State Lists Mohel Precautions

New York State’s health commissioner struck an accord this week with an organization of fervently Orthodox rabbis based in Williamsburg, Brooklyn, on the controversial practice of metzitzah b’peh, or oral suctioning by a mohel of blood from a circumcision wound.

But separate discussions are continuing with New York City’s health commissioner, who has been discouraging the practice, saying it puts babies at risk of contracting the Herpes virus.In the agreement, signed this week, rabbis representing mohels who serve the fervently Orthodox community (the only ones to currently practice suctioning the blood orally rather than through a pipette or a piece of gauze) agreed to have them voluntarily comply with several guidelines intended to reduce the possibility that they could transmit the Herpes virus to babies.

"This is exactly what we were hoping for," said Rabbi David Niederman, a spokesman for the Central Rabbinical Congress of the U.S.A. and Canada, the Williamsburg rabbinical group. "We are for one thing: that we should be able to observe our religious tradition the way we are doing it for thousands of years, and we should not have to do it underground. This is not a political win," he said. "It’s a win for religious freedom."

The Rabbinical Congress rabbis, meeting in Albany with New York State Health Commissioner Dr. Antonia Novello, a former U.S. surgeon general, announced that they would ask their mohels to now:
Sanitize their hands similarly to surgeons, cleaning under their nails under running water and washing their hands for up to six minutes with antimicrobial soap or an alcohol-based hand sanitizer;
Clean their mouths with a sterile alcohol wipe and rinse for at least 30 seconds with a mouthwash that is at least one-quarter alcohol;
Cover the circumcised area with antibiotic ointment and sterile gauze;
Agree to be tested for the herpes virus if a baby shows evidence of herpes following a brit milah where metzitzah b’peh was used, along with his parents and health care workers. That testing will be DNA testing, according to one source familiar with the proceedings, and if the mohel is found to carry the same strain as the baby, he will be banned from using oral suctioning when conducting circumcisions.

Health officials from Rockland, Orange and Westchester counties participated in the discussions, but those from New York City’s Department of Health and Mental Hygiene did not. The city health department has been at vocal odds with the fervently Orthodox community for over a year over the practice, and over the adjudication of the Williamsburg religious court’s inquiry into one particular mohel, Rabbi Yitzchok Fisher who, according to city officials, transmitted the Herpes Type 2 virus to at least two babies, one of whom subsequently died.

The city health department has documented seven cases of babies becoming infected with Herpes Type 2 in recent years as a result of having metzitzah b’peh done at their ritual circumcisions.

According to Rabbi Niederman, negotiations are also underway with New York City Health Commissioner Dr. Thomas Frieden.

"There has been dialogue with the commissioner," he said. "We believe and hope that we will be able to finalize this issue with the city as well. But we’re in the middle of negotiations and discussions, so I don’t want to get into specifics."

City Health Department officials could not be reached at press time.

Herpes Type 2 is commonly transmitted among adults and, in otherwise healthy people generally does nothing more than cause cold sores. An estimated 80 percent of the adult population over age 40 carries the virus, according to infectious disease specialists. It is distinct from the sexually transmitted disease Herpes Type 1. But even type 2 can be deadly to those with immature or suppressed immune systems, like newborns.

While New York State’s highest health authorities have approved this new protocol as sufficient, another expert is questioning whether it will really safeguard newborn babies.

Dr. Jonathan Zenilman, chief of infectious diseases at John Hopkins Bayview Medical Center, said that these steps "would be unacceptable in any other medical context. There’s no evidence to say that this would or would not reduce the risk of transmitting the virus."

Using Purell, a popular brand of alcohol-based hand sanitizer "probably wouldn’t do much against herpes," he said. There is also concern about compliance, he said. "The likelihood of it all falling into place, especially with a community that is adamantly opposed to public health intervention and has shown little understanding of the transmission risks of this disease, I doubt there will be compliance," said Zenilman.

"From a public health viewpoint this makes no sense.

"In addition to questions of compliance, there are also questions about enforcement. What would happen if a mohel were said not to be complying with the new protocol?"

The rabbis are signing this but I’m not sure what their signature means. It may have some legal significance, I’m just not sure," said Rabbi David Zwiebel, director of government affairs and general counsel for Agudath Israel of America. His organization was active in fighting city Health Department efforts to curb the use of metzitzah b’peh, but has not been involved in the negotiations between the Williamsburg group and State health officials.

It is the first time that a government agency has issued protocols governing the practice of brit milah, Rabbi Zwiebel said. "My preference would have been that the rabbis promulgate these guidelines on their own and the state Health Department then saying that they were acceptable, rather than the state imposing them.

"But on the whole it’s a positive step, he said. "I hope this will reduce risk of any transmission of the virus and will also lead to an avoidance of future conflicts between the governmental interests in protecting public health and the community’s interest in preserving its religious traditions."