The goal of this site is to share the medical literature related to illnesses that could potentially be acquired at the mikveh.

The information presented here comes from the current medical literature. It is reliable information that integrates clinical experience with research information and expert opinion.

This site will share research studies and case reports that relate to the mikveh. We will include related matters that might be pertinent

It is not the goal of this site to discuss religious practices.

Medical Literature on mikveh acquired illness Information presented in this site has been obtained through a review of on-line medical data bases. This sources include PubMed Ovid CINAHL EBSCOhost UptoDate Online Google Scholar Search terms include Mikveh Mikvah Ritual bath Content 1. Infection a. Vaginal colonization with Beta-Streptococcus b. GI infection 2. Potential threats 3. Historical Literature Studies Identified Group B Streptococcus Drai-Hasid, R., et al, (2015) Ritual Immersion in a Mikveh Is Associated with Increased Risk of Group B Streptococcal Carrier State nn Israeli Parturient Women. Open Journal of Obstetrics and Gynecology, 5, 769-774. http://dx.doi.org/10.4236/ojog.2015.514108 Back ground Obstetricians and pediatricians are very concerned about Group B Streptococcus (GBS) injections in newborn babies. Women can carry the GBS without ill effect. Unfortunately they can pass it to their new babies at the time of delivery. A few babies will be become colonized with the germ without serious effect like their mother. A few will develop terrible infection from GBS including meningitis, pneumonia or even fatal sepsis. It is known that the carrier rate in healthy women at the end of pregnancy is around 10-30%. Most heath experts agree that treating the GBS culture positive women reduces the chance for baby to develop infection. Study Goal The goal of this study was to estimate the GBS carrier rate among Jewish woman delivering at Hadassah University Hospital and to estimate in mikveh was associated with a higher rate of GBS. Results They tested 436 Jewish women. 77 had a positive GBS culture. The carrier rate was 17.7% Orthodox Jewish woman had a carrier rate of 20.6% Secular Jewish woman had a carrier rate of 13% 40% of the Orthodox women went to Mikveh during pregnancy. No association was found between mikveh use during pregnancy and GBS carrier state. No babies developed GBS infection. Discussion The carrier rate among Jewish women is similar to what is seen in Europe and the United States. It is thought that GBS carrier rates are higher in women of Black race, women who use tampons and intrauterine devices, It is also associated with obesity and lower colon counts of lactobacilli. There is no data on GBS colonization in baths and swimming pools. There is one small study reporting higher GBS colonization after water births. This study demonstrates an association between religiosity and GBS colonization. It is not known if the mikveh has GBS in the water. It is not known if the women who participate in niddah have different bacterial flora in the vagina than women who don’t use mikveh and internal vaginal self-examination. The Role of Mikveh Immersion in GBS Carrier Rate amongst Orthodox Jewish Women Jeanette Toney M.D., Meghan Rattigan D.O., Yen-Hong Kuo, PhD Jersey Shore University Medical Center Department of Obstetrics and Gynecology Presented on June 5, 2018 at the Resident Research Symposium Manuel, D.G., Shahin, R., Lee, W., & Grmusa, M. (1999) The First Reported Cluster of Food-borne Cyclosporiasis in Candida. Canadian Journal of Public Health, 90 (6): 399-402 Background Cyclosporiasis is an intestinal infection caused by a pathogenic protozoan Cyclospora cayetanensis, It is a single cell parasite that is spread by feces or feces-contaminated food and water. The most common symptom is watery diarrhea. Other symptoms may include nausea, loss of appetite, resulting in weight loss, cramping, bloating and fatigue. This study was a public health report from the North York Public Health Department describing a 1996 outbreak of Cyclosporiasis. Methodology The investigation was started by a report for a local physician who treated three family members with diarrhea. The offending organism was identified in stool samples. All three had attended a catered luncheon at a religious institution 11 days earlier. The hostess of the luncheon had contacted 15 guest and learned that many had a similar illness. All of the guests had attended only this luncheon in common. The caterer had prepared the cooked food in an off-sight kitchen. The fresh food was prepared at the institution’s kitchen. There had been a report of the filtration system failure at the mikveh causing the rain water to become brackish around the time of the luncheon. The authors hypothesized that the guest became ill through exposure to the mikveh water. Methods Everyone attending the luncheon was interviewed regarding symptoms, food and beverage consumption and demographic data. This included 49 guest, 2 relatives and the 4 catering staff. Everyone was asked to supply a stool sample. The authors also attempted to identify all people who used the mikveh during the month prior to the luncheon or two weeks following the luncheon. Employees of the institution and the attached school were also interviewed. Attendance records were examined to look at patterns of student absenteeism in the time period in question. Hosts of other events who worked with the same caterers were contacted and asked about guest illnesses. The environment was investigated. Samples were taken from the kitchen faucets and water traps, the mikveh, the rainwater collection system, the street water main, the institutional plumbing, and the caterer’s kitchen. Food items served at the luncheon were traced back with the health of public health inspectors. Results 35 of 49 71%) guests became ill. All age groups (4-76 years) were affected. No one needed to be hospitalized. Incubation for symptoms was 6-13 days after the luncheon. 4 additional people became ill. Two people who ate food that was brought home from the luncheon and 2 of the catering staff. The food source was traced back the strawberry flan that was garnished with fresh berries washed in the kitchen. Cross contamination was found between the mikveh filtration system and the institutions hot water line. Discussion The cluster of food-borne Cyclosporiasis was related to the mikveh filtration system causing contamination of the potable hot water line. It appears to be a human error caused by a plumbing error. Potential Infections There are a wide variety of illnesses associated with public swimming pools. Mikveh is different from public pools but theoretically health threats could be similar. A review of the recent medical literature on swimming pools generated the following list of illnesses. Adenovirus infections Cryptosporidiosis Echovirus infection Enterovirus infection Escherichia coli infection Fungal infections of the feet Giardia infection Group A Coxsackie virus Nonovirus illness Norwalk gastroenteritis Ocular and respiratory illnesses Pseudomonas aeruginosa skin infections Historical Literature Weekly Bulletinof the New York Departmentof Health. American Journal of Public Health. (1914) July; 4 (7): 620-626 On page 622 there is a brief report on the sanitation of the ceremonial baths of the Jewish synagogues. A bacteriologic evaluation of the pools conducted by Dr. Manheimer of Colombia University showed there to be a “serious menace” to the health of the people using the baths. THOMAS SCHLICH; Medicalization and Secularization: the Jewish Ritual Bath as a Problem of Hygiene (Germany 1820s–1840s), Social History of Medicine, Volume 8, Issue 3, 1 December 1995, Pages 423–442, https://doi.org/10.1093/shm/8.3.423 Abstract Summary In the 1820s and 1840s the Jewish Ritual bath in Germany was criticized on the basis of medical arguments. Associated with this critique were demands for a change in the traditional Jewish way of life in general, especially as concerning the Jewish religion. The new role assigned to religion can be seen as part of a process of ‘secularization’. The criticism of the ritual bath was justified by medical arguments and entailed a demand for an extension of the medical sphere of competence, and thus formed part of a development described as ‘medicalization’. An historical investigation of the debate on the Jewish ritual bath illuminates the way in which medicalization and secularization were different aspects of the same process of the attribution of complementary circumscribed spheres of medicine and religion.

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