State offers new guidelines on oral-suction circumcision

Oral-suction circumcision

• If a mohel is infected with oral herpes and performs an oral-suction circumcision, the infant can be exposed to the herpes virus.

• Oral herpes spreads easily through saliva, especially when saliva touches a cut or break in the skin, such as during metzitzah b'peh.

• State Department of Health protocols regarding circumcision may be found at diseases/communicable/ herpes/newborns/ circumcision_protocol.htm

(Original publication: June 21, 2006)

The state Health Department has issued guidelines for the safe practice of oral-suction circumcision following cases involving the alleged transmission of herpes to newborn children by a Monsey-based mohel.

The state and an organization of several Orthodox Jewish rabbis from New York signed the agreement June 12.

The guidelines — rules that are binding upon the rabbis and that govern hygiene and other practices relating to the ritual — followed months of meetings and consultations between the state and the rabbinical group, Dr. Antonia Novello, the state's commissioner of health, said by telephone yesterday.

"To my amazement, I never thought I would be in a situation where the division with state and religion would come to the forefront as it did," she said, adding that the document was drafted to balance public health concerns with religious sensitivity. "The state can do what is right and still respect something that was being done before we were born."

The state now requires that all cases of newborn herpes be reported. The mandate took effect May 12.

The decision to develop guidelines on oral-suction circumcision came after Monsey-based mohel Yitzchok Fischer — a rabbi trained in religious circumcision — was suspected of infecting three New York City babies with herpes in 2004. One died and another suffered brain damage. He was not charged in the cases.

Two additional cases of infant herpes through the oral-suction method were reported by physicians in 2005 in New York City. The identity of that mohel or mohels was not revealed.

The centuries-old practice, called metzizah bi peh or metzitzah b'peh, involves a mohel using his mouth to suction blood from the wound after the foreskin is removed. The ritual is performed by Hasidic and ultra-Orthodox Jews.

Most other Jewish mohels wear surgical gloves and use sterilized instruments to perform the circumcision rite. Many other mohels who perform the oral part of the ritual use a medical tube to suction the blood, several rabbis have said.

Fischer's attorney, Mark J. Kurzmann of Pearl River, has said there was no conclusive medical evidence that the infants contracted the virus from the rabbi. The rabbi took a herpes test, but the results have not been released by the state or the city.

Although county health departments do not regulate circumcision, Dr. Joan Facelle, Rockland's commissioner of health, welcomed the protocols.

"This is something that certainly, you know, I think is a step forward, so my personal reaction is that this is progress and a good thing," she said.

The health departments in 57 New York counties have accepted the protocols, and New York City's department is reviewing them, Novello said.

The guidelines advise mohels conducting oral-suction circumcision about how to correctly wash their hands and clean their fingernails, and says mohels should "rinse mouth thoroughly with a mouthwash containing greater than 25 percent alcohol" for at least 30 seconds.

Mohels believed to have transmitted herpes to newborns through metzitzah b'peh will be tested. If the strain of the baby's herpes matches their own, the mohels will be banned for life from performing the ritual in New York.

Others measures are prescribed for cases where the cause of herpes is not definitive.

Novello said her department would meet twice with rabbis in the state — with Yiddish interpreters — to ensure mohels understand the requirements.

"Everything that is written we want to show them with a sense of respect, not punitive," she said.



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