Vaccination and Contagious Disease in Rabbinic Literature

1. From Smallpox to HPV: Vaccination and Contagious Disease in Rabbinic Literature Rabbi Edward Reichman, M.D.Professor, Emergency MedicineProfessor, Education and BioethicsAlbert Einstein College of Medicine

2. Infectious Diseasein Jewish Law

3. Smallpox

4. Early Description of Smallpox Ninth Book of the Al’Mansuri.  With commentary of Geraldus de Solo.  Translated into Hebrew by Tobiel ben Samuel de Leiria.  Portugal, 1388. Ramses V c.1000 BCE Spots on mummified remains of face believed to be smallpox. Rhazes 860-930 C.E

5. Believed Cause of Smallpox Otzar HaChaim Dr. Jacob Zahalon 1683 Caused by the menstrual blood while the fetus is in utero

6. Pre-Modern Treatment for Smallpox Use of Transference Balance the Four Humours Fasting

7. Halakhic IssuesTo Flee or Not Flee • שו"ת מהרי"ל סימן מא מה דכתב מר דנראה שהוא איסור' לברוח +בשעת הסכנה+ • ..... מכל הני מורה דאין טוב לעמוד במקום סכנה כו'. וכן ראיתי גדולים שהלכו למקום אחר. שולחן ערוך יורה דעה סימן קטז סעיף ה rama עוד כתבו שיש לברוח מן העיר כשדבר בעיר, ויש לצאת מן העיר בתחלת הדבר, ולא בסופו )תשובת מהרי"ל סי' ל"ה /מ"א/(. וכל אלו הדברים הם משום סכנה, ושומר נפשו ירחק מהם ואסור לסמוך אנס או לסכן נפשו בכל כיוצא בזה.

8. Fasting in Times of Plague • שולחן ערוך אורח חיים סימן תקעו • סעיף א • כשם שמתענים ומתריעים על הגשמים כך היו מתענים על שאר הצרות; • סעיף ב • וכן על הדבר. איזהו דבר, עיר שיש בה ת"ק רגלי ויצאו ממנה שלשה מתים בשלשה ימים זה אחר • זה, הרי זה דבר. יצאו ביום א' או בד' ימים, אין זה דבר. היו בה אלף ויצאו ממנו ששה מתים בג' ימים זה אחר זה, הרי זה דבר. יצאו ביום אחד או בארבעה ימים, אין זה דבר; וכן לפי חשבון זה; • מגן אברהם אורח חיים סימן תקעו ס"ק ג • על החולאים - וה"ה כשאבעבועות פורחי' בתינוקות ומתים יש לגזור תעני' וכבר חבר הגאון מוהר"ר משה סליחה ע"ז ובשל"ה כ' דכל אחד יבריח בניו מן העיר בעת הזאת ואם לא עשו זאת הן חייבין בנפשותם:

9. Special Prayers Composed for Times of Plague Italy 1700

10. Bikur Cholim (visiting the sick) Aaron ben Moses Rofeh Takanot shel Benei haHavurah de-Bikkur Cholim Berlin, 1750

11. Fear of Contagion from the Physician שו"ת נשמת כל חי חו"מ סימן מט Izmir 19th century נשאלתי בימי חורפי מקדמוני ביחיד בית הכנסת אחד שהיה רופא חולים ובזמן מגפה ב"מ היה רופא לנגפים במגפה והוא רוצה לבא ולהכנס בבית הכנסת והיחידים מעכבים בידו שלא להכנס שהם יראים שמא יתנגפו בנוגע אליו I was asked regarding a physician member of a synagogue who treated patients during the plague and who wished to pray in synagogue. Other congregants protested out of concern that they might contract the disease.

12. New Treatment- Inoculation Constant Desbordes c. 1820 Louis-Léopold Boilly- 1807

13. Side Effects of Inoculation In Memory of Peleg, Son of Thomas and Mary Conklin, who died of the Smallpox by Innoculation: Jan 27th, 1788, Aged 17 years (Huntington, Long Island)

14. Impact of Smallpox on American History

15. Reporting on 72 Bostonians inoculated in March 1730, Benjamin Frankin noted that only two died while “the rest have recovered perfect health. “Of those who had it in the common way,” he continued, “’tis computed that one in four died.” “In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way,” he wrote. “I long regretted bitterly, and still regret that I had not given it to him by inoculation. “This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way and that, therefore, the safer should be chosen.”

16. Impact of Smallpox on Jewish Community Aleh Terufah R. Avraham b. R. Shlomo Nansich London, Alexander and Son, 1785 treatise written by a man who lost two sons to smallpox and beseeched the rabbis to allow the new treatment - inoculation

17. Smallpox- Halakhic Issues Rabbi Israel Lipschutz (1782-1860) Tiferet Yisrael - commentary on the Mishnah

18. Inoculation on Shabbos Rabbi Eliezer Fleckles 1754-1826

19. Edward Jenner and the Cure for Smallpox

20. Opposition to Vaccination

21. Jewish Opposition to Vaccination Rabbi Hermann Adler Chief Rabbi of England 1891-1911

22. Eradication of Smallpox

23. Vaccination Today

25. Flu Vaccine and Swine Flu From The Israel Ministry of Health האם קיים איסור על אכילת בשר חזיר?במשרד הבריאות מבהירים כי אין כל חשש מאכילת מזונות וכי המחלה איננה מועברת במזון בארגון הבריאות העולמי מדגישים כי אין חשש מאכילת בשר חזיר שבושל כהלכה Is is there a prohibition to eat pork (re. catching Swine Flu)?No! The Ministry of Health clarifies that there is no danger in food consumption. The disease is not transmitted through food. The WHO emphasizes that there is nothing to be concerned about eating pork that is cooked "according to Halacha"

26. Vaccination and Autism

28. Infectious Disease in the Jewish Community

29. Measles Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013 Morbidity and Mortality Report September 13, 2013 On March 13, 2013, an intentionally unvaccinated adolescent aged 17 years returned to New York City from London, United Kingdom, while infectious with measles. This importation led to the largest outbreak of measles in the United States since 1996. A total of 58 cases were identified, including six generations of measles infection in two neighborhoods of the borough of Brooklyn. All cases were in members of the orthodox Jewish community. No case was identified in a person who had documented measles vaccination at the time of exposure.

33. Halakhic Issues- Shabbos Can a doctor administer a tetanus shot on Shabbos?

34. Government Liability for Vaccination Complications

35. Vaccination and Liability Liability of those who refuse to Vaccinate May 28, 2013 A measles outbreak in the New York is prompting bioethicist Art Caplan to wonder about the consequences of parents choosing not to vaccinate their children. He argues that parents should have the right to not vaccinate, but they should also expect to be sued if their child gets someone else sick. If your kid gets the measles, and makes my kid sick (can happen since vaccine is not 100% effective), my newborn baby die (newborns can’t benefit from vaccines) or my wife miscarry (fetuses are at especially high risk), then shouldn’t I be able to sue you for the harm you have done? Caplan says providing a legal avenue to hold an unvaccinated person accountable for sickening someone serves two goals. First, it provides a measure of justice for a family that is affected by an unvaccinated person’s choice. Second, the possibility of a lawsuit would encourage individuals to get vaccinated.

36. Compulsory Vaccination

37. תלמוד בבלי מסכת כתובות דף ל עמוד א מתקיף לה רב אדא בר אהבה: ממאי דכי קא מזהר להו יעקב לבניה, על צינים ופחים דבידי שמים נינהו? דלמא על אריא וגנבי דבידי אדם נינהו! אטו יעקב אהא אזהר, אהא לא אזהר? יעקב על כל מילי אזהר. וצינים פחים בידי שמים נינהו? והתניא: הכל בידי שמים, חוץ מצינים פחים, שנאמר: צינים פחים בדרך עיקש שומר נפשו ירחק מהם! רש"י מסכת כתובות דף ל עמוד א צינים פחים - קור וחום.

39. Denial of School Admissionand Risk to Others • Herd immunity • Vaccination in not 100% effective • Some students cannot vaccinate for medical reasons (e.g. cancer)

40. R. Bleich Tradition 2015

41. School Vaccination

42. California’s Tough Vaccination Law By THE EDITORIAL BOARDJULY 13, 2015 California sets a smart example for the nation by passing tough new laws that will require the vast majority of children in day care or kindergarten to be vaccinated against a slew of infectious diseases next year. The state will no longer grant exemptions based on a parent’s religious convictions or “personal belief” that vaccines might be harmful. It will only allow exemptions for children with medical conditions that make vaccination unsafe. This public health policy ought to be adopted by all states. While all states require schoolchildren to be vaccinated, nearly all allow exemptions for families with religious objections (only Mississippi and West Virginia limit exemptions to medical necessity), and 20 currently allow exemptions based on a parent’s personal beliefs. Those beliefs are often based on irrational fears that vaccines might cause autism, a link based on fraudulent science that has long been discredited.

43. HPV and Cervical Cancer • Human Papillomavirus (HPV) is a common virus that is spread through sexual contact. Most of the time HPV has no symptoms so people do not know they have it. • There are approximately 40 types of genital HPV. Some types can cause cervical cancer in women and can also cause other kinds of cancer in both men and women. Other types can cause genital warts in both males and females. • The HPV vaccine works by preventing the most common types of HPV that cause cervical cancer and genital warts. It is given as a 3-dose series. Information slide from Dr. Warren Siegel Department of Pediatrics Coney Island Hospital

44. Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States • Every year, about 12,000 women are diagnosed with cervical cancer and almost 4,000 women die from this disease in the U.S.

45. Ethical/Halakhic Issues

46. Should We Routinely Vaccinate All Our Children for HPV? Rabbi Menachem Burstein Dr. Chana Katan לא כן

47. Issues to Consider • Some may marry ba’alei teshuva • Some will go “off the derech” and could benefit from the vaccine. When to administer the vaccine? • At a younger age bundled with other vaccines. • At a later age as part of the usual mandatory course for marriage.

48. The Future Protection Without a Vaccine A team of scientists announced what could prove to be an enormous step forward in the fight against H.I.V. Scientists at Scripps Research Institute said they had developed an artificial antibody that, once in the blood, grabbed hold of the virus and inactivated it. The molecule can eliminate H.I.V. from infected monkeys and protect them from future infections. But this treatment is not a vaccine, not in any ordinary sense. By delivering synthetic genes into the muscles of the monkeys, the scientists are essentially reengineering the animals to resist disease. Researchers are testing this novel approach not just against H.I.V., but also Ebola, malaria, influenza and hepatitis.

49. The End

50. The End החותם של חזקיהו המלך Comments, inquiries or suggestions welcome saraneddie@optonline.net