4 New Cases of Herpes Because of "metzitzah b'peh" in NYC

Four recent cases of neonatal herpes infection following a Jewish circumcision ritual have health officials once again urging parents in New York City’s ultra-Orthodox population to avoid the practice or at least limit its risks.

Health officials on Sunday said there have been three cases of herpes simplex virus 1 infections in infant boys reported to the New York City Department of Health and Mental Hygiene since Dec. 1, 2019. The fourth case was reported in September 2019.

Health officials don’t believe the cases are linked. The infants were hospitalized, received intravenous antiviral drugs and are now recovering, health officials said.

Rabbi David Zwiebel, executive vice president of Agudath Israel of America, declined to comment.

The ritual is known as metzitzah b’peh. A mohel, a religious leader who performs the circumcision during a bris, uses his mouth to suck blood from the cut.

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Since April 2006, when reporting of cases became mandatory, 22 babies were reported to have developed infections following metzitzah b’peh. Two died.

City health officials have struggled through several attempts to stem the religious practice.

Five commissioner’s orders, including one recent one, have been issued since 2014 to mohels. The order prohibits them from engaging in direct orogenital suction. Violating the order is a misdemeanor.

Beginning in 2012,  the city required parents to sign a consent form that warned of the ritual’s dangers, which the mohel was then expected to retain. Health officials said the form, which was intended to be educational, eroded trust with the community and was viewed by some members of the community as an intrusion during a sacred gathering.

The form was replaced with an educational brochure in 2015, which is still in use today, according to Demetre Daskalakis, the deputy commissioner for the division of disease control at the city’s health department.

While the city continues to stress that avoiding the practice is the only way to effectively eliminate the risk of herpes transmission, said Dr. Daskalakis, the city is also adopting a new harm-reduction strategy that has been used elsewhere.

Health professionals are being urged to inform parents and religious leaders that steps can be taken to reduce the risk of disease transmission, including asking the mohel to use antiseptic mouthwash immediately before performing direct orogenital suction to reduce viable herpes virus in the saliva. Mohels should also use sterile instruments, antiseptic skin cleanser and hand sanitizer, according to the advisory.

Health department workers over the past month have visited with dozens of clinicians to go over the basics of neonatal herpes and talk about harm-reduction strategies, said Dr. Daskalakis.

Trying to undo a ritual that is thousands of years old is challenging, said Dr. Daskalakis. Offering the option of don’t do it, but also instructions on how to keep an infant healthy, is, he said, “the best we’re going to do.”

The harm-reduction effort is a way to “build a bridge between what is a ritual that doesn’t seem medically OK, to some medical strategies that at least reduce harm,” he said.

Write to Melanie Grayce West at melanie.west@wsj.com