As New York City health authorities and ultra-Orthodox groups clash over metzitzah b’peh, officials in other cities are making no effort to regulate the risky oral suction technique sometimes used during ritual circumcision.
In fact, unlike in New York City, health authorities elsewhere often have no mandate to monitor the incidence of the herpes strain known as HSV-1 that babies can contract from the procedure. The disease’s consequences for adults are seldom serious, but HSV-1 can cause developmental disabilities, nerve damage and occasionally death in infants due to the underdeveloped state of their immune systems.
Assessing the possible risks and rate of infection is further complicated by the fact that outside the New York City area, even some ultra-Orthodox mohels and the families they serve appear to accept use of more sterile procedures, which are endorsed by local governments and rejected by many ultra-Orthodox groups in New York.
In Baltimore, which has a large ultra-Orthodox population, a representative for the county department of health said her office doesn’t “have anything to do with” tracking herpes or circumcision rites, and referred questions to the Maryland Office of Health Care Quality. A spokesperson from the state office confirmed that neonatal herpes was not mandated to be reported. “The Department agrees that this is not a safe practice,” the spokesperson wrote in an email, adding, “We are not aware of any cases associated with this practice in Maryland.”
The department’s lack of awareness could reflect the absence of mandated reporting of the illness. It might also reflect caution about antagonizing the community. In March, Helene King, a spokeswoman for Sinai Hospital, which serves Baltimore’s large ultra-Orthodox population, declined to answer even a general question from the Forward about babies with HSV-1 being admitted soon after their circumcisions. “With such a close-knit community as the Baltimore Orthodox one is, I would not want to chance that any family or families would realize they were in an article like this,” she wrote.
The Forward contacted several prominent mohels from Baltimore’s ultra-Orthodox community, including Rabbi Michael Henesch. None would agree to be interviewed about whether they used metzitzah b’peh.
Other cities with sizable ultra-Orthodox populations, such as Chicago, Los Angeles and San Francisco, do not mandate that herpes cases be reported to the state. In Canada, officials in Montreal and Toronto confirmed that herpes was a communicable disease to be reported, but they were not aware of any cases.