NYC DOH: ‘Metzitzah B’peh’ Should Not Be Performed During ‘Bris Milah’

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New York City Health Commissioner Dr. Thomas Farley today issued a statement strongly urging that direct oral-genital suction not be performed during Jewish ritual circumcision, and announced that several hospitals, including those serving Hasidic Jewish communities and all Health and Hospital Corporation hospitals, have agreed to distribute a brochure that describes the risk of contracting the herpes virus from this practice, known as metzitzah b’peh.

Health Department investigations of newborns with herpes virus between 2000 –2011 have shown that 11 infants contracted the herpes virus when mohelim, or ritual circumcisers, placed their mouths directly on the child’s circumcision wound to draw blood away from the circumcision cut. Ten of these infants were hospitalized, at least two developed brain damage, and two babies died.

“There is no safe way to perform oral suction on any open wound in a newborn,” Commissioner Farley said. “Parents considering ritual Jewish circumcision need to know that circumcision should only be performed under sterile conditions, like any other procedures that create open cuts, whether by mohelim or medical professionals.”

The medical risk for metzitzah b’peh is herpes simplex virus type 1. Many adults are infected with herpes simplex virus type 1, which is usually transmitted orally through common activities. It is different than herpes simplex virus type 2, which is usually transmitted sexually. A married couple who have only had marital relations with each other could still contract herpes simplex virus type 1 without sexual contact with anyone else. The common cold sore on the mouth is how Herpes simplex virus type 1 often presents, but most persons with infection do not know they are infected, because they have no history of symptoms.

For example, in November 2004, a Health Department investigation found that twins contracted herpes virus following a ritual circumcision which included direct oral-genital suction (metzitzah b’peh) even though the mother had no history of oral or genital herpes, nor was there any recent history of herpes among hospital staff who cared for the infants. At 16 days, the twins were evaluated for fever and lesions on their abdomens, buttocks and perineums, including their genitals. One of the twins died.

The Health Department brochure “Before the Bris” describes the risk to infants of contracting herpes through direct oral-genital suction and advises parents considering ritual Jewish circumcision to ask the mohel several days before the bris if he practices direct oral-genital suction (metzitzah b’peh). This will give parents time to talk to a health care provider and consider other options for circumcision.

The following hospitals have agreed to distribute “Before the Bris” to parents considering out-of-hospital circumcision of their newborn boys:

• All HHC facilities

• Maimonides

• NYU-Langone

• North Shore LIJ

• Staten Island University

• Lenox Hill

• New York Methodist

• New York Presbyterian

• Forest Hills

Some religious authorities approve of alternatives to direct oral-genital suctioning that avoid direct contact between the mohel’s mouth and the open wound of a baby’s circumcised penis, such as suctioning blood from the circumcision wound with a sterile glass tube, or using a sponge or sterile gauze pad to wipe the blood away. There is no evidence that these methods can spread herpes infection to newborns.

(Press Release From NYC DOH)


29 COMMENTS

  1. Avrohom Oveinu did the whole Millah on himself, and could not reach with his mouth to do Metzitza P’peh, so it says that there was a special Neis which extended his neck, so that his mouth should reach. Just like the extension of the arm of Bas Pharoh.
    Moshe did the Metzitze B’peh on Eliezer, even though Tzipoiro did the Milah, even though Moishe had Aral Sfosayim.

  2. There were no recorded cases of the herpes virus in Avrohom Avinu’s time. If there were you be assured that Avrohom Avinu, because he kept the Torah even before it was given, would have found another method to care for the wound.

  3. From 2000 till 2011 is 11 years. Using very rough stats:
    NYC has 2 million Jews out of 8 million = 25%
    300 babies are born in NYC per day = 109,500/year =
    1,204,500/11 years = 301,125 Jewish babies in 11 year.
    If 45% are boys, that’s 135,506 brissim in 11 years.

    During those 11 years, 11 Jewish baby boys contracted herpes supposedly from mohalim.

    That’s a 0.008% rate! I.e., not even 1 one-hundreth of 1 percent. Does the DOH always suggest stopping a medical/religious/cultural practice with such a low probability?

  4. My wife’s OG/BYN said that the risk of a bacterial staph infection from the plastic tube used in place of Metzitza b’peh is far greater and more common that the possibly minor risk of viral infectio associated with actual metzitzah bpeh. However, since staph infections can come from anywhere, it’s not blamed on the mohel.

  5. Cherrybim
    Avraham avinu did the ratzon Hashem. If it wasnt a mitzvah he wouldnt have done it, and if its unhealthy it wouldnt be a mitzvah. Deracheha darchei noam.

  6. To #3

    1. Even the Bnei Sh’chem had to do Metzitza B’peh, because it says “Komoinu” (Like Us).

    2. Why always, where does it say? How about Emunah Pshutah?

  7. Enlightened I think the jeboo dayan said it at the asifa.

    Rav shlomo zalman aurbach ZTL said that suction using a tube is halachically the same as direct metzizah bepeh. He was scared to publicize it saying “I’m too old to have people break my windows”.

  8. Take it no other way its a direct assault on Judaism, never trust the Gov. they are never there to solve a problem only to grab power

  9. Maimonides Labor and Delivery is almost exclusively supported by the frum community. For them to get involved and give out this pamphlet is a shanda. The community should consider a boycott.

    The cases they blame on the Mohel have not been proven conclusively to have come from the Metzizah. They asked the nursing staff if anyone had an outbreak of herpes, and since they answered no, they assumed its the Mohel – without even asking and/or testing the Mohel. If they were so sure its the Mohel they should be charging him with manslaughter, but they know they can’t prove it.

  10. These are facts that are not in dispute:

    1. Herpes Simplex Virus 1 infections transmitted through metzitza b’peh have killed babies, and have left at least two children seriously brain damaged.

    2. A baby who gets the Herpes virus will carry it for his or her entire life…almost certainly transmitting it to others. Some of those ohers will become ill as well, and some might even die. And all of them and everyone to whom they transmit the Herpes virus will carry it for the rest of their lives too.

    3. Use of a glass tube is halachically permitted, according to Rav Shlomo Zalman. (I have a son-in-law in advanced kollel…he learns that the tube is in fact mutter…even though he DID have metzitza b’peh used at the brisim of his sons, my grandsons).

    So…if the halacha dictates whenever a life is at risk, we do should not rely on probabilities – that we must do what is necessary to protect that life…what is the big deal? Tradition for tradition’s sake?

  11. I’ve done extensive research on the issue. The debate is framed incorrectly today, period. I’d strongly advise anyone who’s interested to read Dr. Shlomo Sprecher’s Hakira article on MBP. Google it, you’ll find it. It’s astoundingly well researched. I’d STRONGLY advise everyone to familiarize themselves with the historical backdrop of the 19th century debate, and then read through every word of the Chasam Sofer’s, Maharam Schick’s, and R’ Ettlinger (Binyan Tzion)’s teshuvos on the subject. Note the DATES that these teshuvos were written.
    If there is a known danger associated with a quasi-mandated practice, we can abrogate said practice in the face of just one life, sfek sfeika of pikuach nefesh. Read the shaila posed to the Chasam Sofer and his teshuva (printed in Dr Sprecher article) teshuva where he says this outright. Read EVERY WORD CAREFULLY of Maharam Schick’s teshuva on this (OC or YD, forget which offhand, #152). It’s clear that if Maharam Schick WAS convinced of a safek PN, he probably would’ve written something a bit different.

    Dzibo Dayan said it at the asifa, that Avraham Avinu incurred a neis to do MBP???? Where is the source?? Also, what in tarnation does that have to do w/ “internet issues”??

  12. R’ SZ Auerbach’s comment alone shows how far afield this MBP debate’s been hijacked in the modern period. There are people out there screaming and hollering loudly about MBP because they probably fancy themselves as soldiers reliving the religio-social battles of the 19th century (v’hamaivin, yavin). People, this is not the 19th c. While people fulminate and rely on teshuvos that may or may not have some possible connection to the modern period, babies (however few) are dying. Wonderful. 008%, you say, huh? Tell that to the parents of babies that died with at least strong circumstantial causal linkage to MBP.

    This “debate” is already being hijacked. All the city is doing is (admittedly, with some bias) attempting to educate parents to make an informed decision. Nothing more, nothing less. NYC is not trying to ban the practice, as was their initial knee-jerk reaction to this a few years ago.

  13. “So…if the halacha dictates whenever a life is at risk, we do should not rely on probabilities – that we must do what is necessary to protect that life…what is the big deal? Tradition for tradition’s sake?”

    YonasonW, that’s exactly what “the big deal” is to some. The problem is that a battle over tradition vis a vis MBP is not applicable today, in reference to how the battle was fought in the mid-late 19th c and early 20th.

  14. ny100k
    these facts are disputed. Even the doh never conclusivley said it came from the mohel. That’s their best guess.
    90% of adults carry the herpes virus. So scaring everybody by saying they will have it for life is meaningless bluster

  15. It is such a busha and a cherpa that such a subject should come out into discussion among the secular society in America where the reshu’yos have no hasaga in minhagim and mesora of klal yisroel, and where they would consider this to be a bizarre ritual, rachmana litzlan. Oy lador she-kach ala beyamav that the Torah and our mesora should be put up to public scrutiny and ridicule.

  16. Why don’t we just require tghat mohelim get periodically tested for the virus and certified as infection-free. Those who carry the virus should not be allowed to do MBP without first informing the parents of the risk involved and getting a signed waiver. Some might be concerned that this will put these mohelim out of work, to which one could answer that maybe they are in the wrong line of work.

  17. #12
    YonasenW
    “These are facts that are not in dispute:

    1. Herpes Simplex Virus 1 infections transmitted through metzitza b’peh have killed babies, and have left at least two children seriously brain damaged. ”

    These facts, are in fact DISPUTED.

    You write herpes infections transmitted through Metzizah b”peh have killed babies, THIS IS PURE CONJECTURE, absolutly never ever proven. It is at best an assumption, the NYC dept of Health assumes that the babies contracted the virus thru Metzizah b’peh.

    Everyone and that is even “you” should NEVER state assumption as facts.

  18. These are facts that are not in dispute:

    They certainly are in dispute.

    #1 has not been proven.

    #3 is as you yourself say “according to Rav Shlomo Zalman”, in other words not according to most people. Since when is everyone mechuyav to accept his psak?

    …if the halacha dictates whenever a life is at risk, we do should not rely on probabilities

    Since when does it dictate this? Milah itself is a sakanah, a greater sakanah than this herpes problem, and in Chazal’s day it was a greater sakanah still. They knew about this, and about the possibility of a hereditary condition making milah fatal. And yet not only did they not abolish milah for everyone, they didn’t even abolish it for parents who had already lost one child. Only after two children have died are their subsequent children exempt from milah. So we certainly do rely on probabilities.

    In the case of herpes, the risk is far smaller than the risk Chazal told us to ignore. Even today, the risk of contracting herpes through metzitzah is far smaller than the risk of someone being killed in a car crash on the way to or from the bris. And yet we accept that risk without question. So why cavil at this infinitesimal risk? Only because it’s a challenge to the Jewish way of doing things.

  19. groisaTzaddik says:
    June 7, 2012 at 10:12 am

    My wife’s OG/BYN said that the risk of a bacterial staph infection from the plastic tube used in place of Metzitza b’peh is far greater and more common that the possibly minor risk of viral infectio associated with actual metzitzah bpeh. However, since staph infections can come from anywhere, it’s not blamed on the mohel.
    ___________________________________________________

    do you really expect anybody will belive theis a sterile clean plastic give more chance of infection that slavia on an open wound

  20. Some of the medical “expertise” that is offered here is quite bizarre but so are some of the other reasons offered for retaining this practice. For some, the issue comes down to simply not giving in to any government mandate which appears to contradict or even address matters that they consider to be 100 percent matters of halacha. Unfortunately, metzitzah b’peh is NOT brought down by Chazal as a chiyuv as part of Milah. Yes, its a minhag from a time where the risks related to possible infection front Herpes virus were unknown. When a minhag poses a risk to the baby, we DO consider sakanah and should not pursue a minhag simply for tradition’s sake

  21. to all who say it is the Jewish way, not it is the cheraidie way. many Orthodox mohels use a tub to do Metzizah, since it does not specify in the gumurha that it must be done with ones mouth.

    to the haters, the government is not banning it, they are informing people who may not understand or know about the risk of MP. and, telling them there are other options available to them, that they where not aware off. then they could go to their rov and discuss it.

    But information is the danger, some like the people to be kept in the dark

  22. groisaTzaddik, where did you get your 90% figure? According to a JAMA article from 2006, the figure is less than 60%. “Seroprevalence of HSV-1 decreased from 62.0% (95% CI, 59.6%-64.6%) in 1988-1994 to 57.7% (95% CI, 55.9%-59.5%) in 1999-2004”

    Although most adults carry the HSV-1 virus, I’m under the impression that it’s only infectious when there are lesions (cold sores and the like). I welcome corrections — I’m not a medical professional.

  23. To those who claim there is a legitimate debate as to whether Herpes virus transmitted through MBP has killed babies….the Flat Earth Society is accepting applications..