The protocol’s findings have punctured a number of myths about mohalim and the practice of metzitzah b’peh. These findings may influence a discovery hearing in the case in the near future, sources close to the case told Yated.
After the plaintiffs successfully challenged former Mayor Bloomberg’s “consent law” on constitutional grounds, the case was sent back to the lower court for re-appraisal against the standards of “strict scrutiny.”
That some people find mbp distasteful is not sufficient to abolish a religious practice, the appeals court ruled several months ago. The crucial question is, does the consent law serve a compelling public interest?
That means a pivotal issue in the lawsuit will now turn on a matter of pure science: can the City scientifically and conclusively prove its contention that mbp is dangerous to newborns and needs to be banned?
Until now, City officials have refused to go the route of conclusive DNA “fingerprinting” — the most conclusive disease-tracking vehicle available. They argue that the harmful nature of mbp and the role of mohalim in transmitting disease are self-evident.
City officials point to numerous cases where, they say, the timing and location of lesions near the bris milah area, together with a positive HSV-1 test, “prove” the mohel is the culprit. With such compelling evidence, what need is there for DNA testing, they ask?
Recent developments in Rockland County, where a groundbreaking “ritual circumcision” protocol has been operating with the collaboration of the Health Department and the Orthodox Jewish community, answer that question with finality.
Rockland County’s Director Of Epidemiology And Public Health: ‘We Look At The Bigger Picture’
According to the terms of the protocol, mohalim and the afflicted newborn’s parents and chief caregivers have agreed in writing to have samples of their DNA extracted and compared with viral samples taken from the baby. If a mohel is found to present a direct match, he agrees to refrain from ever again practicing mbp, anywhere.
“The purpose of the protocol is to use all our scientific, medical and technological expertise to investigate all points of exposure to the HSV-1 virus, to conduct a comprehensive search focusing of the highest risk factors,” Dr. Alleyne said in a wide-ranging interview with Yated.
Rockland County’s head epidemiologist expressed his belief that a scientific investigation can only operate effectively if bias is set aside.
“Suppose I have a hunch that it’s person A who is transmitting the virus,” he elaborated. “If DNA testing rules that out by showing his DNA does not match samples from the patient, then we have to face the reality that what we thought occurred did not occur, no matter how compelling our theory seemed to us.
“We then shift gears and look at the bigger picture,” Dr. Alleyne said. “It won’t help to continue focusing on person A. We turn to other likely sources and screen each one through DNA ‘fingerprinting.’”
In line with the protocol, he described “ruling out HSV in a number of cases, in contrast to policy in other places where a suspected case remains in the HSV classification even if proven otherwise.”
Dr. Alleyne referred to 8 cases of suspected herpes that were reported to him in 2014. “Thanks to the protocol, we were able to careful monitor and conduct investigations into these cases, with the result that were able to rule out 5 as clearly not HSV, with only 3 cases positively confirmed as such.”
While some medical and media critics pounced on the newly reported cases as fresh evidence of the dangers of mbp, Dr. Alleyne’s team went ahead with DNA testing as per the Rockland County protocol, allowing the truth to emerge.
In two of the HSV cases, samples taken from the mohel, parents of the baby and various caregivers were sent to the State’s lab in Albany and compared with virus samples from the infected baby. In both cases, the mohel’s DNA did not match that of the infant on whom they had performed mbp.
These findings collapsed the City’s contention that “timing and location of the baby’s lesions, plus a positive HSV test,” is all that is necessary to conclude that mbp was the cause of herpes infection.
In another recent episode that further discredited the City’s assertion, NYC health officials announced a new case of neonatal herpes following mbp, and fired off yet another new Health Alert about the dire consequences of the practice.
However, after the case was transferred (over the City’s objections) to Rockland County where the infant and his parents resided, it was discovered that the baby, hospitalized and treated with anti-viral medication for two weeks, had never had herpes.
The “positive” HSV outcome was a false-positive, not uncommon with rapid-detection tests that are frequently administered to infants. The misdiagnosis served to fuel the suspicion that other reported cases of herpes by the NYC DOH might also have been false-positives.
Keeping Rockland County On The Cutting Edge Of Public Health Advances
Dr. Alleyne described the initial phase of the DNA-testing process, saying its effectiveness depended on the “serious commitment of all parties in seeing that quality specimens are collected and sent on to the State lab in Albany in a timely fashion.”
“It’s a time-consuming process but if done correctly, the results are conclusive and well worth the effort,” he said.
“The swabbing is done against the cheek with sterile q- tips, 60 swabs over a period of 30 days to two months, even 90 days if necessary,” he explained. “Since 80 percent of any given population have had a herpes infection at some point in their lives, most people have antibodies containing traces of the virus. This can sometimes resurface as a cold sore. It can also happen that the person is asymptomatic, without any symptoms at all, but microscopic traces of the virus still remain.
“The point is, once a person has had a herpes infection, he or she can ‘shed’ at any time,” meaning traces of the virus in the person’s saliva can yield a specimen for testing purposes,” Dr. Alleyne clarified.
“DNA testing can find a direct genetic match, assuming the ‘shedding’ in the specimen is strong enough to grow a virus in a lab. DNA testing can also show conclusively that there is no match between the specimens.”
Hailing the protocol as a “major breakthrough” and a “model of what can be achieved for the public good through collaboration,” Dr. Alleyne spoke of his passion to “keep Rockland County Health Department on the cutting edge of public health advances.”
“The underlying principle guiding us is that through a collaborative effort with the community we can promote our core principle, the public heath, and empower and educate the public to join us in our work.
‘DISEASE DETECTIVES’ ON A MISSION
“We like to think of ourselves as ‘disease detectives’ on a mission,” Rockland County’s Director of Public Health quipped. He lauded his colleagues, Commissioner of Health Dr. Patricia Shnabel Ruppert, and Medical Director of Disease and Control Prevention Dr. Anil Vaidian, for their exceptional dedication and teamwork.
“We seek out every possible clue with the goal of minimizing the risks of communicable illnesses. We’re looking for transparency and openness for the sake of being able to track diseases, isolate causes and eradicate illness.”
Asked if he was able to work cooperatively with the Jewish community, Rockland’s head epidemiologist noted that mohalim and community leaders have been very forthcoming. Mohalim agreed to identify themselves, to sign affidavits testifying to having participated in cases under investigation and to undergo the time-consuming testing process, he said.
“As per agreement with and under the guidance of their rabbis, any mohel who proves to be a direct match with an infected baby promises to refrain from mbp from that moment on, in this country and anywhere in the world,” Dr. Alleyne told Yated.
“We take pride in the fact that since engaging with the community and collaborating to create the protocol, we’ve seen the strengthening of mutual trust,” he added, pointing to the fact that the Health Department received a number of “self-reported” cases of herpes from the Monsey-New Square communities.
Overturning the myth that the incidence of HSV-1 is underreported in the Jewish community because community leaders seek to perpetuate mbp at the expense of their children’s health, Rockland County’s leading epidemiologist cited incidents he personally witnessed that demonstrate the exact opposite.
“Families stepped forward on their own and called us, because they trust our focus is truly on the welfare of their child. They can see our own pain at watching a tiny newborn stuck with an IV needle. There is nothing more heart wrenching.”
“We want the message to go out to all parts of the community, ‘Don’t be fearful of the Rockland County Health Department. We’re here to help you, to make sure your families stay healthy and free of disease.
“Thanks to community cooperation,” he said, “we’re hopeful that in terms of identifying [sources of infection] and eradicating neonatal herpes, we see light at the end of the tunnel.”
A community liaison described an early morning drive with Dr. Alleyne to the home of one of the mohalim in order to perform the swabbing in a private setting. The protocol had just begun operations and this was the very first mohel to be tested.
As they knocked on the mohel’s door, the community liaison turned to Dr. Allenyne. “Dr.,” he said, reflecting on the long odyssey that had led to this moment, “you’ve accomplished in a few weeks of working with us what another health department couldn’t do in years of working against us. Thank you.”
Attorney Robert Simins who has worked for many years with mohalim suspected of transmitting mbp, said he witnessed a level of personal sacrifice in mohalim participating in the protocol that few are aware of.
“Mohalim as a group have long been derided by the NYC DOH for refusing to cooperate in the effort to trace the source of herpes infection in newborns,” Mr. Simins told Yated. “Yet, Rockland County had more than full cooperation from all mohalim in the three confirmed cases recently tested under the protocol.”
In one case, Simins noted, the mohel had to travel numerous times from Montreal to Monsey for his testing, which required him to leave his post as a principal of a yeshiva of hundreds of students. He insisted on doing so at his own expense, welcoming the opportunity for a rare mitzvah.
In another case, a mohel had to forego doing the milah on a grandson born during the testing period as the protocol provides that the mohel may not do mbp during the testing period.
Yated interviewed one of the mohalim who signed the protocol to learn how they feel about the unprecedented exposure and scrutiny to which the protocol subjects them, as well as the frequent disruption of their personal lives during the course of the testing.
Rabbi B., who asked to remain anonymous, responded that “inconvenience would not and should not be a factor that would hinder cooperation with health authorities. Being a mohel is more than a profession, it’s a sacred mitzvah and personal sacrifice is often required to do the mitzvah.”
“Throughout history,” he added, “mohalim were devoted to their work even when it was outlawed and punishable by death. Even today in times of freedom, you see mesiras nefesh in the way mohalim are ready to leave the comfort of their home and spend Shabbosim and Yomim Tovim far away just to perform a bris for those in need.
“When a secular authority attempts to regulate bris milah in the name of health, it triggers our suspicion,” Rabbi B. said. “Especially when the regulation seems to be agenda-driven and based on libelous allegations. But when a health agency is respectful of the mbp practice as in Rockland County, I embrace the opportunity to work with them.
“Here, the rabbis and government officials worked together to design a limited protocol that would help identify whether in fact the mohel has been the source of transmission. Speaking for all my colleagues, we welcome that effort.”
Rabbi S. added that “if no link is established within a given period, possibly 3-4 years, I personally feel the protocol should be discontinued.”
Asked about the willingness of mohalim to identify themselves to health authorities, Rabbi B. said the willingness to step forward “is nothing new. It comes down to a matter of trust. When respect guides the discussion as can be seen in Rockland County, we would work with any unbiased agency to investigate and discover how to minimize any health risk to the baby and ensure the safest practices.”
For mohalim and rabbonim, he said, health and safety are of the highest priority.
“Our own standards of professionalism and caution are based on halacha and when it comes to bris milah, surpass that of the medical establishment.”
“For that reason, a mohel is willing to delay a bris until after the 8th day when the baby appears to need the delay, even when doctors would permit us to go ahead. Because we are makpid to go to all lengths and take every possible precaution to safeguard a child’s health.