The cause was attributed to ritual circumcision that involved an ultra-Orthodox Jewish practice known as metzitzah b'peh, in which the circumciser (mohel) places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound (direct orogenital suction).
In the cases where typing was performed in the outbreak, the isolates were HSV-1 (oral herpes). Oral contact with a newborn's open wound risks transmission of HSV and other pathogens.
As circumcision is a surgical procedure and should be performed under sterile conditions. Orogenital suction should be avoided, for obvious reasons.
