A Jewish ritual in which a circumciser sucks blood from a male newborn’s genital organ has caused 11 cases of infant herpes and killed two babies in the past decade, U.S. health authorities said Thursday.
The cases of herpes simplex virus (HSV-1) infection were all documented in New York City from 2000 to 2011 and several were within the same neighborhood, according to the report by the Centers for Disease Control and Prevention.
Six cases were confirmed and the rest were deemed probable, since the infants underwent the religious procedure but their mothers and health care workers did not have the virus, which is common in adults but can be lethal to children.
“Oral suction of an open wound poses an inherent risk for transmission of HSV-1 and other pathogens to a newborn infant and is not safe,” the CDC’s Morbidity and Mortality Weekly Report said.
“Circumcision is a surgical procedure that involves cutting intact skin; sterile technique should be used to minimize infection risk.”
HSV-1 is a common infection that some experts say affects as many as 90 percent of the population, usually causing cold sores and fever blisters on the mouth but sometimes also resulting in genital herpes. There is no cure.
In infants, infection with HSV-1 can cause death or permanent disability.
A more virulent type, HSV-2, is frequently linked to genital lesions in men and women and affects about 16 percent of the global population, according to the World Health Organization.
One of the children who died was a twin who was circumcised outside the hospital in a religious ceremony performed by a mohel, or circumciser, who cut away the foreskin and then sucked the blood with his own mouth.
“At eight days of life, the twins were circumcised by mohel A, who performed direct orogenital suction. At 16 days of life, both twins were evaluated for fever and lesions on their abdomen, buttocks and perineum, including the genitals,” said the CDC report.
Both twins tested positive for HSV-1 infection. The twin who was circumcised first died from the spreading infection.
Their mother had no history of oral or genital herpes and no genital lesions at or after delivery, which is when herpes transmission to an infant typically occurs.
Nor were there any cases of herpes found among 14 hospital workers who cared for the infants after birth.
But the mohel who performed the procedure was tested 97 days after the circumcision and was found to be positive for HSV-1.
The other infant death occurred after a similar ritual in 2011, but since the mohel could not be identified for testing, authorities consider it a “probable" case.
The CDC said some rabbinical authorities insist on the practice as an integral part of the circumcision ritual, while other ultra-Orthodox authorities allow the blood from the circumcision wound to be removed by a glass tube or other means.
Similar cases have also been documented in Canada and Israel, but it is difficult to prevent the practice since it is a religious ritual that usually takes place outside of standard health care facilities, the CDC added.