The New York City Health Department has recommended that infants not undergo oral-suction circumcisions after several babies were infected with herpes.
The department's action was prompted after a Monsey-based rabbi was suspected of infecting three babies with herpes in 2004. One died and another suffered brain damage. The department said two more cases were reported in the city this year.
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 used by Hasidic and ultra-Orthodox Jews.
The Monsey rabbi, Yitzchok Fischer, 57, has agreed to stop performing the oral procedure until a religious panel investigates the method. The agreement between Fischer and New York City ended a court case brought by the city.
Because the religious panel did not offer its recommendations by a Dec. 1 deadline, New York City Health Commissioner Dr. Thomas R. Frieden this week issued his warnings to the Jewish community in a letter.
"Because there is no proven way to reduce the risk of herpes infection posed by metzitzah b'peh, the Health Department recommends that infants being circumcised not undergo metzitzah b'peh," Frieden wrote.
Frieden wrote that parents must be made aware of the risks associated with oral-suction circumcision, even though the chances of the infant contracting herpes is considered rare.
A newborn's immune system is not developed enough to fight serious infection, and herpes infections pose grave risks, he said.
The New York City Health Department investigation found that Fischer infected three children with herpes in 2004 through oral-suction circumcision.
Two additional cases of infant herpes through the oral-suction method were reported by physicians in 2005, the commissioner wrote. The identity of that mohel or mohels was not revealed.
Fischer had agreed to stop using the method this year while his court case was pending, authorities said.
The department found that in all cases, the transmission of herpes was within the time frame of an oral-suction circumcision, Frieden said.
Many rabbis say that Jewish law does not mandate mouth suction and that a mohel is allowed to use a tube, sponge or sterile gauze pad instead of the mouth to wipe away blood. Others contend it is mandated by Jewish law, and the spread of disease is rare.
Fischer's lawyer, Mark J. Kurzmann of Pearl River, has said there has been no conclusive medical evidence that the infants contracted the virus from the rabbi. He said the rabbi used oral suction for two of the three circumcisions in question. Oral-suction circumcisions were done on the twins who became infected with herpes.
Rockland Health Commissioner Dr. Joan Facelle also has voiced concerns about the health risks posed by the procedure. She said her department had not received any reports of herpes in infants in Rockland, and she couldn't legally prevent the use of the procedure.
Facelle has said she planned to start an educational campaign in Rockland to inform parents about the potential risks.
Most people with oral herpes don't know they are infected and have no symptoms, the city Health Department said. Even without symptoms, people can spread the infection.