September 12, 2012 Mayor Michael R.

Bloomberg City Hall New York, NY 10007 Dear Mayor Bloomberg: On behalf of the Infectious Diseases Society of America (IDSA), I am writing to express support for passage of the proposed regulation currently under consideration by the New York City Board of Health that would require written informed parental consent for circumcision that involves direct oral suction, a procedure also known as the metzitzah bpeh (MBP). IDSA represents nearly 10,000 physicians and scientists devoted to patient care, education, research, and public health in infectious diseases (ID). The Society's members focus on the epidemiology, diagnosis, investigation, prevention and treatment of infectious diseases in the United States and abroad. Our members care for patients of all ages with serious infections, including meningitis, pneumonia, hepatitis, HIV/AIDS, tuberculosis, surgical infections, those caused by unusual or drug-resistant microorganisms as well as new and emerging pathogens, and those with underdeveloped or weakened immune systems that make them particularly susceptible to life-threatening organisms. IDSA strongly supports the use of scientific evidence to inform public health policy. The epidemiological investigations conducted by the New York City Department of Health and Mental Hygiene (DOHMH) present strong evidence that herpes simplex virus type 1 (HSV-1) can be transmitted to a newborn when circumcision involves direct orogenital suction of the penile incision. These investigations further found that newborns receiving orogenital suction after circumcision are at greater risk of contracting HSV infection than circumcised infants who did not. Because neonatal immune systems are underdeveloped, HSV infection in newborns is more likely to result in death or permanent disability. Indeed, of the eleven cases investigated by DOHMH between 2004 and 2011, two of the infants died and at least two others suffered brain damage. Given the severity of these consequences, the risks associated with MBP as well as the importance of practicing circumcisions and related procedures in a sterile environment should be clearly communicated to parents or legal guardians in advance of the procedure. Accordingly, IDSA supports the informed consent requirement currently under consideration and urges the Board of Health to approve it. Sincerely,

Thomas G. Slama, MD FIDSA President

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cc:

Thomas Farley, MD, MPH Commissioner NYC Department of Health and Mental Hygiene Sam Miller, Assistant Commissioner for Public Affairs, NYC Department of Health and Mental Hygiene