‘It’s All About Hand Washing’

Chasidic residents of Williamsburg and Borough Park are currently battling two dangerous disease outbreaks — a minor spread of the measles and a more serious eruption of the intestinal infection Shigella.

In these two Brooklyn neighborhoods, over 160 residents have contracted Shigella this year, with a particular effect on the Satmar community residing there, according to Dr. Sharon Balter, medical epidemiologist in the New York City Department of Health’s Bureau of Communicable Disease. Shigella spreads when microscopic quantities of infected fecal matter contaminate food or water, and symptoms typically include diarrhea, fever, nausea and abdominal pain, the Department of Health reported. The illness can last several weeks, and doctors sometimes prescribe antibiotics to clear up particularly serious cases.

“Somebody is infected and they excrete this stuff in their waste, and because of poor hygiene practice, that waste gets into someone’s mouth,” said Dr. Michael Augenbraun, hospital epidemiologist at University Hospital of Brooklyn. “All it takes is one contaminated or sick food handler.” Infection only requires a very small amount of bacterial exposure, he explained.

In the densely populated chasidic households and day care centers, Shigella spreads particularly rapidly among children, whose cleanliness habits are less than ideal, both doctors and community members agree.

“It’s always children,” said Rabbi David Niederman, president of the United Jewish Organizations of Williamsburg. “The children play and eat together and are so intimately involved.”

And the illness is largely contained within the Williamsburg and Borough Park Satmar populations.

“It’s an insular community; they don’t tend to share food with other people,” Augenbraun said. “The fact that an infection like this is restricted to this community is perhaps not that surprising.”

But doctors fear that the infection may be spreading through other means besides ordinary child’s play.

After using the bathroom and before eating, Orthodox Jews instinctively recite a Hebrew blessing as they pour water over their hands in a ritual motion, repeated three times. As cold water sloshes from little hand to hand, bacteria can potentially spread if the child has not also used soap and water.

“You can’t walk away without washing your hands, because halachically, you are unclean,” said Joel, a Satmar resident of Williamsburg, who requested not to have his last name disclosed for his own safety. But according to Joel, this ritual hand washing simply involves cold water, and children will often grab the ritual plastic cup without having first washed their hands with soap. “When you touch the cup, you can spread the disease,” he said.

Rabbi Niederman vehemently disagrees, citing that children are taught to wash their hands with soap and that they perform a different type of ritual washing than do adults.

But Joel insists that health issues are not widely discussed in the Satmar schools and neighborhood, and outbreaks like these occur frequently due to poor hygiene. “There’s something here that isn’t in other communities,” Joel said. “It makes sense.”

While doctors affirm that bacteria may very well spread through the cold water exchanges, they have no way to prove whether or not the illness is passing through ritual washing. Instead, they are reiterating the importance of hand washing, rather than disputing the hygiene practices of Satmar families.

“It’s really important to wash your hands with soap and water after going to the bathroom and before eating,” Balter said. She stresses that it is very important for residents to partake in both ritual and ordinary hand washing, in order to prevent infection. In an effort to teach proper washing methods to community members, the Department of Health will send representatives to some of the day care centers and will post instructive flyers in Yiddish, according to Balter.

Both Balter and Augenbraun advise that residents should supervise their children as they rub their hands together for at least 20 seconds, making sure that they use soap and preferably warm water, which is more effective in killing germs. When a sink is unavailable, portable antibacterial products can serve a similar purpose, Augenbraun explained.

“It’s all about hand washing, hand washing, hand washing,” he said. “I think people tend to disregard it because it sounds so simple. It really is about cleanliness.”

In addition to the Shigella outbreak, Borough Park chasidim have also been experiencing an abnormal spread of the measles, likely imported from Israel and Belgium. Infected visitors have spread the disease predominantly among babies who have not yet reached vaccination age, said Dr. Jane Zucker, assistant commissioner for the Bureau of Immunization in the city’s Department of Health. Thus far, Zucker added, there have been 26 measles cases in Borough Park this year and over 1,000 in Israel since August.

“Because there is such a large outbreak in Israel and there is so much travel back and forth … that’s a real set-up,” she said. “There were certainly a lot of Jewish holidays in the spring.”

While the measles are certainly a threat to Borough Park’s chasidic population, Shigella infection is by far a more pervasive hazard — an illness that has no vaccine and can only be avoided through careful and cleanly behavior.

“[The rabbis] need to demand and insist that hand washing and hand hygiene is a lifestyle,” Augenbraun said. “There needs to be some leadership on this issue.”