After the deaths of two children who contracted the herpes virus through an ultra-orthodox practice of circumcision, the New York City Board of Health voted today to require parents to sign a written consent that warns them of the dangers.
In the most contentious part of the Jewish ritual, known as metzitzah b'peh, the practitioner, or mohel, places his mouth around the baby's penis to suck the blood to "cleanse" the wound. The city wants parents to know the risks before circumcision.
Some estimate that 70 percent of the general population is infected with the Type 1 herpes I (HSV-1), which can be transmitted from the mouth to the child. It is different from Type 2 or genital herpes (HSV-2), which is a sexually transmitted disease and can cause deadly infections when a newborn passes through an infected birth canal.
Neonatal herpes infections are nearly always fatal in infants.
The 5,000-year-old religious practice of circumcision, performed during a ceremony known as the bris, is seen primarily in ultra-Orthodox and some orthodox communities. New York has one of the largest such communities in the country.
In 2003 and 2004, three babies, including a set of twins, were infected with Type 1 herpes; the cases were linked to circumcision, and one boy died. Another died in 2010. In the last decade, 11 babies in the city have contracted the virus, and two have had brain damage, according to health officials.
Dr. Jay K. Varma, the New York City deputy commissioner for disease control, told the New York Times, "There is no safe way to perform oral suction on an open wound in a newborn."
But some rabbis have said that they will oppose the law on religious grounds, insisting it has been performed "tens of thousands of times a year" worldwide. They say safeguarding the life of a child is one of the religion's highest principles.
"This is the government forcing a rabbi practicing a religious ritual to tell his congregants it could hurt their child," Rabbi David Niederman, executive director of the United Jewish Organization of Williamsburg, told ABCNews.com. "If, God forbid, there was a danger, we would be the first to stop the practice."
But Dr. William Schaffner, chair of preventive medicine at Vanderbilt University, told ABCNews.com during the investigation of one of the deaths last spring, "It's certainly not something any of us recommend in the modern infection-control era."
"This is a ritual of historic Abraham that's come down through the ages, and now it has met modern science," he said. "It was never a good idea, and there is a better way to do this."
The modern Jewish community uses a sterile aspiration device or pipette to clean the wound in a circumcision.
About two-thirds of boys born in New York City's Hasidic communities are circumcised in the oral suction manner, according to Rabbi David Zwiebel, executive vice president of the Orthodox Jewish organization Agudath Israel of America.
The Department of Health argues parents should be informed of the risks before making a decision. Since 2004, it has received "multiple complaints from parents who were not aware that direct oral suction was going to be performed as part of their sons' circumcisions," according to a public notice.
The law requires mohels to explain the oral suction procedure and its risks, including the possible transmission of herpes simplex virus, and have parents sign a waiver.
With reporting by Katie Moisse.