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Vos Iz Neias

Today the de Blasio Administration reached a new tentative agreement with a coalition of Rabbinical leaders from across New York City regarding the circumcision ritual of direct oral suction, also known as metzitzah b’peh (MBP).

This new agreement fulfills the Mayor’s commitment to finding a more effective policy that protects children and religious rights in a way that more actively engages the cooperation of the community.

This agreement focuses on two key areas: maximizing awareness of parents and minimizing risk to infants.

While the de Blasio Administration continues to believe that MBP carries with it health risks, given the sacred nature of this ritual to the community, the Administration is pursuing a policy centered around education of health risks by the health care community and respect for traditional practices by the religious community.

Increasing trust and communication between the City and this community is critical to achieve the Administration’s ultimate goal of ensuring the health and safety of every child, and this new policy seeks to establish a relationship based on engagement and mutual respect.
Under the new policy:

•      The Administration will ask hospitals, obstetricians and pediatricians who serve the community to distribute information about the health risks associated with MBP. Health care providers will also provide parents with contact information for the Department of Health and Mental Hygiene (DOHMH) for parents who seek additional information.

The city has agreed to no longer require that a mohel obtain a signed consent form before he is allowed to perform the ritual. The City will support a Board of Health consideration to repeal the health code provision regarding written consent.

•      The community will direct mohelim to continue to respect the wishes of any family that has chosen to not have MBP performed on their son.

•      In cases where an infant has HSV-1 (herpes simplex virus 1) associated with MBP, the rabbinical coalition has pledged, for the first time, to cooperate with the DOHMH in identifying the mohel in question and asking the individual to undergo testing.

•      In cases where the mohel tests positive for HSV-1, DOHMH, with support from and cooperation of the community, will conduct DNA testing to attempt to definitively establish the source of the baby’s infection as part of a comprehensive investigation of any other possible sources.

•      If the mohel is found, by DNA match, to have infected the infant with herpes, he will be banned for life from performing MBP by DOHMH, with support from and cooperation of the community.

•      Rabbinical coalition has also agreed to engage in campaign to have every mohel who performs a circumcision or MBP take steps to lessen the risk of transmission of HSV-1.

Background:
Some New Yorkers who have their infant sons ritually circumcised also have the mohel perform direct oral suction on the wound, a ritual known as Metzitzah B’Peh. The position of New York City is that this ritual risks the transmission of HSV-1, which while rare, can lead to serious brain damage or death.

In 2012, the City adopted new Health Code provision requiring the mohel to obtain informed consent from parents acknowledging that they are aware DOHMH recommends MBP not be performed because of the risk of brain damage and death, but want the procedure to be performed anyway. Since the regulation went into effect, DOHMH has concluded that there have been six cases following MBP in New York City, including four in 2014.  A signed consent form was provided by the mohel in only one of these six cases. There are also widespread reports in news and media reports of many mohels overtly ignoring the signed consent reform requirement and pledging to continue to do so.

There are numerous published reports in the medical literature of similar cases of HSV-1 following ritual circumcision in NYC before 2000.

The biology, epidemiology, and clinical manifestations of HSV-1 indicate that herpes transmission can occur during MBP. Seventy-three percent of adult New Yorkers are infected with HSV-1, and most adults with oral herpes infection have no symptoms.  Herpes infection in newborn infants is very rare (less than15 cases among approximately 125,000 births in NYC each year), and more than half of newborns who become infected develop life-threatening disease with substantial long-term negative consequences; roughly 1 in 5 infants infected with herpes dies.

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