The Cityâ€™s current policy is that a rash or blisters found in the bris milah area within 7-10 days after circumcision, plus an HSV-1 positive test, point conclusively to the mohel and mbp as the mode of transmission. Health authorities attempt to identify the mohel; if they are successful, he is banned.
The newest scientific evidence, however, in the form of a groundbreaking DNA testing program operating in Rockland County for the past two years, does not support the Cityâ€™s theory.
â€œThe two definitive non-matches that occurred in Rockland are a clear refutation of New York Cityâ€™s hypothesis,â€ attorney Mr. Yerachmiel Simins, who has counseled mohalim, told Yated.
â€œFrom Rockland Countyâ€™s perspective, the individuals who did the metzitzah bâ€™peh in the cases under investigation were not the ones who matched the specimen [from the infected baby], and that tells us we have to look at the bigger picture,â€ Rockland Countyâ€™s chief epidemiologist Dr. Oscar Alleyne told Yated.
He and his associates Commissioner of Health Dr. Patricia Shnabel Ruppert, and Medical Director of Disease and Control Prevention Dr. Anil Vaidian, are committed to doing just that. â€œWe continue using all our expertise to broaden the search for the mode of transmissionâ€¦ to track down every possible â€˜entry point,â€™ and to isolate the source of the infection,â€ he said. â€œOnly then can we best educate the public about the most effective health measures to prevent transmission.â€
The newest scientific findings go to the heart of the mbp controversy and have broad implications. Among other things, they challenge the negative stereotypes of mohalim, metzitzah bâ€™peh and the frum community that have taken root in the public mind.
Thanks to Rockland Countyâ€™s pioneering protocol with the Monsey-New Square communities, one of those stereotypes, the image of Orthodox Jews as an enclave of religious fanatics bent on pursuing dangerous rituals at the expense of helpless infants, has crumbled.
In addition to clearing two mohalim of suspicions that they infected two baby boys, the Rockland County DNA operation has illuminated the moral dynamics that drive the Orthodox community, offering a perspective vastly different from that disseminated by New York Cityâ€™s DOH.
In contrast to the Cityâ€™s allegations that Orthodox Jews refuse to cooperate with health authorities, Dr. Alleyne speaks of the â€œcommunity collaboration and mutual trust that made this protocol possible.â€
Not only did Rocklandâ€™s leading epidemiologist secure the participation of mohalim and parents in submitting to DNA testing – a process that posed logistic hurdles and personal hardship for mohalim who lived far from Rockland County. He also won the trust and respect of the communityâ€™s rabbonim and leaders.
Rabbonim and mohalim have agreed that any mohel who has been scientifically proven to have infected a newborn will never again practice mbp, anywhere. That pledge testifies not only to their foremost regard for their childrenâ€™s safety, but to their faith in the integrity of Rockland Countyâ€™s Department of Health.
Dr. Allenyne also won agreement from all mohalim who participated in the protocol that if any were found to have the HSV-1 antibody – which happens to occur in approximately 80 percent of the general population – that mohel would not perform mbp as long as the investigation was pending.
This stipulation in some cases required mohalim to wait up to six months or more until all the specimens had been collected and sent to the state lab in Albany, and the results analyzed.
Collaboration Over Confrontation
In its determination to examine all possible â€œentry pointsâ€ through which HSV-1 is passed to the newborn, Rockland County health officials have quietly broken ranks with NYCâ€™s long-standing policy of targeting the mohel exclusively, and ignoring or downplaying other sources of herpes risks.
Dr. Alleyne told Yated of his vision of keeping Rockland County â€œon the cutting edge of advances in public health.â€ The key to realizing that vision, he said, is to invest in the power of collaboration with the community to achieve the maximum benefit for all concerned.
â€œAdopting a position of mistrust defeats my whole goal in public health,â€ he said.
In the past, pressured by NY City health officials to come forward and submit to herpes tests, mohalim had refused, protesting the one-sidedness of the investigation that carried a predetermined verdict.
To reinforce its allegations against the mohel, health authorities had made a practice of pumping out a new Health Alert each time a case of herpes infection was reported or even suspected, linking the infection to the mohel and to mbp.
The witch hunt against mohalim and intimidation tactics against parents drove a deep wedge between the City and the community it professes to be serving.
So poisoned were relations that the Rockland protocol that calls for extensive participation in the testing process by mohalim was initially met with ridicule by some City officials, who scoffed at the very notion that a mohel would cooperate.
Dr. Alleyne was reportedly cautioned, â€œYou will never get a mohel who performs mbp to identify himself. The practice of mbp is shrouded in the tightest secrecy.â€
City officials are said to be stunned by Rockland Countyâ€™s success in achieving unprecedented access to mohalim and partnership with the Orthodox Jewish community.
â€œHe succeeded because he and his colleagues are truly dedicated to their calling and because they chose collaboration over confrontation,â€ a community liaison reflected in a talk with Yated.
â€œThe irony is, when it comes to public health, we are on the same side of the issue as both health departments,â€ the liaison added. â€œWe too want to know where infections are coming from. But the truth can only come through an unbiased investigation, not one that is agenda-driven.â€
A Tale Of Two Health Departments
The sharp contrast between the two health departments in the matter of dealing with HSV in newborns comes vividly across in an article in the Forward newspaper. The author notes the deep mistrust that inhibits parents in New York City â€œfrom divulging the name of their mohel,â€ contrasting it with the collaboration that produced the DNA protocol in Rockland County.
He points out how â€œan hourâ€™s car ride north of New York City, Dr. Alleyne has secured the cooperation of one of the largest ultra-Orthodox communities in America where â€œabout 91,000 Jews, mainly ultra- Orthodox, live.â€
â€œSince Alleyne began working with the community two years ago, parents have come forward voluntarily to report eight suspected cases of neonatal herpes. In the three confirmed cases of the disease, mohels, parents and other caregivers have submitted to weeks of oral swabs, which are then sent to a laboratory for testing,â€ the article noted.
â€œIf anyone tests positive for HSV-1, the laboratory runs an analysis of the strain in his or her mouth to see if it matches the strain in the infected infant.â€
The article quoted Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories, saying the DNA method â€œis a powerful and informative way to uniquely identify the virus and help determine the source, similar to that used in investigations for other infectious diseases, such as tuberculosis.â€
Pressure Building On
De Blasio To Fulfill Campaign Promise
The DNA â€˜non-matchesâ€™ that have undermined the Cityâ€™s narrative have prompted critics to renew the call for a scientific method to establish a direct DNA match between the viral sample in an infant and the person being tested – as opposed to relying on theories and speculation.
The Cityâ€™s policy of classifying HSV-1 based on the location and timing of symptoms plus a positive HSV test, had run into trouble even before the discovery of the non-matches.
The Rockland County team investigating a case classified as neonatal herpes discovered the babyâ€™s illness had been misdiagnosed – the HSV-1 positive was actually a false-positive. That threw into question other â€œpositivesâ€ obtained by the City through the rapid-detection test – typically used to diagnose cases of neonatal herpes. It raised further doubts about the Cityâ€™s statistics on neonatal disease.
The impact of these developments – and possibly of further â€œsurprisesâ€ said to be around the corner – may have pressured the City to adjust its approach in dealing with neonatal herpes.
That may account for the abrupt media blitz about Mayor de Blasioâ€™s administration â€œnearing an accordâ€ with plaintiffs in the bris milah lawsuit – just as news of the non-matches was about to go public.
Interestingly, the announcement of an imminent â€œaccordâ€ occurred when negotiations were not even on the table, having broken off some time ago, someone with knowledge of the negotiations informed Yated. â€œMedia reports of renewed negotiations actually preceded the re-starting of those talks,â€ he said. â€œIt was a case of the cart going before the horseâ€¦. as if talk of an accord would deflect public scrutiny from the â€˜bad newsâ€™ of the non-matches.â€
The negotiations were portrayed in a New York Times article as a natural outgrowth of ongoing efforts by Mayor de Blasio to fulfill his campaign promise to the Orthodox community, a crucial political constituency.
De Blasio pledged â€œto rescind the consent requirement on â€˜Day 1â€™ of his administration and find a solution that would be more acceptable to Orthodox leaders, while still protecting childrenâ€™s health,â€ the article said.
That was one year ago.
The Times article described how one mohel, in the interim, resolved it on his own.
â€œRabbi Shimon Hess, a well-known ultra-Orthodox mohel, said he drew up his own form in response to the Bloomberg regulation. It stated, â€˜I am knowledgeable that New York City says metzitzah bâ€™peh is dangerous. However, I trust the Talmud, and the Talmud says that not to do metzitzah bâ€™peh is dangerous.â€™â€