contact with the mouth and an open wound is a hazard."

To highlight the risks involved, Varma cited an incident in 2004 when twin boys were diagnosed with herpes following oral-genital suction during circumcision. About two weeks later, both babies developed fevers and lesions around their genitals, buttocks and abdomen. One of boys later died.

The boys' mother and hospital staffers were ruled out as a possible source of infection.

Dr. Philip Tierno, director of clinical microbiology and pathology at New York University Medical Center, said the sucking practice is a "bad idea."

"There are about 500 different microorganisms in the human mouth," he said. "So, I think it's insanity. It's not only unhygienic, but it can potentially kill the child. So, for the protection of children this is a practice that should be discontinued."

More information

For more on herpes, visit the U.S. National Library of Medicine.

View the original article here

Circumcision Ritual May Carry Herpes Risk, CDC Says

An ultra-Orthodox Jewish circumcision practice in which the circumciser places his mouth on a newborn's newly circumcised penis and sucks blood away from the wound carries a risk of transmitting the herpes virus to the baby, sometimes fatally, according to a new report from the Centers for Disease Control and Prevention.

The report is based on researchers' investigation into the cases of 11 infants in New York City who were infected with the herpes virus after this procedure, known as metzitzah b’peh ("direct orogenital suction"), between November 2000 and December 2011. Ten of these infants were hospitalized, and two died.

Some of the infants’ parents were not aware this technique would be a part of their child’s circumcision, the researchers found. Parents should be aware of the risk of herpes in metzitzah b’peh, and should inquire in advance whether direct orogenital suction will be performed so the practice can be avoided, the CDC researchers said.

"Oral contact with a newborn’s open wound risks transmission of [herpes simplex virus] and other pathogens," the researches wrote in their report. "Circumcision is a surgical procedure that should be performed under sterile conditions."

The virus that was found in most of the infants, called herpes simplex virus type 1 (HSV-1) — which is typically associated with cold sores, but does not always cause any symptoms — is highly prevalent in the general adult population, the report said. A 2004 study showed that 73 percent of adults ages 20 and older in New York City carried the virus.

At least three of the infants, including one who died, were circumcised by the same person, the report said. The New York City Commissioner of Health has issued a directive ordering that person to stop performing direct orogenital suction during circumcisions.

At least three mohliem (circumcisers) performed the circumcisions of the 11 infected infants, and there may have been as many as eight mohliem, the CDC said. In some cases, parents refused to identify their child's circumciser to CDC officials.

The rate of newborn boys who undergo direct orogenital suction and contract herpes infections is 24.4 per 100,000, the report said. That's 3.4 times higher than the rate of herpes infections seen in the general newborn male population, which is 8 per 100,000. Other cases of herpes are typically transmitted from mother to infant during delivery.

Neonatal herpes infections is a potentially disabling, life-threatening infection, the report said.  

Physicians should counsel parents considering out-of-hospital circumcisions about the risks of direct orogenital suction, and should consider herpes infection when evaluating a newborn male infant with a fever following Jewish ritual circumcision, and inquire about direct orogenital suction, the CDC said.

Mohelim should inform parents about whether they perform direct orogenital suction, and explain the risk of virus transmission, so that parents can choose not to have their newborns exposed, the report said.

Pass it on: An ultra-Orthodox Jewish circumcision practice may transmit the herpes virus to a newborn.

Follow MyHealthNewsDaily on Twitter @MyHealth_MHND. Find us on Facebook.

Copyright 2012 MyHealthNewsDaily, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

View the original article here