New England Journal of Medicine

hevrutot

hevruta

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hevrutot

The Jerusalem Post

A new study in thehas found that ultra-Orthodox boys who sit in– face-to-face groups studying the Talmud in close quarters – were more likely to contract the mumps – even though they had received the requisite vaccinations – than counterparts who study in an ordinary classroom with all students facing the front.Higher rates of infectious diseases have also been reported among Israeli haredim, mostly boys but also members of their family of both sexes and all ages – partly because they have considerably lower vaccination rates than their American counterparts but also due to the crowding and close proximity in which they live and study.Among the complications of mumps, which has almost been wiped out in the US because of vaccination, is orchitis [inflammation of one or both of the testicles], while meningitis, pancreatitis, deafness, mastitis and facial Bell‚s palsy were much less frequent. According to the NEJM article.Themethod of learning, practiced at all levels of Talmud study in yeshivot, involved lively conversation and arguments over the Talmud, and partners are often switched, thus helping to spread infections.In the mumps outbreak, according to Dr. Albert Barskey of the US Centers for Disease Control and Prevention and colleagues, over 3,500 cases were reported in haredi teens aged 13 to 17 in New Jersey, New York City and Rockland and Orange countries in New York. The mumps apparently came from an 11-year-old boy in a haredi boys summer camp in New York’s Catskill Mountains. The boy had been vaccinated as recommended.Over 400 of the cases resulted in orchitis.When people are in close proximity over a long period, as in yeshivot, viruses like the mumps are more likely to overwhelm them even if they had received the requisite doses of vaccine, the NEJM study said.Some cases have spread to girls, who do not learn in, but are exposed in crowded homes and at religious family gatherings. A few years ago, a major measles outbreak in Israel developed when an infected hassid came with his family to Israel to attend a huge wedding and post-nuptial celebration [Sheva Brachot] during the week after it.Asked to comment, chief of the Health Ministry’s epidemiology department Dr.Paul Slater, himself a haredi, toldthat the ministry has not changed its policy on vaccinations of haredim as a result of the outbreaks. “We do not give a third vaccination against the mumps. We have an outbreak once in a long while. We are busy catching up and vaccinating those who have not received the two vaccinations,” he said. “It is a huge investment in manpower.”Yeshiva students should go to their family health centers [tipat halav] for vaccinations, but when there is a major outbreak, public health nurses come to yeshivot. The problem is that most of the students will refuse because most public health nurses are women, whom they don’t want to touch them, Slater added.The average vaccination rate among haredi children is only 70 percent, compared to more than 95% among Arabs and a bit lower among the general Jewish population.“We haven’t changed our policy on haredi vaccination; nobody in the world has either. The mumps outbreak died out on its own,” said Slater. “I have been in this field for 25 years, and I have developed a sense of modesty about possible successes.We don’t know what infectious disease will be coming next. It is very hard to anticipate. I don’t wish the mumps on anybody, but we can’t vaccinate everybody every year. Yet we are trying our best to increase vaccination coverage to the level recommended by the Health Ministry. One can measure antibody levels and find they are OK, but due to the close proximity, they can still get sick.”Asked whether changing the tradition of hevruta in small spaces would reduce the infection level, Slater said that nothing would induce the yeshivot to change their study habits.”But when asked whether better ventilation would “dilute” the viruses in the air, Slater said, “Yes, keeping the windows open and better ventilation would improve things, but this is something we can’t control.”