nyc
2005-10-15 00:28:24 UTC
http://www.thejewishweek.com/news/newscontent.php3?artid=11539
City Risking Babies' Lives With Brit Policy: Health Experts
Renowned authorities, one at Bloomberg-named medical school, blast
mayors administration over controversial circumcision practice.
Debra Nussbaum Cohen - Staff Writer
A renowned expert on sexually transmitted disease denounced as
outrageous this week the Bloomberg administrations failure to ban
New York City mohels from suctioning blood with their mouths from a
babys penis in the circumcision rite.
[It] is a major public health hazard, declared Dr. Jonathan
Zenilman, a professor of epidemiology at the Bloomberg School of
Public Health the Johns Hopkins University education and research
center named for New Yorks philanthropist mayor, its biggest
financial supporter.
Zenilman, who grew up in an Orthodox family in Woodmere, L.I., warned
that allowing the practice known as metzitzah bpeh is actually
crazy due to the potentially fatal danger of transmitting herpes to
vulnerable newborns.
A prominent colleague, Dr. John Santelli, chair of the Department of
Population and Family Health at Columbia Universitys Mailman School
of Public Health, joined the criticism.
Those kids are at very high risk of death and encephalitis, he said,
explaining, If you cut the skin as obviously you have to in a
circumcision it increases risk of transmission to the infant.
Newborns just dont have great immune systems, so the worst time to
get a case of herpes is in the newborn.
Metzitzah bpeh, which is practiced routinely by some fervently
Orthodox mohels, has been at the center of a case involving Rabbi
Yitzchok Fischer, a Monsey-based mohel suspected of having infected
three babies with herpes. One of the baby boys died last October.
But the city Department of Health and Mental Hygiene, which began
investigating the suspected link of the infections to Rabbi Fischer,
agreed not to ban the practice after vigorous lobbying by New Yorks
fervently Orthodox community, including of Bloomberg. In his
re-election campaign, Bloombergs TV commercials tout him as a
champion of public health.
On Sept. 15 the city withdrew the lawsuit it had filed against Rabbi
Fischer and the court order banning him from using the technique, and
turned the case over to an Orthodox rabbinical court, or bet din, in
Williamsburg, Brooklyn. Rabbi Fischer agreed to stop using the
technique pending the bet dins resolution of the case.
This appears to be the first time the city has turned the adjudication
of a public health issue over to a religious body.
Zenilman and Santelli said the narrow focus on Rabbi Fischer is
misplaced. They said because Herpes Simplex Virus Type 1 is a very
common disease studies cited by the Health Department in its legal
briefs say that 65 percent of Americans have contracted it by age 12
the potential impact on public health goes far beyond concern over one
mohel.
From a public health standpoint, at the least there should have been
a consent decree that this practice would not continue in this
community, said Zenilman, who also heads the Johns Hopkins Center for
Reproductive Tract Infections and is president of the American STD
(Sexually Transmitted Diseases) Association. It is within the scope
of a public health authority to ban it, and I find it outrageous that
it hasnt been.
Santelli, who is also a pediatrician, stressed, This is a public
health problem. Its certainly a dangerous practice from a medical
point of view.
Indeed, legal documents filed in connection with the case by the
director of the Health Departments Bureau of Sexually Transmitted
Diseases, state that Herpes Type 1, which generally causes just fever
blisters and cold sores in healthy older children and adults, is fatal
as much as 30 percent of the time in newborns.
Dr. Susan Blank, the bureaus director, turned down an interview
request from The Jewish Week. Requests for access to the results of
the Health Departments investigation of Rabbi Fischer have gone
unanswered.
Rabbi David Zwiebel, executive vice president of Agudath Israel, an
umbrella body of ultra-traditional Orthodox groups, has said metzitzah
bpeh is probably performed more than 2,000 times a year in New York
City. Many additional instances occur in other areas with substantial
populations of ultra-traditional Jews, such as Rockland County.
The New York Times reported in August that Rabbi Fischer had done some
12,000 circumcisions.
Parts of the Orthodox community and Rabbi Fischers attorney frame the
issue as one of religious practice that should be free from government
interference. They question claims that it spreads herpes.
Mohels use antiseptic mouthwash before performing oral suction, they
say, and the known incidence of herpes among infants who have
undergone it is minuscule.
According to the Times, the citys Health Department recorded cases in
1988 and 1998, though doctors in New York, as in most states, are not
required to report neonatal herpes.
Prominent members of the large Satmar chasidic community, based in
Brooklyn and Rockland County, including Rabbi David Niederman, a
spokesman for the rabbinical court handling the case, have told The
Jewish Week the community will continue the practice. A delegation of
chasidic leaders lobbied Bloomberg on the issue in August. Their bloc
vote is sought after by mayoral candidates.
Were going to do a study and make sure that everybody is safe, and
at the same time it is not the governments business to tell people
how to practice their religion, Bloomberg said on a radio program one
day later.
Health Commissioner Thomas Frieden told the Times the city did not
intend to ban or regulate the practice, partly because any such an
attempt would be virtually unenforceable. Circumcision generally takes
place in private homes.
Not all ultra-traditional groups mandate the practice, and the Modern
Orthodox-oriented Rabbinical Council of America recommends using a
sterile tube and gloves to avoid direct oral-genital contact.
The criticisms by Zenilman and Santelli come in the wake of a paper in
the medical journal Pediatrics last year that studied eight cases of
baby boys in Israel who developed herpes after their circumcision,
most probably as a consequence of transmission by the mohels
saliva, it stated.
Oral metzitzah after ritual circumcision may be hazardous to the
neonate because it carries a serious risk for transmission of the
herpes simplex virus, the paper concluded.
Asked its reaction to the experts warning this week, the Health
Department reissued a statement it released last month:
Our goal was for Rabbi Fischer to discontinue practicing metzitzah
bpeh, a spokesman said. He has now agreed to do so. It has always
been our preference for the religious community to regulate itself as
long as the publics health was protected.
While cases of herpes transmission from mohel to baby are rare, they
are documented going back as far as an 1811 medical book that detailed
an outbreak in Krakows Jewish quarter.
Metzitzah bpeh was abandoned by all but fervently Orthodox mohels in
the 1950s, when diseases including herpes, syphilis and gonorrhea were
shown to be transmitted from mohel to baby.
As with Herpes Type 2 the kind that results in genital blisters in
adults there is no cure for Type 1, only treatment for outbreaks.
The virus can be passed from one person to another even when there are
no symptoms, say medical experts.
Its often an asymptomatic disease, Santelli said.
According to Zenilman, People shed the virus occasionally even
without the presence of lesions, and any immune system suppression,
including cancer and HIV-AIDS, can prompt shedding. Even taking
inhaled steroids for asthma can prompt someone to unknowingly shed the
Herpes 1 virus.
An actual outbreak of lesions can be prompted by trauma to the mouth,
like having a dental cleaning, by having a fever for any reason, or
being congested, or by exposure to the sun.
Its an everyday occurrence, Zenilman said. Although an individual
can look absolutely healthy and have no illness, they can be shedding
virus.
Transmitting the virus, he said, requires genital-genital contact,
oral-genital contact or other direct transmission across mucous
membranes, like contact between a herpes blister on someones finger
and someone elses mouth.
Rabbi Fischers attorney, Mark Kurzmann, has said the infection of the
three baby boys including twins from Brooklyn which became evident
shortly after Rabbi Fischer circumcised them is nothing more than a
tragic coincidence.
The twins were circumcised on Oct. 16, 2004, and admitted to
Maimonides Medical Center eight days later with fever and lesions in
the genital area, according to court documents. Two days after that,
one of the twins died of liver failure as a result of Type 1 Herpes
Simplex Virus.
At about that time, the Health Department became aware of another
baby, on Staten Island, who developed signs of herpes infection a week
and a half after Rabbi Fischer circumcised him using metzitzah bpeh.
That baby was hospitalized for three weeks and recovered after
antiviral treatment.
Kurzmann said he had no comment in response to the statements by
Zenilman and Santelli.
In a September interview, Kurzmann said it appears more likely than
not that the babies contracted the herpes from someone prior to the
bris, or a person other than Rabbi Fischer after the bris.
That, said Zenilman, is nearly impossible because of when and where on
the boys the herpes lesions appeared.
If it had passed from mother to baby during birth, he said, it would
have required that the mothers in question had active herpes lesions
in the birth canal. The newborns, in turn, would have had sores all
over their bodies, not just in their genital areas.
Alternatively, Zenilman said, a mother-passed infection would have
caused an encephalitis-like disease, and the baby also would have
shown evidence of the disease in his first week of life, before the
brit.
It is also highly unlikely another nurse in the hospital or caregiver
caused the infection, he said, as that would have required the nurse
to spit on the babys penis or have direct mouth-to-genital contact
that could have infected all three babies.
City Risking Babies' Lives With Brit Policy: Health Experts
Renowned authorities, one at Bloomberg-named medical school, blast
mayors administration over controversial circumcision practice.
Debra Nussbaum Cohen - Staff Writer
A renowned expert on sexually transmitted disease denounced as
outrageous this week the Bloomberg administrations failure to ban
New York City mohels from suctioning blood with their mouths from a
babys penis in the circumcision rite.
[It] is a major public health hazard, declared Dr. Jonathan
Zenilman, a professor of epidemiology at the Bloomberg School of
Public Health the Johns Hopkins University education and research
center named for New Yorks philanthropist mayor, its biggest
financial supporter.
Zenilman, who grew up in an Orthodox family in Woodmere, L.I., warned
that allowing the practice known as metzitzah bpeh is actually
crazy due to the potentially fatal danger of transmitting herpes to
vulnerable newborns.
A prominent colleague, Dr. John Santelli, chair of the Department of
Population and Family Health at Columbia Universitys Mailman School
of Public Health, joined the criticism.
Those kids are at very high risk of death and encephalitis, he said,
explaining, If you cut the skin as obviously you have to in a
circumcision it increases risk of transmission to the infant.
Newborns just dont have great immune systems, so the worst time to
get a case of herpes is in the newborn.
Metzitzah bpeh, which is practiced routinely by some fervently
Orthodox mohels, has been at the center of a case involving Rabbi
Yitzchok Fischer, a Monsey-based mohel suspected of having infected
three babies with herpes. One of the baby boys died last October.
But the city Department of Health and Mental Hygiene, which began
investigating the suspected link of the infections to Rabbi Fischer,
agreed not to ban the practice after vigorous lobbying by New Yorks
fervently Orthodox community, including of Bloomberg. In his
re-election campaign, Bloombergs TV commercials tout him as a
champion of public health.
On Sept. 15 the city withdrew the lawsuit it had filed against Rabbi
Fischer and the court order banning him from using the technique, and
turned the case over to an Orthodox rabbinical court, or bet din, in
Williamsburg, Brooklyn. Rabbi Fischer agreed to stop using the
technique pending the bet dins resolution of the case.
This appears to be the first time the city has turned the adjudication
of a public health issue over to a religious body.
Zenilman and Santelli said the narrow focus on Rabbi Fischer is
misplaced. They said because Herpes Simplex Virus Type 1 is a very
common disease studies cited by the Health Department in its legal
briefs say that 65 percent of Americans have contracted it by age 12
the potential impact on public health goes far beyond concern over one
mohel.
From a public health standpoint, at the least there should have been
a consent decree that this practice would not continue in this
community, said Zenilman, who also heads the Johns Hopkins Center for
Reproductive Tract Infections and is president of the American STD
(Sexually Transmitted Diseases) Association. It is within the scope
of a public health authority to ban it, and I find it outrageous that
it hasnt been.
Santelli, who is also a pediatrician, stressed, This is a public
health problem. Its certainly a dangerous practice from a medical
point of view.
Indeed, legal documents filed in connection with the case by the
director of the Health Departments Bureau of Sexually Transmitted
Diseases, state that Herpes Type 1, which generally causes just fever
blisters and cold sores in healthy older children and adults, is fatal
as much as 30 percent of the time in newborns.
Dr. Susan Blank, the bureaus director, turned down an interview
request from The Jewish Week. Requests for access to the results of
the Health Departments investigation of Rabbi Fischer have gone
unanswered.
Rabbi David Zwiebel, executive vice president of Agudath Israel, an
umbrella body of ultra-traditional Orthodox groups, has said metzitzah
bpeh is probably performed more than 2,000 times a year in New York
City. Many additional instances occur in other areas with substantial
populations of ultra-traditional Jews, such as Rockland County.
The New York Times reported in August that Rabbi Fischer had done some
12,000 circumcisions.
Parts of the Orthodox community and Rabbi Fischers attorney frame the
issue as one of religious practice that should be free from government
interference. They question claims that it spreads herpes.
Mohels use antiseptic mouthwash before performing oral suction, they
say, and the known incidence of herpes among infants who have
undergone it is minuscule.
According to the Times, the citys Health Department recorded cases in
1988 and 1998, though doctors in New York, as in most states, are not
required to report neonatal herpes.
Prominent members of the large Satmar chasidic community, based in
Brooklyn and Rockland County, including Rabbi David Niederman, a
spokesman for the rabbinical court handling the case, have told The
Jewish Week the community will continue the practice. A delegation of
chasidic leaders lobbied Bloomberg on the issue in August. Their bloc
vote is sought after by mayoral candidates.
Were going to do a study and make sure that everybody is safe, and
at the same time it is not the governments business to tell people
how to practice their religion, Bloomberg said on a radio program one
day later.
Health Commissioner Thomas Frieden told the Times the city did not
intend to ban or regulate the practice, partly because any such an
attempt would be virtually unenforceable. Circumcision generally takes
place in private homes.
Not all ultra-traditional groups mandate the practice, and the Modern
Orthodox-oriented Rabbinical Council of America recommends using a
sterile tube and gloves to avoid direct oral-genital contact.
The criticisms by Zenilman and Santelli come in the wake of a paper in
the medical journal Pediatrics last year that studied eight cases of
baby boys in Israel who developed herpes after their circumcision,
most probably as a consequence of transmission by the mohels
saliva, it stated.
Oral metzitzah after ritual circumcision may be hazardous to the
neonate because it carries a serious risk for transmission of the
herpes simplex virus, the paper concluded.
Asked its reaction to the experts warning this week, the Health
Department reissued a statement it released last month:
Our goal was for Rabbi Fischer to discontinue practicing metzitzah
bpeh, a spokesman said. He has now agreed to do so. It has always
been our preference for the religious community to regulate itself as
long as the publics health was protected.
While cases of herpes transmission from mohel to baby are rare, they
are documented going back as far as an 1811 medical book that detailed
an outbreak in Krakows Jewish quarter.
Metzitzah bpeh was abandoned by all but fervently Orthodox mohels in
the 1950s, when diseases including herpes, syphilis and gonorrhea were
shown to be transmitted from mohel to baby.
As with Herpes Type 2 the kind that results in genital blisters in
adults there is no cure for Type 1, only treatment for outbreaks.
The virus can be passed from one person to another even when there are
no symptoms, say medical experts.
Its often an asymptomatic disease, Santelli said.
According to Zenilman, People shed the virus occasionally even
without the presence of lesions, and any immune system suppression,
including cancer and HIV-AIDS, can prompt shedding. Even taking
inhaled steroids for asthma can prompt someone to unknowingly shed the
Herpes 1 virus.
An actual outbreak of lesions can be prompted by trauma to the mouth,
like having a dental cleaning, by having a fever for any reason, or
being congested, or by exposure to the sun.
Its an everyday occurrence, Zenilman said. Although an individual
can look absolutely healthy and have no illness, they can be shedding
virus.
Transmitting the virus, he said, requires genital-genital contact,
oral-genital contact or other direct transmission across mucous
membranes, like contact between a herpes blister on someones finger
and someone elses mouth.
Rabbi Fischers attorney, Mark Kurzmann, has said the infection of the
three baby boys including twins from Brooklyn which became evident
shortly after Rabbi Fischer circumcised them is nothing more than a
tragic coincidence.
The twins were circumcised on Oct. 16, 2004, and admitted to
Maimonides Medical Center eight days later with fever and lesions in
the genital area, according to court documents. Two days after that,
one of the twins died of liver failure as a result of Type 1 Herpes
Simplex Virus.
At about that time, the Health Department became aware of another
baby, on Staten Island, who developed signs of herpes infection a week
and a half after Rabbi Fischer circumcised him using metzitzah bpeh.
That baby was hospitalized for three weeks and recovered after
antiviral treatment.
Kurzmann said he had no comment in response to the statements by
Zenilman and Santelli.
In a September interview, Kurzmann said it appears more likely than
not that the babies contracted the herpes from someone prior to the
bris, or a person other than Rabbi Fischer after the bris.
That, said Zenilman, is nearly impossible because of when and where on
the boys the herpes lesions appeared.
If it had passed from mother to baby during birth, he said, it would
have required that the mothers in question had active herpes lesions
in the birth canal. The newborns, in turn, would have had sores all
over their bodies, not just in their genital areas.
Alternatively, Zenilman said, a mother-passed infection would have
caused an encephalitis-like disease, and the baby also would have
shown evidence of the disease in his first week of life, before the
brit.
It is also highly unlikely another nurse in the hospital or caregiver
caused the infection, he said, as that would have required the nurse
to spit on the babys penis or have direct mouth-to-genital contact
that could have infected all three babies.